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Patient care > phlebotomy > Flashcards

phlebotomy Flashcards

1
Q

carry freshly oxygenated blood to the body
- branches into arterioles & capillaries

A

arteries

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2
Q

What do the coronary arteries do?

A

supply blood rich in oxygen and nutrients to the heart

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3
Q

supply blood to the lower extremities

A

femoral arteries

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4
Q

carry deoxygenated blood to the lungs

A

pulmonary arteries

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5
Q

carry deoxygenated blood from the body to the heart

A

veins

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6
Q

return deoxygenated blood from the head & neck to the heart

A

jugular veins

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7
Q

return deoxygenated blood from the lower extremities to the heart

A

saphenous veins

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8
Q

carry deoxygenated blood back to the heart from the lungs

A

pulmonary veins

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9
Q

permeable & act as exchange vessels
- oxygen & nutrients&raquo_space; body cell from capillary»carbon dioxide & other body waste move out of body cell»capillary

A

capillaries

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10
Q

What is osmosis

A

A change in concentration

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11
Q

how can you prevent infection

A
  • proper PPE
  • hang hygiene
  • safety disposal of equipment
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12
Q

identify patients by…

A
  • full name
  • DOB
  • home address
  • telephone #
  • last 4 of SSN
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13
Q

why must you confirm consent prior

A

deliberately touching a patient w/o consent is battery
- criminal offense
- document refusal & notify RN

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14
Q

check all equipment for…

A

expiration dates
corruption
-missing labels
- defects
- cracks
- breaks
- rips
- tears

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15
Q

needles

A

single use item
- retract needle into the sharps container as soon as it leaves the vein
- prior to use check if burred or bent

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16
Q

tubes. What should check for before use?

A
  • check for defaults & expiration dates/cracks & breaks
  • do not use if label is missing
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17
Q

adapters

A

single use item
- dispose if cracked, broken, or contaminated

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18
Q

tourniquets

A

multi/single use item
- multi use&raquo_space; dispose contaminated with hair, blood, or dirt

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19
Q

alcohol pads

A

single use item
- check for rips or tears

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20
Q

what and how should a specimen be labeled?

A

patient full name, DOB, time/date, facility ID, legibly, military time, facing same direction, does not completely or partially cover stopper, do not wrinkle or crease, double check patient ID/wristband

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21
Q

test that requires small amounts of blood, patient has no accessible vein, capillary blood, the patient is at risk for iatrogenic anemia, and low volume blood

A

dermal punctures

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22
Q

low hemoglobin & hematocrit count resulting from large amounts of blood smaples

A

iatrogenic anemia

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23
Q

what is the point of care for a dermal puncture?

A
  • glucose
  • cholesterol
  • hematocrit
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24
Q

what can you use to perform a dermal puncture?

A
  • may use capillary pipettes & micro collection tubes
  • other test may require glucometer
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25
Q

what stick do you use on infants under 1 years old

A

heal stick

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26
Q

what kind of blood does a dermal puncture consist of?

A

arterial
capillary
venous

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27
Q

where do you perform a dermal puncture

A

3rd/4th finger on nondominant hand
- on the side of the finger

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28
Q

what do you check for before a dermal puncture?

A
  • if finger is cold
  • cyanotic
  • scared
  • swollen
  • rash
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29
Q

equipment for dermal punctures

A

gloves, alcohol wipes, adhesive bandages/self-adherent wraps, tape, gauze, lancet, micro collection tube

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30
Q

what are the steps prior to venipunture?

A
  • review requisition
  • gather supplies
  • double check requisition
  • all supplies should be gathered prior to putting tourniquet on patient
  • check expiration date
  • look for defects
  • arrange supplies
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31
Q

where should you put your phlebotomy tray?

A

-use a chair
- avoid putting on bedside table

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32
Q

how should position your patient for venipuncture?

