Pre-analytical considerations Flashcards
1
Q
what do you call the phase that begins when a test is ordered and ends when testing begins?
A
pre-analytical phase
2
Q
this refers to the resting metabolic state of the body early in the morning after fasting (except water) for approx. 12 hours
A
basal state
3
Q
what do you call the state that is ideal for establishing reference ranges because effects of diet, exercise, and other factors are eliminated?
A
basal state
4
Q
what are the tests affected by age?
A
RBC, WBC, & Renal function
5
Q
RBC in younger patients
Identify if higher or lower
A
higher
6
Q
WBC in younger patients
Identify if higher or lower
A
higher
7
Q
Renal Function in older patients
Identify if higher or lower
A
lower
higher siya in younger ones, together with RBC & WBC
8
Q
C-reactive proteins in higher altitudes
Identify if higher or lower
A
higher
9
Q
what test or what is most affected in higher altitudes?
A
RBC
higher RBC; since lesser oxy, body produces more RBC to make up for reqs
10
Q
RBC in higher altitudes
Identify if higher or lower
A
higher
11
Q
Hematocrit in higher altitudes
Identify if higher or lower
A
higher
12
Q
uric acid in higher altitudes
Identify if higher or lower
A
higher
13
Q
creatinine in higher altitudes
Identify if higher or lower
A
lower
14
Q
what is the normal pH level of our blood?
A
7.35-7.45
15
Q
what happens when there is a decrease in total body fluid which can occur with persistent vomiting or diarrhea?
A
Dehydration
16
Q
A condition caused by dehydration in which blood components that cannot easily leave the bloodstream become concentrated in smaller plasma volume
A
hemoconcentration
17
Q
what increases when you are dehydrated?
dehydration = hemoconcentration
A
- RBCs
- Iron (Fe)
- Calcium (Ca)
- Sodium (Na)
- Potassium (K)
nonfilterable analytes; Mnemonics: ReFeCaNaK
18
Q
how long does fasting usually last?
A
8 to 12 hours
usually overnight
19
Q
what is higher in patients with high-protein diets?
A
NPN (non-protein nitrogenous substances)
NPN = urea, uric acid, creatinine, ammonia, creatine, biuret
NPN are waste products from amino acid excess
20
Q
what tests are elevated when caffeine is consumed?
A
Cortisol and Adrenocorticotropic hormone (ACTH)
21
Q
Upon ingestion of carbohydrates or sugar-laden substances, what levels are increased?
A
Insulin and Glucose levels are increased
glucose levels return to normal within 2 hours if px has normal glucose metabolism
22
Q
what levels are affected when excessive amounts of water and fluid is consumed?
Identify if higher or lower
A
lower Hgb & electrolyte levels
23
Q
what happens when u intake foods such as butter/marg, cheese, cream, and oils?
Identify if higher or lower, and what is affected ofc
A
higher lipid levels
cholesterol and triglycerides are examples of lipids
24
Q
what do you call the condition wherein there is an abnormal increase in blood lipid content?
A
lipemia
25
what color is the serum/plasma if the patient has high lipid levels?
**turbid (cloudy)** in lipemic specimen
**transparent light yellow** in normal
26
Lipemia can be present for up to how many hours?
up to 12 hours
## Footnote
- this is why a 12-hour fast is required for an accurate testing of triglycerides
27
can chemistry tests be performed on lipemic specimens?
no. because cloudiness interferes with the testing procedure
28
speciman condition that would lead you to suspect hat the patient was not fasting when it was collected
cloudy white serum/plasma
29
this is also called icterus wherein it is a condition characterized by increased bilirubin in the bloodstream
| bilirubin = product after degrading hemoglobin
jaundice
30
what tests are affected in alcohol intake?
| Identify if higher or lower
higher triglycerides, liver enzymes & analytes
31
this is the other term for **daily** in terms of variations in blood components
diurnal
32
other term for having a 24-hour cycle; used term in variations or fluctuations of blood components every 24-hours
circadian
33
what tests are higher in the morning?
- Cortisol
- ACTH
- Iron
- Aldosterone
- BIlirubin
- Hgb
- Insulin
- Potassium
- Testosterone
- RBCs
| mnemo: Cortisol = sol/sun; ACTH = atching; Iron = clothes b4 work
## Footnote
cortisol, acth, iron, + everything blood
34
Cortisol in the morning
| Identify if higher or lower
Higher
35
what tests are higher in the afternoon or evening?
- GH = growth hormone
- Acid Phosphate = for seminal fluid
- Creatinine
36
what analyte is depressed when in a supine position?
