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PMTP2 > Pre-analytical considerations > Flashcards

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

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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

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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

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4
Q

what are the tests affected by age?

A

RBC, WBC, & Renal function

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5
Q

RBC in younger patients

Identify if higher or lower

A

higher

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6
Q

WBC in younger patients

Identify if higher or lower

A

higher

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7
Q

Renal Function in older patients

Identify if higher or lower

A

lower

higher siya in younger ones, together with RBC & WBC

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8
Q

C-reactive proteins in higher altitudes

Identify if higher or lower

A

higher

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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

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10
Q

RBC in higher altitudes

Identify if higher or lower

A

higher

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11
Q

Hematocrit in higher altitudes

Identify if higher or lower

A

higher

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12
Q

uric acid in higher altitudes

Identify if higher or lower

A

higher

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13
Q

creatinine in higher altitudes

Identify if higher or lower

A

lower

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14
Q

what is the normal pH level of our blood?

A

7.35-7.45

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15
Q

what happens when there is a decrease in total body fluid which can occur with persistent vomiting or diarrhea?

A

Dehydration

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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

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17
Q

what increases when you are dehydrated?

dehydration = hemoconcentration

A
  • RBCs
  • Iron (Fe)
  • Calcium (Ca)
  • Sodium (Na)
  • Potassium (K)

nonfilterable analytes; Mnemonics: ReFeCaNaK

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18
Q

how long does fasting usually last?

A

8 to 12 hours

usually overnight

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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

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20
Q

what tests are elevated when caffeine is consumed?

A

Cortisol and Adrenocorticotropic hormone (ACTH)

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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

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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

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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

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24
Q

what do you call the condition wherein there is an abnormal increase in blood lipid content?

A

lipemia

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25
Q

what color is the serum/plasma if the patient has high lipid levels?

A

turbid (cloudy) in lipemic specimen
transparent light yellow in normal

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26
Q

Lipemia can be present for up to how many hours?

A

up to 12 hours

  • this is why a 12-hour fast is required for an accurate testing of triglycerides
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27
Q

can chemistry tests be performed on lipemic specimens?

A

no. because cloudiness interferes with the testing procedure

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28
Q

speciman condition that would lead you to suspect hat the patient was not fasting when it was collected

A

cloudy white serum/plasma

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29
Q

this is also called icterus wherein it is a condition characterized by increased bilirubin in the bloodstream

bilirubin = product after degrading hemoglobin

A

jaundice

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30
Q

what tests are affected in alcohol intake?

Identify if higher or lower

A

higher triglycerides, liver enzymes & analytes

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31
Q

this is the other term for daily in terms of variations in blood components

A

diurnal

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32
Q

other term for having a 24-hour cycle; used term in variations or fluctuations of blood components every 24-hours

A

circadian

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33
Q

what tests are higher in the morning?

A
  • Cortisol
  • ACTH
  • Iron
  • Aldosterone
  • BIlirubin
  • Hgb
  • Insulin
  • Potassium
  • Testosterone
  • RBCs

mnemo: Cortisol = sol/sun; ACTH = atching; Iron = clothes b4 work

cortisol, acth, iron, + everything blood

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34
Q

Cortisol in the morning

Identify if higher or lower

A

Higher

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35
Q

what tests are higher in the afternoon or evening?

A
  • GH = growth hormone
  • Acid Phosphate = for seminal fluid
  • Creatinine
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36
Q

what analyte is depressed when in a supine position?

A

Calcium (4%)

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37
Q

Chemotherapy effect in blood cells (especially WBCs & platelets)

Identify if higher or lower; increase or decrease

A

decrease in blood cells

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38
Q

what does AST mean?

A

Aspartate aminotransaminase

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39
Q

ALP standa for?

A

Alkaline Phosphatase

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40
Q

LDH stands for?

A

Lactate dehydrogenase

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41
Q

NSAIDs and Anti-TB

Identify if higher or lower; wat is affected?

A

elevates liver enzymes

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42
Q

Opiates effect

Identify if higher or lower; wat is affected?

A

higher liver and pancreatic enzymes

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43
Q

Oral Contraceptives

Identify if higher or lower; wat is affected?

A
  • higher erythrocyte sedimentation rate (ESR)
  • lower Vit. B12
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44
Q

Steroids and diuretics

Identify if higher or lower; wat is affected?

A

higher amylase and lipase values

may cause pancreatitis

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45
Q

Steroids and diuretics

Identify if higher or lower; wat is affected?

A

higher amylase and lipase values

may cause pancreatitis

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46
Q

Arterial pH & PaCO2 levels in exercise

Identify if higher or lower

A

lower; reduced levels

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

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47
Q

What tests are increased by moderate muscular activity?

