UCD Limited Skills Phlebotomy Flashcards
What are the primary functions of the cardiovascular system?
circulate blood
deliver O2 and nutrients to cells
dispose of waste products
What are the functions of the heart?
propels blood for transport of respiratory gases, nutrients, waste and immune substances
circulates blood to the lungs for O2/CO2 exchange
Describe pulmonary circulation
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
Describe systemic circulation
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)
Compare and contrast the inferior and superior vena cava
inferior vena cava - collects blood below the heart
superior vena cava - collects blood from above the heart
BOTH send deoxygenated blood to the heart
Compare and contrast the L and R sides of the heart
Right - receives deoxygenated blood from tissue and organs
Left - receives oxygenated blood from lungs
What are the 4 types of heart valves?
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
Which side of the heart has more muscle mass? Why
L side of heart
exiting blood must travel farther, need more muscle to force it
What are the function of coronary blood vessels?
Nourished heart
What are the layers of the heart from inner to outer?
endocardium - inner lining
myocardium - heart muscle
epicardium - top layer of heart
Pericardium - sac holding the heart
What parts of the heart receive blood? Deliver blood?
Atria - receives blood
Ventricle - delivers blood
What are the 4 heart chambers, what kind of blood do the do they contain, where does it receive/deliver blood?
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
What are the function of valves?
Prevents backflow of blood
What is the function of blood?
- 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
What are the two components of blood?
Plasma - liquid
formed elements - cells
What is the difference between plasma and serum?
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
What are the 4 main plasma proteins and their functions?
- albumin - maintains osmotic balance in blood
- globulins (immunoglobulins) - antibodies (IgG, IgM, etc)
- fibrinogen - clotting
- prothrombin - clotting
What are the 3 cellular elements of blood? Describe both
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
What are the differences between arteries, veins and capillaries in structure and function?
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
What are the steps of coagulation? What is a blood clot primarily made of? What are the tests relating to blood clotting?
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
What is a hematoma? What is hemolysis? Why do we want to avoid it?
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
Explain the concepts of cardiac polarization, depolarization and repolarization
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
What happens during the P wave?
atrial depolarization/contraction
What happens during the QRS wave?
atrial repolatization and ventricle depolarization overlap
ventricular contraction and the beginning of ventricular recovery
What happens during the T wave of an EKG?
ventricular repolarization
What happens during the PR segment of an EKG?
AV nodal delay
time from beginning of atrial contraction to beginning of ventricular contraction
What is the ST segment in an EKG?
the time between ventricles are contracting and emptying
What is the TP interval of an EKG?
time during which ventricles are relaxing and filling
What can cause marks to appear on ECG paper?
heat and pressure
What does each vertical box on an EKG represent?
amplitude/voltage; 0.1 mV
Why do electrodes have jelly like substances on them?
it serves as an electrode that enables the transfer of electrical activity
Where are the standard leads located?
R arm - L arm
R arm - L leg
L arm - L leg
R leg is for groundign
Where are the augmented leads located?
All are in accordance to R arm, L arm and L leg
L hip
R hip
Sternum
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
What is this artifact and what causes it?
wandering baseline
caused by body movement or leads falling off
What is this artifact and what causes it?
AC interference
electrical interference
What is this artifact and what causes it?
somatic tremor
shivering, parkinson’s
What is this artifact and what causes it?
interfering baseline
caused by disruption in electrical connection
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
What are 4 common disease caused by bacteria?
UTI, pneumonia, TB, and strep throat
What are 5 conditions that are required for bacterial growth?
nutrients, moisture, temp (37*), oxygen (or lack thereof), neutral pH
What is inflammation
local response to infection or injury
- destroys/inactivated foreign invaders
- sets stage for tissue repair
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)
What are the four classic symptoms of inflammation?
erythema, edema, pain and heat
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
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
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
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
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
Where should broken glassware and spilled material be placed?
impervious biohazard bag or container spill site
How should soiled linen be disposed?
double bagged and transported in labeled leakproof biohazard bag
How should biohazard waste be disposed?
impermeable red polyethylene or polypropylene biohazard labeled bag or container
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
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
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
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
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:
- put on impermeable gown and face shied, utility gloves
- separate sharps from non-sharps
- rinse under cold water
- clean hinged instruments with disposable brush
- rinse with hot water
- towel dry instruments - dispose towels and brushes into biohazard
- remove gloves and wash hands
- dry hands, put on gloves, place sanitized instruments in identifiable site for disinfection and sterilization
What hand washing material is most effective for eliminating microorganisms on hands?
alcohol based hand rubs - more effective than antimicrobial soap and water
Sharps container should only be half up to how long? How full should it be?
30 days
3/4 filled
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
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
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
What the equation to convert Fahrenheit to Celsius?
C = (F -32) x 5/9 F = (C x 9/5) + 32
What’s more accurate: axillary or oral temp? Why? What temperature measurement is most accurate for infants?
oral - closed cavity
infants - temporal artery
What are some factors that can affect oral temp?
eating, drinking, smoking exercising
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
Where are all the arteries located?
temporal, carotid, apical, brachial, radial, femoral, popliteal, dorsalis pedis
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
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+
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
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
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
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
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
What if a pt refuses to give their blood
pt’s right
documentation according to policy
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
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
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
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
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
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
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
What are the preferred veins?
1st choice - median cubital
2nd - cephalic vein
3rd - basilic vein
What does an accidental arterial puncture look like?
bright red blood, pulsing
apply direct pressure by phlebotomist for 5-10 minutes
requires documentation