Calcium (4%)
37
Chemotherapy effect in blood cells (especially WBCs & platelets)
| Identify if higher or lower; increase or decrease
decrease in blood cells
38
what does AST mean?
Aspartate aminotransaminase
39
ALP standa for?
Alkaline Phosphatase
40
LDH stands for?
Lactate dehydrogenase
41
NSAIDs and Anti-TB
| Identify if higher or lower; wat is affected?
elevates liver enzymes
42
Opiates effect
| Identify if higher or lower; wat is affected?
higher liver and pancreatic enzymes
43
Oral Contraceptives
| Identify if higher or lower; wat is affected?
- higher erythrocyte sedimentation rate (ESR)
- lower Vit. B12
44
Steroids and diuretics
| Identify if higher or lower; wat is affected?
higher amylase and lipase values
| may cause pancreatitis
45
Steroids and diuretics
| Identify if higher or lower; wat is affected?
higher amylase and lipase values
| may cause pancreatitis
46
Arterial pH & PaCO2 levels in exercise
| Identify if higher or lower
lower; reduced levels
## Footnote
During exercise, u need energy (glucose and insulin) which will be produced through aerobic & anaerobic respiration.
Anaerobic = glycolysis → pyruvate → lactic acid (decrease blood pH)
Aerobic = releases H+ & CO2 from muscles
47
What tests are increased by moderate muscular activity?
Glucose, Insulin, Lactic Acid, Total Protein, & Potassium, CK, LDH
| LACKAS = lactic acid, Creatine & creatinine kinase, K, AST
## Footnote
During exercise, u need energy (glucose and insulin) which will be produced through aerobic & anaerobic respiration.
Anaerobic = glycolysis → pyruvate → lactic acid (decreases blood pH)
Aerobic = releases H+ & CO2 from muscles
48
what electrolyte is increased after exercise and generally returns to normal after several minutes of rest?
Potassium
| K+ is released from the cells during exercise
49
What enzyme levels are increased by exercise?
- Skeletal muscle enzyme levels are increased
- CK & LDH
| remaining elevated for 24 hours or more
50
What enzyme levels are increased by exercise?
- Skeletal muscle enzyme levels are increased
- CK & LDH
| remaining elevated for 24 hours or more
51
what tests are increased when there is hemolysis?
KLAMP!
- K - Potassium
- L - LDH
- A - AST
- M - Magnesium
- P - Phosphorus
52
what electrolyte levels significantly increase within 30 minutes of standing?
potassium levels
| this is attributed to the release of intracellular potassium from muscle
53
what immunoglobulin/s are increased when smoking?
IgE only
| IgA, IgG, IgM are decreased; GAM(E)
54
WBCs during stress
| Identify if higher or lower
higher
55
Why do we need to avoid burns, scarred, and tattooed areas?
- impaired circulation
- painful
- increased risk of infection
56
some veins are hard because they are partially or completely occluded. what are the two types of occlusions?
- sclerosed (hardened)
- thrombosed (clotted)
57
this is the swelling caused by the abnormal accumulation of fluid in the tissues
| sometimes results when fluid from an IV infiltrates surrounding tissues
Edema
58
this is a swelling that is often caused by blood leaking from a blood vessel during or following venipuncture
| may also be a mass of blood that is often clotted
hematoma
59
this is the term for a breast removal through surgery
mastectomy
60
this is the term used to characterize the obstruction or stoppage of normal lymph flow due to breast removal
lymphostasis
61
Impaired lymph flow makes the arm susceptible to a type of swelling called?
lymphedema
| lymphostatic arm also is prone to infection
62
what tourniquet do you use for obese patients?
Bariatric tourniquet
| blood pressure cuffs may also be used
63
what do you call the tubings and other devices that are specifically designed to allow entry to veins or arteries?
Vascular Access Devices (VADs)
64
this VAD is within a vein and is a quick way to deliver fluids, meds, blood transfusion products, and other substances
IV Line
| Intravenous = w/in a vein
65
blood samples can be drawn from an arm with IV
| True or False
False
| u cannot draw blood unless it's done distal to the IV
## Footnote
- turn off IV for 2 mins; tourniq distal; veni distal to the IV; then restard IV
- u can "catch" the specimen if the catheter is newly inserted then no IV fluid is administered yet
66
what do you call the catheter placed in an artery?
| also known as A-line
Arterial Line
67
what do you call the catheter placed in an artery?
| also known as A-line
Arterial Line
| commonly in the radial artery of the rist
68
this VAD is typically used to provide accurate and continuous measurement of a patient's blood pressure
Arterial Line
69
can we perform venipuncture on an arm with an arterial line?