A

full extension of the arm is down with palm facing upwards(supination)
- patient should never be standing, on a high stool, or edge of examination table

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33
Q

how do you select and palpate a vein?

A
  • look for tattoos, scarring, hematomas
  • ask if patient has a preference
  • palpate the vein
  • if you cannot find one, ask to palpate other arm
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34
Q

what order should you palpates veins in

A

1st- median cubital
2nd- cephalic
3rd- dorsal (hand) veins
4th- basilic

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35
Q

vein located in the middle of the arm on the anterior surface & least painful

A

median cubital vein

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36
Q

vein located outside lateral surface of arm, might be more painful
- easy to use for patients that obese

A

cephalic vein

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37
Q

what do you do if your patient has an IV catheter and you need to preform venipuncture?

A
  • try to find another vein
  • ask RN if infusion can be stopped temporally
  • perform venipuncture distal to IV insertion site
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38
Q

what is the ideal vein?

A

well anchored, spongy, bouncy, straight, & easy-access

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39
Q

what do you do if your patient is having a blood transfusion and you need to collect blood?

A

use opposite arm or collect distally

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40
Q

what are specific considerations before performing venipuncture?

A
  • mastectomy
  • tattoos
  • hematoma
  • edema
  • scars
  • sclerosis
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41
Q

where should apply a tourniquet

A

7.6 to 10.1 cm (3-4 in) above the antecubital area

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42
Q

when should you remove a tourniquet

A

release prior to 1 min point or when blood flow begins

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43
Q

feels hard, similar to bone & you must avoid when doing venipuncture

A

tendons

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44
Q

sclerosis or scaring

A

hard veins

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45
Q

if having difficulty with palpation, what can u do?

A
  • warm cloth or infant heal warmer
  • hand below heart level
  • rub area of palpated vein
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46
Q

antiseptic application

A
  • wear gloves
  • 70% alcohol
  • clean area 6.1 to 6.1 cm (2.5 to 2.5 in)
  • airdry
  • if not drying, dab with sterile gauze
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47
Q

how should you insert a needle

A

should be a quick smooth movement
- stop at resistance

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48
Q

what happens when you puncture the wall of the vein

A

you are in the lumen of the vein
if you partially pernitrate the vein, blood will leak and cause a hematoma

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49
Q

what do you do with veins that are forked?

A

avoid sticking
- veins have valve and you may not get blood return

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50
Q

-cerebrospinal
- amniotic fluid
- material from wound
- urine specimens through catheter

A

non-blood specimens

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51
Q

low-cost, low-risk
- require time (collected every 2, 4, or 24 hrs)

A

urine speciemens

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52
Q

how do you perform a urine specimen test

A
  • wear gloves (replace between handling)
  • perform on flat surface
  • collect in sterile container with lid
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53
Q

examines appearance, color, odor, pH, specific gravity, protein levels, glucose, & hemoglobin

A

urinalysis

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54
Q

urine specimens should never be…

A

left unrefrigerated

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55
Q

identifies microorganisms, decides which antibiotic can kill pathogens, and has to be clean-catch midstream or from catheter

A

culture test

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56
Q

most common test, no prep or time restrictions, document time & date of collection

A

random collection

57
Q

urine before bed, collect immediately in the morning, more concentrated, refrigerate if unable to get to lab within 1 hour

A

first urine in the morning

58
Q

how many mLs is a urine collection container

A

30-60 mLs

59
Q

begins at specific time, must keep over ice or refrigerate

A

24 hour urine collection

60
Q

what should you do if your patient with a 24 hour collection forgets to urinate, or if urine isn’t in ice?

A

notify the nurse, document
- it is out of your scope of practice as a PCT to discard a test

61
Q

patient has to fast 24 hours, collect blood & urine together every 1-2 hours

A

glucose tolerance test

62
Q

The patient urinates prior to eating, collected every 2 hours after patient eats a predetermined amount of carbs or glucose. test for patients with diabetes, monitors insulin dosage. What test is this?