A

Glucose, Insulin, Lactic Acid, Total Protein, & Potassium, CK, LDH

LACKAS = lactic acid, Creatine & creatinine kinase, K, AST

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

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48
Q

what electrolyte is increased after exercise and generally returns to normal after several minutes of rest?

A

Potassium

K+ is released from the cells during exercise

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49
Q

What enzyme levels are increased by exercise?

A
  • Skeletal muscle enzyme levels are increased
  • CK & LDH

remaining elevated for 24 hours or more

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50
Q

What enzyme levels are increased by exercise?

A
  • Skeletal muscle enzyme levels are increased
  • CK & LDH

remaining elevated for 24 hours or more

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51
Q

what tests are increased when there is hemolysis?

A

KLAMP!
- K - Potassium
- L - LDH
- A - AST
- M - Magnesium
- P - Phosphorus

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52
Q

what electrolyte levels significantly increase within 30 minutes of standing?

A

potassium levels

this is attributed to the release of intracellular potassium from muscle

53
Q

what immunoglobulin/s are increased when smoking?

A

IgE only

IgA, IgG, IgM are decreased; GAM(E)

54
Q

WBCs during stress

Identify if higher or lower

A

higher

55
Q

Why do we need to avoid burns, scarred, and tattooed areas?

A
  • impaired circulation
  • painful
  • increased risk of infection
56
Q

some veins are hard because they are partially or completely occluded. what are the two types of occlusions?

A
  • sclerosed (hardened)
  • thrombosed (clotted)
57
Q

this is the swelling caused by the abnormal accumulation of fluid in the tissues

sometimes results when fluid from an IV infiltrates surrounding tissues

A

Edema

58
Q

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

A

hematoma

59
Q

this is the term for a breast removal through surgery

A

mastectomy

60
Q

this is the term used to characterize the obstruction or stoppage of normal lymph flow due to breast removal

A

lymphostasis

61
Q

Impaired lymph flow makes the arm susceptible to a type of swelling called?

A

lymphedema

lymphostatic arm also is prone to infection

62
Q

what tourniquet do you use for obese patients?

A

Bariatric tourniquet

blood pressure cuffs may also be used

63
Q

what do you call the tubings and other devices that are specifically designed to allow entry to veins or arteries?

A

Vascular Access Devices (VADs)

64
Q

this VAD is within a vein and is a quick way to deliver fluids, meds, blood transfusion products, and other substances

A

IV Line

Intravenous = w/in a vein

65
Q

blood samples can be drawn from an arm with IV

True or False

A

False

u cannot draw blood unless it’s done distal to the IV

  • 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
Q

what do you call the catheter placed in an artery?

also known as A-line

A

Arterial Line

67
Q

what do you call the catheter placed in an artery?

also known as A-line

A

Arterial Line

commonly in the radial artery of the rist

68
Q

this VAD is typically used to provide accurate and continuous measurement of a patient’s blood pressure

A

Arterial Line

69
Q

can we perform venipuncture on an arm with an arterial line?

A

NO! even tourniquet application is prohibited

70
Q

what do you call the permanent surfical connection of an artery and a vein?

A

arteriovenous (AV) shunt

71
Q

this VAD bypasses the capillaries and forces arterial blood directly into a vein

A

AV shunt

72
Q

what do you call the shunt created for dialysis?

A

AV fistula

this is visibly as a large bulging section of a vein

73
Q

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?

A

AV graft

74
Q

what do you call the buzzing sensation when you palpate a shunt?

A

thrill

caused by the pressure of the arterial blood flow meeting the passive flow of the vein

75
Q

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?

A

Blood Sampling Device

76
Q

what are peripheral veins?

A

veins that are anywhere on the body except the abdomen and chest

77
Q

what are peripheral veins?

A

veins that are anywhere on the body except the abdomen and chest

78
Q

this is a VAD that consists of a tubing inserted into a main vein or artery

A

Central Vascular Access Device (CVAD)

79
Q

this is a type of CVAD inserted into a large vein then advances into the superior vena cava

A

Central Venous Line (CVC)

80
Q

this is a type of CVAD inserted into a large vein then advances into the superior vena cava

A

Central Venous Line (CVC)

81
Q

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

A

Implanted port

82
Q

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

A

Peripherally inserted central catheter (PICC)

83
Q

what do you do to patients who are allergic to the glue used in adhesive bandages?

A

wrap with self-adherent bandaging material (Coban)

then instruc px to remove in 15 minutes

84
Q

patients on aspirin or anticoagulant therapy may take longer to stop bleeding

true or false

A

True

85
Q

what is the medical term for fainting?

loss of consciousness and postural tone

A

syncope

86
Q

what do you call the fainting that is caused by a response of the nervous system to abrupt pain, stress, or trauma?