NO! even tourniquet application is prohibited
70
what do you call the permanent surfical connection of an artery and a vein?
arteriovenous (AV) shunt
71
this VAD bypasses the capillaries and forces arterial blood directly into a vein
AV shunt
72
what do you call the shunt created for dialysis?
AV fistula
| this is visibly as a large bulging section of a vein
73
What do you call the shunt created using a piece of vein or tubing to form a loop from the artery to the vein that can be seen under the skin?
AV graft
74
what do you call the buzzing sensation when you palpate a shunt?
thrill
## Footnote
caused by the pressure of the arterial blood flow meeting the passive flow of the vein
75
what do you call the needleless devise that is connected to an arterial or central venous catheter for the specific purpose of collecting blood specimens?
Blood Sampling Device
76
what are peripheral veins?
veins that are anywhere on the body except the abdomen and chest
77
what are peripheral veins?
veins that are anywhere on the body except the abdomen and chest
78
this is a VAD that consists of a tubing inserted into a main vein or artery
Central Vascular Access Device (CVAD)
79
this is a type of CVAD inserted into a large vein then advances into the superior vena cava
Central Venous Line (CVC)
80
this is a type of CVAD inserted into a large vein then advances into the superior vena cava
Central Venous Line (CVC)
81
this CVAD is a small chamber attached to an indwelling line that is surgically implanted under the skin and most commonly located in the upper chest or arm
Implanted port
82
this CVAD is a line inserted into the peripheral venous system and threaded into the central venous system
| usually placed in the antecubital vein above the antecubital fossa
Peripherally inserted central catheter (PICC)
83
what do you do to patients who are allergic to the glue used in adhesive bandages?
wrap with self-adherent bandaging material (Coban)
| then instruc px to remove in 15 minutes
84
patients on aspirin or anticoagulant therapy may take longer to stop bleeding
| true or false
True
85
what is the medical term for fainting?
| loss of consciousness and postural tone
syncope
86
what do you call the fainting that is caused by a response of the nervous system to abrupt pain, stress, or trauma?
vasovagal syncope
87
what do you do when patient vomits during veni?
stop agad.
| when in extreme pain, stop also
88
these are tiny, nonraised, purple, or brownish colored spots that appear on the patient's skin when a tourniquet is applied
petechiae
89
these spots are minute drops of blood that escape the capillaries and come to the surface of the skin below the tourniquet
petechiae
90
what may be the outcome when a patient has petechiae?
site may bleed excessively
91
Differentiate petechiae and ecchymoses
- Petechiae are generally less than 3mm in diameter
- Ecchymoses are larger than 5mm
92
what is the most common complication of venipuncture?
hematoma
93
caused by blood leaking into the tissues during or following venipuncture and is identified by swelling at the site
Hematoma
94
what will you do if hematoma forms during collection?
stop draw; hold forceful pressure over the site for several minutes (3-5 if suspected arterial)
95
what is the adjective used to describe an adverse condition brought on by the effects of treatment?
iatrogenic
96
removing blood on a regular basis or in large quantities may lead to what?
iatrogenic anemia
97
what do you call the blood loss to a point at which life cannot be sustained?
exsanguination
98
Life may be threatened if blood collected over a short period is more than how many percent?
if more than 10% = threaten lyf
99
this occurs when the additives from a tube flows back into a patient's vein
reflux
100
what do you call the stagnation of normal venous blood flow caused by tourniquet application?
venous stasis
101
what do you call the result of venous stasis wherein a **decrease in the fluid content of the blood with a subsequent increase in nonfilterable large molecule** or protein-based blood component is observed?
hemoconcentration
102
what activities can result in the collection of specimens affected by hemoconcentration?
1. heavy massaging of site
2. vigorous hand pumping
3. vein-probing
4. drawing blood from occluded veins
5. long-term IV therapy
6. tourniq application more than 1 min
103
what occurs when RBCs are damages/destroyed and hemoglobin escapes into the fluid portion of the specimen?
Hemolysis
104
what do you call a specimen that has a plasma/serum that is dark red?
hemolyzed malamang haha but **gross hemolysis if dark**
## Footnote
- pink = slight hemo
- dark pink to light red = moderate hemo
- dark red = gross hemo
105
what analytes increase when hemolysis occurs?
KLAMP!