A

postpradial test

63
Q

how do you perform a clean-catch midstream urine test

A
  • clean the urinary meatus prior to urinating
  • have patient pee in toilet 1st and then continue urinating into the specimen cup
64
Q

what should you do prior to collection for a culture & sensitivity test?

A

clean the genitals with antiseptic

65
Q

what should antiseptic never be

A

alcohol, hydrogen peroxide, or iodine

66
Q

examines for bacterial growth. provides info on pH, specific gravity, WBCs, hemoglobin, bilirubin, protein, & glucose

A

reagent strip method test

67
Q

expected pH range

A

4.6 to 8.0
- should usually be 6.0

68
Q

indicator of the concentration of urine
- all other test should come back negative

A

specific gravity

69
Q

expected range for specific gravity

A

1.010 to 1.030
- usually 1.010 to 1.025

70
Q

if SG is less than 1.010 urine is

A

diluted

71
Q

if SG is greater than 1.010 urine is

A

concentrated

72
Q

highly concentrated urine is an indicator of

A

dehydration

73
Q

WBCs in reagent strip test indicates?

A

infection

74
Q

Hemoglobin indicates

A

infection, cancer, kidney disease, chemical poisoning, & other pathology

75
Q

ketones idicate?

A

product of fat metabolism
- diabetes mellitus, starvation or vomitting

76
Q

bilirubin

A

liver disease or RBC destruction

77
Q

What does protein on a reagent strip test indicate?

A

inflammation, infection, kidney disease, or chemical poisoning

78
Q

glucose

A

diabetes mellitus

79
Q

test for hormones, alcohol, & drug levels

A

saliva sample

80
Q

swabs the inside of cheek to collect DNA

A

buccal swab

81
Q

patient should take deep breaths & expectorate by coughing deeply & spit into cup

A

sputum speciemen

82
Q

when is the best time to collect a sputum speciemen

A

in the morning, & several hours before eating

83
Q

test for bacterial infection, parasites, occult blood, has dietary restrictions prior to collection

A

stool specimens

84
Q

what is not allowed in a stool specimen collection

A
  • do not allow urine or toilet paper/water into specimen cup
  • do not refrigerate if being tested for parasites
85
Q

what do you do if your patient has to pee during a stool collection test?

A

have patient urinate 1st and then defecate into hat

86
Q

test that identifies blood that is not visible in the stool

A

fecal occult blood test

87
Q

testing for strep throat

A

throat swab

88
Q

steps in a throat swab

A
  • wipe both tonsils & all inflamed areas
  • stand to the side
89
Q

test that counts sperm to access fertility
- keep warm & protect from light
- send to lab within 1 hour
- make sure patient does not use a condom

A

semen specimen test

90
Q

test that identifies bacteria or microorganisms in blood, diagnose infections

A

blood culture test

91
Q

disinfecting for a blood culture test

A
  • 70% alcohol (may not be enough)
  • iodine, chlorhexidine gluconate, or 70% ethyl alcohol with providone.
  • cleanse site for 30-60 seconds
92
Q

what should you make sure of if performing a blood culture test?

A

make sure patient isn’t going into septic shock

93
Q

how do you collect culture & sensitivity test

A
  • regular venipuncture
  • collect aerobic specimen 1st
94
Q

blood collection under the skin, due to wall of blood vessels periced, blood leaks into tissue

A

hematoma

95
Q

inflammation of veins

A

phlebitis

96
Q

tiny hemorrhages
- small red or purple spots on skin

A

petechia

97
Q

a blood clot from not applying enough pressure to venipuncture site

A

throbus

98
Q

severe sweating

A

diaphoresis

99
Q

what do you do if your patient is having a seizure during phelbotomy

A

stop & get emergency assistance

100
Q

what are the s/s of shock?

