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BIOL 430 > UCD Limited Skills Phlebotomy > Flashcards

UCD Limited Skills Phlebotomy Flashcards

1
Q

What are the primary functions of the cardiovascular system?

A

circulate blood
deliver O2 and nutrients to cells
dispose of waste products

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2
Q

What are the functions of the heart?

A

propels blood for transport of respiratory gases, nutrients, waste and immune substances

circulates blood to the lungs for O2/CO2 exchange

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3
Q

Describe pulmonary circulation

A

blood leaves the right ventricle and goes to the lungs for O2

right atrium (deoxygenated blood) -> R ventricle -> pulmonary trunk -> pulmonary arteries -> Lungs (becomes oxygenated blood) -> pulmonary veins -> L atrium (oxygenated blood) -> left ventricle

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4
Q

Describe systemic circulation

A

carries oxygenated blood from the L ventricle to the body systems

L atrium (oxygenated blood) -> L ventricle -> aorta -> systemic arteries -> tissues/organs (deoxygenated) -> systemic veins -> superior/inferior vena cava -> R atrium -> R ventricle (deoxygenated)

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5
Q

Compare and contrast the inferior and superior vena cava

A

inferior vena cava - collects blood below the heart
superior vena cava - collects blood from above the heart

BOTH send deoxygenated blood to the heart

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6
Q

Compare and contrast the L and R sides of the heart

A

Right - receives deoxygenated blood from tissue and organs

Left - receives oxygenated blood from lungs

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7
Q

What are the 4 types of heart valves?

A

AV Valves - separates atrium and ventricle on each half of the heart

  • Tricuspid valve - between R atrium and R ventricle
  • Bicuspid valve - between L atrium and L ventricle

Semilunar valves - separates the ventricle and vasculature. Contain 3 leaflets

  • Pulmonary valves - opening of right ventricle into pulmonary trunk
  • Systemic valves - opening L ventricle into aorta
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8
Q

Which side of the heart has more muscle mass? Why

A

L side of heart

exiting blood must travel farther, need more muscle to force it

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9
Q

What are the function of coronary blood vessels?

A

Nourished heart

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10
Q

What are the layers of the heart from inner to outer?

A

endocardium - inner lining
myocardium - heart muscle
epicardium - top layer of heart
Pericardium - sac holding the heart

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11
Q

What parts of the heart receive blood? Deliver blood?

A

Atria - receives blood

Ventricle - delivers blood

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12
Q

What are the 4 heart chambers, what kind of blood do the do they contain, where does it receive/deliver blood?

A

Right atrium - Deoxygenated blood from the venae cavae
Left atrium - oxygenated blood from the lungs

Right Ventricle - deoxygenated blood to the lungs
- part of the pulmonary circulation

Left Ventricle - oxygenated blood to body systems
- systemic circulation

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13
Q

What are the function of valves?

A

Prevents backflow of blood

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14
Q

What is the function of blood?

A
  • transport O2 and nutrients from the lungs to the tissues
  • forms blood clots to prevent excess blood loss
  • carrying cells and antibodies that fight infection
  • bringing waste products to the kidneys and liver, which filter and clean the blood
  • regulates body temp
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15
Q

What are the two components of blood?

A

Plasma - liquid

formed elements - cells

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16
Q

What is the difference between plasma and serum?

A

Plasma - liquid, cell-free part of blood that has been treated with anticoagulants

Serum - liquid part of blood AFTER coagulation
- devoid of clotting fibers like fibrinogen

Serum = plasma - fibrinogen

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17
Q

What are the 4 main plasma proteins and their functions?

A
  • albumin - maintains osmotic balance in blood
  • globulins (immunoglobulins) - antibodies (IgG, IgM, etc)
  • fibrinogen - clotting
  • prothrombin - clotting
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18
Q

What are the 3 cellular elements of blood? Describe both

A

Erythrocytes (RBC’s)

  • anuclear, biconcave disks
  • contain hemoglobin
  • transports O2, CO2
  • 4.5-6.0 million per uL
  • lifespan of 120 days

Leukocytes (WBC’s)

  • provide immunity
  • destroy pathogens
  • produced in the bone marrow
  • 4500-11000 per uL
  • circulate in the bloodstream for several hours then migrate into the tissues

Thrombocytes (platelets)

  • vital role in blood clotting (hemostasis)
  • 140-440k per uL
  • lifespan of 9-12 days
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19
Q

What are the differences between arteries, veins and capillaries in structure and function?

