Medical Assistant Training: Radiologic Studies PDF

[[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) Chapter Introduction ==================== ### **Objectives** ### **Knowledge Base** 1. Spell and define, using the glossary, all the Words to Know in this chapter. 2. Describe the role of the me...

[[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) Chapter Introduction ==================== ### **Objectives** ### **Knowledge Base** 1. Spell and define, using the glossary, all the Words to Know in this chapter. 2. Describe the role of the medical assistant in radiographic procedures. 3. Explain the methods and importance of using safety precautions in radiologic procedures. 4. Describe safety precautions used for pregnant women in radiologic studies. 5. Describe how to instruct patients on diet and preparation for radiologic studies. 6. Differentiate amongst the types of radiologic procedures used to diagnose patients. 7. Describe sonography and ultrasound. 8. Describe the purpose of sonography and ultrasound. 9. Explain patient preparation for various ultrasounds. 10. Describe the procedure for a magnetic resonance imaging (MRI) scan, positron emission tomography (PET) scan, and computed tomography (CT) scan. 11. Describe the purpose of an MRI, PET scan, and CT scan. ### **Words to Know** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **46-1**Radiologic Studies ========================== Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **46-1aSafety** --------------- **Figure 46--1** **Figure 46--2** **Quick Tips** ### **Practical Application** **Patient Education** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **46-1bX-Rays and Radiation Therapy** ------------------------------------- **Figure 46--3** **Figure 46--4** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **46-1cPreparing Patients for X-Rays** -------------------------------------- **Quick Tips** ### **Practical Application** **Figure 46--5** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **46-2**Radiologic Procedures ============================= Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **46-2aGallbladder Imaging** ---------------------------- **Figure 46--6** **Patient Education** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **46-2bUpper GI Series---Barium Swallow** ----------------------------------------- **Patient Education** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **46-2cLower GI Series---Barium Enema** --------------------------------------- **Table 46--1** ### **Preparation for Barium Enema (Prep may vary per facility)** -- -- -- -- **Figure 46--7** **Quick Tips** ### **Practical Application** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **46-2dIntravenous Pyelogram** ------------------------------ **Table 46--2** ### **Preparation for Intravenous Pyelogram (IVP) (Prep may vary per facility)** -- -- -- -- **Patient Education** **Patient Education** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **46-2eKub** ------------ **Figure 46--8** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **46-2fMammography** -------------------- **Figure 46--9** **Table 46--3** ### **Instructions for Mammography Preparation (Prep may vary per facility)** -- -- -- -- **Patient Education** - Schedule the mammography during the first week following the patient's menstrual cycle because the breasts must be compressed firmly during the procedure to obtain a satisfactory image for diagnostic purposes, and during this time, the patient would experience less discomfort. - Advise patients to omit caffeine from their diets for 7 to 10 days prior to this examination to reduce the possible effects of swelling and soreness that caffeine often produces. - After the procedure, some areas of the breasts might become temporarily discolored. However, it does not damage the breast tissue and should not be alarming. - At the advice of the provider, a mild analgesic may be taken to relieve any discomfort or aching the patient might experience. **Quick Tips** ### **Practical Application** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **46-2gCT Scans** ----------------- **Figure 46--10** **Figure 46--11** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **46-2hNuclear Medicine** ------------------------- Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **46-2iSonographic Studies** ---------------------------- **Patient Education** ### **Preparation for Ultrasound Procedure (Prep may vary per facility)** -- -- -- -- Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **46-3**Magnetic Resonance Imaging (MRI) ======================================== **Figure 46--12** **Figure 46--13** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **46-4**Positron Emission Tomography (PET) Scan =============================================== **Figure 46--14A** **Figure 46--14B** **Table 46--5** ### **Preparation for Pet Scan** -- -- -- -- Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) Chapter Review ============== **46-5a**Chapter Summary ------------------------ - Radiologic technology, also referred to as diagnostic imaging, plays a significant role in the diagnosis and monitoring of many diseases and injuries. Your role might be to assist the radiology technologist at your facility or to schedule patients for radiology procedures and testing at outside facilities; depending on the practices in your state, you might be allowed to take certain X-rays and operate the equipment yourself. - Radiologic studies are made with X-rays (roentgen rays), which are high-energy electromagnetic radiation produced by the collision of a beam of electrons with a metal target in an X-ray tube. - Any person working in a facility that performs radiologic tests can be at risk for excessive radiation exposure. You must institute safety measures to protect both you and the patients. - X-rays can be damaging to an unborn child, especially in the first three months of pregnancy (first trimester), sometimes before the patient is even aware, she is pregnant. Before scheduling any female patient, whose age