A

cold, clammy, pale, rapid pulse, increased shallow breathing , blank stare

101
Q

what do you do if your patient is going into shock

A
  • call for help
  • ensure open airway
  • lying down, lower head bellow their body
  • keep warm
102
Q

how do you handle and transport a specimen?

A
  • test require time, heat, cold, or protection form light
  • important to secure high quality test results
103
Q

glucose in the blood cells can break down & interfere with test results due to…

A

delays

104
Q

the blood specimen you are transporting must sit on ice, what is being tested?

A

ammonia & lactic acid

105
Q

test has to be 37 C (98.6 F)

A

cold agglutions

106
Q

test must be wrapped in foil

A

bilirubin & folate levels

107
Q

test must be room temp.
-15 to 30 or ice slurry for 1 hour
- delivery time is important

A

blood gas test

108
Q

test should take place within 1 hour of collection

A

coagulation

109
Q

if test delay up to 24 hours @ room temp, then test results will not be affected

A

prothrombin

110
Q

room temp.

A

22 C (72.6 F)

111
Q

antibiotic peaking in the body

A

peak

112
Q

draw at certain amount of time before giving antibiotic

A

trough

113
Q

urine samples…

A
  • refrigerated
  • get to lab within 1 hour of collection
  • room temp for no longer than 72 hours with reagent strips
114
Q

room temp up to 72 hours

A

culture and sensitivity test

115
Q
  • vaginal swabs
  • blood or bodily fluids from crime scene
  • postmortem specimen
  • toxicology testing after overdose
  • must have special training
A

forensic specimen

116
Q
  • confirms maternal drug use 24 to 72 hours after childbirth of newborns urine is positive for substances
  • analysis within 24 hours of childbirth
A

neonatal drug testing

117
Q

legal BAC

A

0.08%

118
Q
  • establishes guidelines for some test tat PCT might perform in patients home and in medical facilities
  • waived test&raquo_space; decrease risk to patients
A

CLIVA 9 clinical laboratory improvement act)

119
Q

chain of custody

A

maintains control and accountability for each specimen from time of collection to disposal

120
Q

culture & sensitivity test should be

A

room temp up to 72 hours
- if not preserved, refrigerate

121
Q

if you go out of order of draw, what do u do

A

continue draws and document mix up

122
Q

what are the only times you wouldn’t continue the draw if you mix up the order?

A

if it is timed or for clotting
- u must do these in correct order of draw

123
Q

when you draw, invert the tube a couple of times to prevent?

A

clotting

124
Q

sitting the tube upright prevents

A

clotting

125
Q

setting the tube sideways causes

A

hemolysis

126
Q

Specimens that need to be put in a culture medium or lactic acid

A

Blood, urine, sputum, wound exudate, stool, and other body substances

127
Q

Ammonia and lactic acid must be kept in…

A

An ice slurry immediately after collection

128
Q

Cold agglutinations

A

Remain body temp (37 C (98.6 F))

129
Q

Bilirubin and folate level

A

Wrap in foil to protect from light

130
Q

Blood gas test

A

Room temp 15 to 30 min or in ice slurry for up to an hour

131
Q

Coagulation test

A

Analysis should take place within 1 hour of collection

132
Q

Prothrombin

A

Time is an exception

133
Q

Photosensitive specimens must be

A

Protected from light

134
Q

Peak and trough values

A

Collect at a specific time after administration of antibiotics

135
Q

Urine specimens

A

Refrigerate and get to lab for testing within 1 hour of collection

136
Q

Preserved urine specimens

A

Keep tube at room temp (22 C (72.6 F)) no longer than 72 hours before urinalysis

137
Q

Culture and sensitivity

A

Room temp up to 72 hours

138
Q

If there are any delays between time of collection and when specimen is supposed to be given to lad for testing, what do u do?

A

Complete laboratory requisition forms

139
Q

What should be included on the laboratory requisition form?

A

Patients name, date, type of test, requesting providers name, ICD-10-C14 code for diagnosis, and a line for providers signature

Patient care (9 decks)

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