A

vasovagal syncope

87
Q

what do you do when patient vomits during veni?

A

stop agad.

when in extreme pain, stop also

88
Q

these are tiny, nonraised, purple, or brownish colored spots that appear on the patient’s skin when a tourniquet is applied

A

petechiae

89
Q

these spots are minute drops of blood that escape the capillaries and come to the surface of the skin below the tourniquet

A

petechiae

90
Q

what may be the outcome when a patient has petechiae?

A

site may bleed excessively

91
Q

Differentiate petechiae and ecchymoses

A
  • Petechiae are generally less than 3mm in diameter
  • Ecchymoses are larger than 5mm
92
Q

what is the most common complication of venipuncture?

A

hematoma

93
Q

caused by blood leaking into the tissues during or following venipuncture and is identified by swelling at the site

A

Hematoma

94
Q

what will you do if hematoma forms during collection?

A

stop draw; hold forceful pressure over the site for several minutes (3-5 if suspected arterial)

95
Q

what is the adjective used to describe an adverse condition brought on by the effects of treatment?

A

iatrogenic

96
Q

removing blood on a regular basis or in large quantities may lead to what?

A

iatrogenic anemia

97
Q

what do you call the blood loss to a point at which life cannot be sustained?

A

exsanguination

98
Q

Life may be threatened if blood collected over a short period is more than how many percent?

A

if more than 10% = threaten lyf

99
Q

this occurs when the additives from a tube flows back into a patient’s vein

A

reflux

100
Q

what do you call the stagnation of normal venous blood flow caused by tourniquet application?

A

venous stasis

101
Q

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?

A

hemoconcentration

102
Q

what activities can result in the collection of specimens affected by hemoconcentration?

A
  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
Q

what occurs when RBCs are damages/destroyed and hemoglobin escapes into the fluid portion of the specimen?

A

Hemolysis

104
Q

what do you call a specimen that has a plasma/serum that is dark red?

A

hemolyzed malamang haha but gross hemolysis if dark

  • pink = slight hemo
  • dark pink to light red = moderate hemo
  • dark red = gross hemo
105
Q

what analytes increase when hemolysis occurs?

A

KLAMP!
1. Potassium
2. LDH
3. AST
4. Mg
5. Phosphate

106
Q

elaborate the reasons for specimen rejection

10 ‘to hehe

A
  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
Q

Peak levels of which analyte typically occur around 08:00
hours?
a. Bilirubin
b. Cortisol
c. Eosinophil
d. Glucose

A

b. cortisol

108
Q

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

A

b. glucose and triglycerides

109
Q

Veins that feel hard and cord-like when palpated may be
a. collapsed.
b. fistulas.
c. thrombosed.
d. venules.

A

c. thrombosed

110
Q

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.

A

c. site may bleed excessively

111
Q

When the arm of the patient is swollen with excess fluids,
the condition is called
a. edema.
b. hemolysis.
c. icterus.
d. syncope.

A

a. edema

112
Q

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.

A

b. CVC

113
Q

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

a. filling the tube stopper end first

114
Q

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.

A

b. discontinue the draw and attempt collection at another site

115
Q

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

A

b. leaving the tourniquet on for over one minute

116
Q

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

A

d. Tube vacuum escaped

117
Q

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

a. healthy individuals

118
Q

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

a. is up against a valve

119
Q

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

a. has no muscle function

120
Q

bariatric phlebotomy chair is designed for individuals who
are
a. apt to faint.
b. mentally ill.
c. overweight.
d. paralyzed.

A

c. overweight

121
Q

An AV fistula is most commonly used for
a. chemotherapy.
b. dialysis access.
c. drawing blood.
d. fluid infusion.

A

b. dialysis access

122
Q

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

A

d. all of the above

123
Q

Which type of therapy can increase bilirubin levels?
a. Acetaminophen pills
b. Blood pressure medications
c. Chemotherapy drugs
d. Oral contraceptives

A

a. Acetaminophen pills

hehe try elimination method ;)

124
Q

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. a change in position from standing to lying down

125
Q

Creatinine clearance is a measure of
a. glucose metabolism.
b. kidney function.
c. liver function.
d. muscular activity.

A

b. kidney function

126
Q

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

a. 4 to 24 hours

127
Q

drugs that interfere with urine samples should be discontinued for?

A

24-48 hours

4-24 hours if blood test

128
Q

drugs that interfere with urine samples should be discontinued for?

A

24-48 hours

4-24 hours if blood test

PMTP2 (8 decks)

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