A

Arteries

  • structure: thick, elastic - creates resistance to blood flow - high pressure for blood to travel
  • most arteries contain oxygenated blood EXCEPT pulmonary and umbilical arteries

goes to aterioles, then goes to

Capillaries - sites of gas and solute exchange

  • thin walls
  • easy diffusion of gases, waste and nutrients

goes to venules, then goes to

Veins - thin and inelastic

  • less resistance, less recoil - ability to stretch to accommodate larger quantities of blood
  • blood typically deoxygenated EXCEPT pulmonary and umbilical veins
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20
Q

What are the steps of coagulation? What is a blood clot primarily made of? What are the tests relating to blood clotting?

A

Stage 1 - primary hemostasis: response to injury

Stage 2 - Secondary hemostasis

  • formation of fibrin strands
  • reinforces platelet plug

Stage 3 - Stabilize fibrin clot

Stage 4 - Fibronolysis - breaks down the clot after healing

Blood clot consists of fibrin, made from fibrinogen

Blood tests:

  • Coagulation: fibrin clot
  • Anticoagulants: heparin, warfarin
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21
Q

What is a hematoma? What is hemolysis? Why do we want to avoid it?

A

Hematoma - accumulation of blood in the tissues
- “bad bruise”

Hemolysis - process of blood clot formation after injury
- want to avoid bc of ruptured RBC’s: spills contents and leads to inaccurate results

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22
Q

Explain the concepts of cardiac polarization, depolarization and repolarization

A

Polarization - resting state of the myocardial wall

  • no electrical activity in the heart during this phase
  • flat line on EKG strip

Depolarization - stimulation/excitation of myocardial cell

Repolarization - process of heart muscle cells returning to resting state so they may be stimulated again

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23
Q

What happens during the P wave?

A

atrial depolarization/contraction

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24
Q

What happens during the QRS wave?