indicates that she is within the childbearing years, you must always ask whether she could be pregnant. - Dietary restrictions, special preps, contrast agents, and fasting techniques are required for many of the radiology procedures. By adding a contrast agent, the density of the structure being assessed changes, and the visualization is improved. Be sure to explain the requirements to the patient so they understand clearly. - The provider might order a variety of radiological imaging tests to assist them with the diagnosis of a condition or injury. Common procedures include bone studies; chest, abdomen, and pelvic studies; KUB; sonograms; CTs; MRIs and PET scans. - Sonograms are records obtained by ultrasonic scanning. Ultrasound technology does not use radiation, so it is considered to be very safe. Ultrasonography is a technique by which internal structures are made visible by recording the reflections of ultrasonic sound waves directed into the tissues. - When scheduling patients for ultrasound studies, advise them about the preparation for the exam. Patient preparation varies, depending on the exam, but avoiding foods that produce gas and drinking plenty of fluids (specific amounts are required for certain tests) are generally the rule. Check with the radiology facility regarding what the patient preparation will be. - Another technique to view the structures inside the human body is called magnetic resonance imaging (MRI). This method allows providers to examine a particular area of the body without exposing the patient to X-rays or surgery. Contraindications include claustrophobia, obesity, pacemakers, and metal implants. - A positron emission tomography (PET) scan is an imaging test that uses a radioactive substance called a tracer to look for disease in the body and show how organs and tissues are working. - When educating the patient, always provide clear and concise oral *and* written instructions for examinations that require advance preparation. Be sure the patient understands the necessary preparations. Answer all questions. Emphasize the importance of being on time for the radiologic appointment to avoid unnecessary delays because some examinations are very long. Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) Chapter Introduction ==================== ### **Objectives** ### **Knowledge Base** 1. Spell and define, using the glossary, all the Words to Know in this chapter. 2. Differentiate between normal and abnormal results for common diagnostic tests performed in the POL. 3. Identify panic values for diagnostic test results. 4. Describe how the hemoglobin, hematocrit, and WBC differential are used in the diagnosis process. 5. Describe how the erythrocyte sedimentation rate is useful in diagnoses. 6. Explain the purpose of the glucose tolerance test (GTT). 7. Explain the purpose of the Glycosylated Hemoglobin (HbA1c) test. 8. Identify common immunology tests used in diagnoses. 9. Explain the purpose of the scratch, patch, and intradermal skin tests. 10. Describe patient education concerning allergies and treatment. 11. Explain the need for a PKU test. 12. Describe the proper collection procedure for a PKU test. 13. Differentiate between a properly collected and improperly collected PKU blood specimen. ### **Skills** 1. Perform a CLIA-waived hematology test. 2. Perform a CLIA-waived chemistry test. 3. Perform a CLIA-waived immunology test. 4. Perform a quality control measure. 5. Maintain lab test results using flow sheets. ### **Behaviors** 1. Explain to the patient the rationale for performance of a procedure. 2. Show awareness of a patient's concerns related to the procedure being performed. ### **Words to Know** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **44-1**Quality Control and Quality Assurance for Diagnostic Testing ==================================================================== 1. Date. 2. Patient's name. 3. Test performed. 4. Results of the test. 5. Your initials. 6. Any kit, reagent strip, or [**reagent**](javascript://) lot numbers and expiration dates. 7. Quality control results. Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **44-2**Hematology Testing ========================== - The red blood cells are filled with hemoglobin, making their primary function delivering oxygen to the cells and picking up carbon dioxide to be exhaled. - The chief function of the white blood cells is to protect the body against invaders such as bacteria and viruses. The granulocytes engulf bacteria and debris, as do the monocytes. The lymphocytes produce antibodies against specific antigens, usually viruses. - The platelets, with other clotting factors, stop bleeding when an injury occurs. - Total red blood cell count. - Total white blood cell count. - Total platelet count. - Hemoglobin. - Hematocrit. - Total granulocyte count. - Total lymphocyte and monocyte count. - Percentage of granulocytes. - Percentage of lymphocytes and monocytes. - Red blood cell indices. **Quick Tips** ### **Practical Application** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **44-2aHemoglobin** ------------------- **Figure 44--1A** **Figure 44--1B** **Procedure 44--1** ### **Determine Hemoglobin Using a Hemoglobinometer** ----------------------------- -- -- Charting Example Laboratory Log Book Example ----------------------------- -- -- Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **44-2bHematocrit** ------------------- **Figure 44--2** **Figure 44--3** **Figure 44--4** **Procedure 44--2** ### **Determine Hematocrit (HCT) Using a Microhematocrit Centrifuge** +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | Charting Example | | | +-----------------------+-----------------------+-----------------------+ **Figure 44--5** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **44-2cComplete Blood Count** ----------------------------- - The normal total red blood cell count for an adult male is 4.5 to 6.0 million per millimeter. A decrease in the total number of red blood cells constitutes a type of anemia. - The normal total red blood cell count for an adult female is 4.0 to 