1. Potassium
2. LDH
3. AST
4. Mg
5. Phosphate
106
elaborate the reasons for specimen rejection
| 10 'to hehe
1. Hemolysis
2. Lipemia
3. Clotting
4. Nonfast specimen when fast is required
5. Improper tube
6. Short draws/wrong volume
7. Improper transport condition
8. Requisition form & specimen label discrepancy
9. Unlabeled/mislabeled specimen
10. Contaminated specimen
107
Peak levels of which analyte typically occur around 08:00
hours?
a. Bilirubin
b. Cortisol
c. Eosinophil
d. Glucose
b. cortisol
108
Which of these tests are most affected if the patient is not
fasting?
a. CBC and protime
b. Glucose and triglycerides
c. RA and cardiac enzymes
d. Blood culture and thyroid profile
b. glucose and triglycerides
109
Veins that feel hard and cord-like when palpated may be
a. collapsed.
b. fistulas.
c. thrombosed.
d. venules.
c. thrombosed
110
Tiny red spots that appear on a patient’s arm when the
tourniquet is applied are a sign that the
a. patient is allergic to nitrile.
b. patient has anemia.
c. site may bleed excessively.
d. veins are sclerosed.
c. site may bleed excessively
111
When the arm of the patient is swollen with excess fluids,
the condition is called
a. edema.
b. hemolysis.
c. icterus.
d. syncope.
a. edema
112
A patient has several short lengths of IV-type tubing
protruding from the chest. This is most likely a(n)
a. A-line.
b. CVC.
c. port.
d. PICC.
b. CVC
113
Which situation would be most likely to allow reflux to occur
during venipuncture?
a. Filling the tube stopper end first
b. Lateral redirection of the needle
c. Tourniquet release on blood flow
d. Using the wrong order of draw
a. filling the tube stopper end first
114
A patient complains of extreme pain when you insert the
needle during a venipuncture attempt. The pain does not
subside, but the patient does not feel any numbness or
burning sensation. You know the needle is in the vein
because the blood is flowing into the tube. You have only
two tubes to fill, and the first one is almost full. What should
you do?
a. Ask the patient if he or she wants you to continue the draw.
b. Discontinue the draw and attempt collection at another site.
c. Distract the patient with small talk and continue the draw.
d. Tell the patient to hang in there as you have only one tube
left.
b. discontinue the draw and attempt collection at another site
115
Which situation can result in hemoconcentration?
a. Drawing a large tube with a small needle
b. Leaving the tourniquet on for over one minute
c. Mixing the specimen too vigorously
d. Partially filling a normal-draw tube
b. leaving the tourniquet on for over one minute
116
You are in the process of collecting a specimen by
venipuncture. You hear a hissing sound, there is a spurt of
blood into the tube, and blood flow stops. What has most
likely happened?
a. Collapsed vein
b. Needle went too deep
c. Reflux of tube contents
d. Tube vacuum escaped
d. Tube vacuum escaped
117
Most test result reference ranges are values for
a. healthy individuals.
b. patients who are ill.
c. people of the same age.
d. specific disorders.
a. healthy individuals
118
If a venipuncture fails to draw blood and the phlebotomist
senses a slight vibration of the needle, this could be a sign
that the needle
a. is up against a valve.
b. penetrated a nerve.
c. struck a hematoma.
d. went through the vein.
a. is up against a valve
119
An arm that is paralyzed
a. has no muscle function.
b. has sensory damage also.
c. is a permanent condition.
d. is the result of a stroke.
a. has no muscle function
120
bariatric phlebotomy chair is designed for individuals who
are
a. apt to faint.
b. mentally ill.
c. overweight.
d. paralyzed.
c. overweight
121
An AV fistula is most commonly used for
a. chemotherapy.
b. dialysis access.
c. drawing blood.
d. fluid infusion.
b. dialysis access
122
Which situation can hemolyze a specimen?
a. Drawing a large tube with a 23-gauge butterfly
b. Forceful aspiration of blood with a syringe
c. Horizontal transportation of tubes of blood
d. All of the above
d. all of the above
123
Which type of therapy can increase bilirubin levels?
a. Acetaminophen pills
b. Blood pressure medications
c. Chemotherapy drugs
d. Oral contraceptives
a. Acetaminophen pills
| hehe try elimination method ;)
124
Pseudoanemia can be caused by
a. a change in position from standing to lying down.
b. drawing a blood specimen through an IV valve.
c. leaving the tourniquet on longer than one minute.
d. using too large of a needle to collect a specimen.
a. a change in position from standing to lying down
125
Creatinine clearance is a measure of
a. glucose metabolism.
b. kidney function.
c. liver function.
d. muscular activity.
b. kidney function
126
Drugs that interfere with blood tests should be stopped or
avoided for
a. 4 to 24 hours.
b. 8 to 12 hours.
c. 12 to 36 hours.
d. 48 to 72 hours.
a. 4 to 24 hours
127
drugs that interfere with urine samples should be discontinued for?
24-48 hours
| 4-24 hours if blood test
128
drugs that interfere with urine samples should be discontinued for?
24-48 hours
| 4-24 hours if blood test