A

atrial repolatization and ventricle depolarization overlap

ventricular contraction and the beginning of ventricular recovery

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25
What happens during the T wave of an EKG?
ventricular repolarization
26
What happens during the PR segment of an EKG?
AV nodal delay | time from beginning of atrial contraction to beginning of ventricular contraction
27
What is the ST segment in an EKG?
the time between ventricles are contracting and emptying
28
What is the TP interval of an EKG?
time during which ventricles are relaxing and filling
29
What can cause marks to appear on ECG paper?
heat and pressure
30
What does each vertical box on an EKG represent?
amplitude/voltage; 0.1 mV
31
Why do electrodes have jelly like substances on them?
it serves as an electrode that enables the transfer of electrical activity
32
Where are the standard leads located?
R arm - L arm R arm - L leg L arm - L leg R leg is for groundign
33
Where are the augmented leads located?
All are in accordance to R arm, L arm and L leg L hip R hip Sternum
34
Where are the precordial leads located?
``` V1 - R sternum V2 - L sternum, 4th ICS V3- between V2/4 V4 - Midclavicular line, 5th intercostal V5 - between V4/6 V6 - midaxillary line ```
35
What is this artifact and what causes it?
wandering baseline | caused by body movement or leads falling off
36
What is this artifact and what causes it?
AC interference | electrical interference
37
What is this artifact and what causes it?
somatic tremor | shivering, parkinson's
38
What is this artifact and what causes it?
interfering baseline | caused by disruption in electrical connection
39
What are three ways that bacteria can produce disease?
secrete toxic substances that damage human tissue act as parasites inside human cells grow on body surfaces and disrupt normal function
40
What are 4 common disease caused by bacteria?
UTI, pneumonia, TB, and strep throat
41
What are 5 conditions that are required for bacterial growth?
nutrients, moisture, temp (37*), oxygen (or lack thereof), neutral pH
42
What is inflammation
local response to infection or injury - destroys/inactivated foreign invaders - sets stage for tissue repair
43
what is the sequence of events for the inflammatory response?
bacteria introduced into wound chemical mediators cause vasodilation and capillary permeability - increased blood flow increases delivery of proteins and WBC - increased permeability to proteins ensures that plasma proteins that participate in inflammation can gain entry to IF chemical mediators recruit neutrophils (chemotaxis)
44
What are the four classic symptoms of inflammation?
erythema, edema, pain and heat
45
Why does swelling occur? How does it help resolve infection?
blood vessels dilate to increase delivery of WBC - results in redness/heat - allows WBCs to get in there and phagocytize bacteria
46
What happens when infection is too great for local control? What happens when it gets into the bloodstream?
infection can spill into lymph nodes - more WBCs assemble to combat infection - causes lymphadenopathy Pyemia - blood poisoning - when infection spills into bloodstream - systemic infection that can lead to death
47
Describe the following types of infections: acute, chronic, latent, opportunistic
acute - rapid onset of symptoms, lasts short time chronic - infection that persists for a long period, sometimes for life - HBV latent - persistent infection in which the symptoms cycle through periods of relapse and remission - HSV opportunistic - caused by normally non-pathogenic organisms in host whose resistance has been decreased
48
According to OSHA, what are specifically potentially infectious body fluids?
``` CSF liquid or semiliquid blood vaginal or seminal secretions saliva in dental procedures unknown body fluid ```
49
What are the major takeaways included in the OSHA compliance guidelines?
barrier protection - PPE - especially gloves environmental protection - isolation/removing physical and mechanical health hazards housekeeping protocols - schedule cleaning or decontamination of work area HBV vaccine Postexposural follow up
50
Where should broken glassware and spilled material be placed?
impervious biohazard bag or container spill site
51
How should soiled linen be disposed?
double bagged and transported in labeled leakproof biohazard bag
52
How should biohazard waste be disposed?
impermeable red polyethylene or polypropylene biohazard labeled bag or container
53
What's the protocol for cleaning spilled material?
``` sprinkle congealing powder over spill scoop up spill put contents in biohazard bag wipe are with germicide place contaminated material in biohazard bag ```
54
What is an Exposure control plan? What is an example of a bloodborne pathogen standards precaution?
Exposure control plan: source of information for answering bloodborne pathogen-related questions and to help ensure exposure control activities are in place Bloodborne pathogen standards precaution: must keep log of sharps-related injuries
55
What is asepsis? What is the difference between medical and surgical asepsis?
asepsis - freedom from infection or infectious material medical - destruction of infectious organism after entering the body - primary goal is to prevent reinfection and transmission to others surgical - destruction of infectious organisms before entering the body \ - used for procedures that invade body's skin or tissues
56
What are the two types of skin flora?
normal - live and survive on our skin constantly, not virulent, but can cause serious infections transient - infectious organisms that attached to skin during person to person or object
57
Describe sanitation, disinfection and sterilization. What's the process of sanitizing contaminated instruments?
sanitation - cleaning of contaminated articles or surfaces to reduce microorganisms disinfection - use of physical or chemical means to destroy pathogens on surfaces and objects sterilization - removal of all living microbes sanitizing contaminated instruments: 1. put on impermeable gown and face shied, utility gloves 2. separate sharps from non-sharps 3. rinse under cold water 4. clean hinged instruments with disposable brush 5. rinse with hot water 6. towel dry instruments - dispose towels and brushes into biohazard 7. remove gloves and wash hands 8. dry hands, put on gloves, place sanitized instruments in identifiable site for disinfection and sterilization
58
What hand washing material is most effective for eliminating microorganisms on hands?
alcohol based hand rubs - more effective than antimicrobial soap and water
59
Sharps container should only be half up to how long? How full should it be?
30 days 3/4 filled
60
What is the vaccine schedule for HBV? When should post vaccination HBV testing be done?
3 doses - 2nd is 4 weeks after 1st - 3rd 6 months after 2nd antibody testing should be 1-2 months after vaccination
61
What is post exposure prophylaxis? What is the protocol for contaminated waste exposure?
Postexposure prophylaxis - taking medicine to prevent disease after a possible exposure contaminated waste exposure - wash exposed site with antibacterial soap and warm running water - report exposure to site supervisor - complete exposure incident report
62
What are the average temperatures for a newborn, 1 y/o, 6 y/o-adult, 70+? What factors cause body temp to rise and fall?
newborn - 98.2 1 y/o - 99.7 6-adult - 98.6 70+ 96.8 Age - body temp in infants rises faster in response to external temp - aging adults lose ability to respond to environmental temp stress - exercise/emotional stress increase metabolic rate gender - women - hormones fluctuate body temp throughout menstrual cycle smoking, drinking hot fluids
63
What the equation to convert Fahrenheit to Celsius?
``` C = (F -32) x 5/9 F = (C x 9/5) + 32 ```
64
What's more accurate: axillary or oral temp? Why? What temperature measurement is most accurate for infants?
oral - closed cavity infants - temporal artery
65
What are some factors that can affect oral temp?
eating, drinking, smoking exercising
66
What is pulse rate, pulse volume, and pulse rhythm?
pulse rate - number to rimes the heart contracts in a minute pulse volume - amount of force placed on arterial walls during heart beat pulse rhythm - amount of time between pulses
67
Where are all the arteries located?
temporal, carotid, apical, brachial, radial, femoral, popliteal, dorsalis pedis
68
What are the factors that effect blood pressure?
blood volume in circulation - greater volume = higher BO blood vessel condition/peripheral resistance - smaller diameter = greater resistance = higher BP - atherosclerosis = fatty cholesterol deposits causes narrowing of vessels - higher BP - arteriosclerosis - hardening of arteries as we age - higher BP degree of blood viscosity strength of myocardium - weaker contractions = stronger BP to compensate for blood circulation demand
69
Describe essential and secondary hypertension
essential: idiopathic - no known cause stage 1: systolic 140+, diastolic 90+ associated with obesity, high blood sodium, cholesterol, family history, race can also be dx if 120+/80+ for 2+ visits over several weeks stage 2: systolic 160+, 100+ Secondary: caused by another underlying pathologic condition - ex. renal disease, pregnancy complication, endocrine imbalance - white coat HT - increased stress being in medical setting preHT - systolic 119+, diastolic 79+
70
What are the 4 basic aspects of tx'ing hypertension?
lifestyle changes - losing weight, changing diet, limit salt and fat older people - more important to pay attention of systolic - should be treated if over 140 meds - diuretic to eliminate fluids/salts, antiHT patient centered treatment: education, community resources, pt relationship
71
What are the different Korotkoff sounds?
Korotkoff: sounds heard during auscultation of BP Phase 1 - faint, clear tapping sounds is heart - systolic BP Phase 2 - swooshing sound as blood flows through artery - sound can completely disappear - auscultatory gap - disappearance of BP sound, common in HTN Phase 3 - reemergence of sharp tapping sound phase 4 - sharp tapping sound becomes fainter and muffled - diastolic BP
72
What are some pt complications with venipuncture?
apprehensive pts - assistance may be needed fainting (syncope) - removed tourniquet and needle immediately seizures - remove tourniquet and needle immediately allergies - check with pt nausea - provide emit basin, tell pt to breath, apply cold compress to forehead vomiting - remove tourniquet and needle, attend to pt obesity - hard to palpate veins, syringe for more control IV Therapy - choose other arm
73
What are some thing the pt can do before the blood draw that can affect lab results?
food - ingestion of food can alter certain levels of blood components (glucose, triglycerides) posture - recumbent to upright can change blood constituents exercise - moderate to strenuous exercise can affect lab results stress - can increase levels of cortisol, WBC alcohol - transient elevation of glucose smoking - affects catecholamine, cortisol, glucose, GH time of day medications sex and age attitude - RBC and hemoglobin increased at high altitude dehydration fever pregnancy
74
What to do if venipuncture pt faints
``` remove needle and tourniquet position pts head btw knees, lay pt flat on ground cold compress on pt head check vitals and observe pt never leave unattended ```
75
What if a pt refuses to give their blood
pt's right | documentation according to policy
76
Why can a tourniquet only be applied for 1 minute?
hemoconcentration can lead to hemolysis affected lab values - large molecules, K, lactic acid and enzymes
77
How can you locate veins that are not prominent?
``` veins not easily located alternate site selection vein enhancement - massage upward from wrist to elbow - gravity - heat ```
78
Why should you not draw blood from a hematoma, burned/scar, arm adjacent to mastectomy?
damaged veins - occluded: blockage of blood vessels usually with a clot - sclerosed: hardened hematoma - solid swelling of clotted blood within tissue - draw below edema - excess find burns, scars, tattoos - prone to infection, reduced circulation mastectomy - removal of lymph nodes interferes with lymph fluid flow - use other side
79
What are some technical complications when obtaining blood?
needle position bevel against upper or lower wall make sure bevel is up and angle is correct needle too deep or shallow - adjust needle position - firmly brace tube holder against pt skin - when too shallow, blood is flowing very slowly: slowly advance needle collapsed vein - stops blood flow - do not put tourniquet too close to site needle beside vein - gently touch area with cleansed finger to redirect needle slightly - withdraw the needle and reanchor vein - never move needle in lateral direction to access basilic vein - too close to brachial artery and nerve faulty tube
80
What do you do if a vein has collapsed?
release vacuum pressure by removing tube wait a few seconds for vein to fill and try another tube use smaller tube
81
What can cause hemolysis?
during venipuncture - vigorous mixing, small needle or large tube, alcohol not dry, probing or pulling plunger back too fast during processing - swimming clots, too high centrifuge speed, unpadded pneumatic tube systems physiological factors - anemias, mechanical valves, blood microorganisms and meds
82
What can cause a hematoma?
improper technique ``` failure to remove tourniquet inadequate pressure and bending arm probing faulty needle insertion too large of a needle accidental arterial pressure e ``` injury to surrounding tissue
83
What are the preferred veins?
1st choice - median cubital 2nd - cephalic vein 3rd - basilic vein
84
What does an accidental arterial puncture look like?
bright red blood, pulsing apply direct pressure by phlebotomist for 5-10 minutes requires documentation

BIOL 430 (14 decks)

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