5.5 million per millimeter. A decrease in the total number of red blood cells constitutes a type of anemia. - The normal total platelet count for males and females is 150,000 to 400,000 per millimeter. - The normal total white blood cell count for males and females is 4,500 to 11,000 per millimeter. When the WBC count is elevated, it indicates a disease process of some type, whether it is an infection or a precursor to leukemia. When the WBC is decreased, the patient could be immunocompromised due to HIV or AIDS infection or current cancer therapy in the form of chemotherapy or radiation treatments. When the WBC count is decreased, the patient is more prone to opportunistic infections because immunity is compromised. - The granulocyte ratio should be larger than the lymphocyte/monocyte ratio. The normal percentage range for granulocytes is 50 to 70 percent with the lymphocyte/monocyte percentage generally in the 20 to 40 percent range. Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **44-2dThe WBC Differential** ----------------------------- **Figure 44--6** **Table 44--1** ### **Categories of White Blood Cells and Their Functions** -- -- -- -- -- -- **Quick Tips** ### **Practical Application** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **44-2eErythrocyte Sedimentation Rate** --------------------------------------- - Acute infections. - Acute inflammatory processes. - Chronic infections. - Rheumatoid arthritis or autoimmune disorders. - Temporal arteritis and polymyalgia rheumatica. - Monitoring inflammatory and malignant diseases. **Figure 44--7** **Procedure 44--3** ### **Perform an Erythrocyte Sedimentation Rate (ESR)** ------------------ -- -- Charting Example ------------------ -- -- Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **44-3**Glucose Testing ======================= **Figure 44--8** **Procedure 44--4** ### **Screen Blood Sugar (glucose) Level** +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | Charting Example | | | +-----------------------+-----------------------+-----------------------+ | Laboratory Log Book | | | | Example | | | +-----------------------+-----------------------+-----------------------+ Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **44-3aGlucose Tolerance Test** ------------------------------- **Figure 44--9** **Quick Tips** ### **Practical Application** **Quick Tips** ### **Practical Application** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **44-3bHemoglobin A1 C** ------------------------ **Figure 44--10** **Procedure 44--5** ### **Perform Hemoglobin A1C (Glycosylated Hemoglobin) Screening** -- -- -- -- -- -- Charting Example **Patient Education** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **44-4**Cholesterol Testing =========================== **Procedure 44--6** ### **Perform a Cholesterol Screening** +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | Charting Example | | | +-----------------------+-----------------------+-----------------------+ Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **44-5**Immunology ================== Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **44-5aMononucleosis Testing** ------------------------------ **Procedure 44--7** ### **Perform a Screening for Infectious Mononucleosis** --------------------- -- -- Charting Example Quality Control Log --------------------- -- -- Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **44-5bAllergy Testing** ------------------------ - *Skin prick test*. The allergen (the substance to which the patient is suspected to be allergic) is applied directly to the patient's skin and scratched or pricked into the epidermis. The areas of application are observed for reaction from antibodies, usually as a reddening of the area with itching. - *Intradermal injections.* This test is more sensitive than the skin prick test. A small amount of the allergen is injected between the epidermis and dermis with an observation of the area for a reaction. Usually, reactions occur immediately, although patients can be instructed to return 24 to 72 hours later for delayed responses to the allergen. - *Skin patch test*. An allergen-soaked pad is placed on the surface of the skin for 24 to 72 hours to observe for a reaction. **Figure 44--11** ### **Scratch Test and Skin Prick Test** **Figure 44--12A** **Figure 44--12B** **Figure 44--12C** ### **Intradermal Test** **Figure 44--13** **Figure 44--14** **Patient Education** 1. Urge patients to follow the allergy serum desensitizing schedule closely to help build up immunity to the substance to which they are allergic. 2. Advise them to avoid what they are allergic to if at all possible. 3. Instruct patients to read all labels carefully (household products, clothing, consumable products, etc.) to identify possible allergens. 4. Urge them to develop and practice good health habits such as following a sensible, well-balanced diet; proper rest; and exercise. They should also be encouraged to wash their hands frequently with soap and warm water for 20 seconds (approximately the length of time it takes to sing the Happy Birthday song at a traditional pace) and teach their families to do so. 5. Advise them to take only prescribed medication and to avoid OTC medications unless advised by the provider. 6. If patients have a known severe reaction to a particular substance, remind them to carry their EpiPen kit with them at all times. ### **Patch Test** ### **Rast Testing** ### **Nasal Smear** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **44-5cTesting for HIV** ------------------------ Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **44-6**PKU Testing =================== **Figure 44--15A** **Figure 44--15B** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **44-7**Testing Outside the Pol =============================== **Figure 44--16** **Table 44--2** ### **Normal Values of Commonly Performed Laboratory Tests and Their Indications** -- -- -- -- -- -- Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) Chapter Review ============== **44-8a**Chapter Summary ------------------------ - It is important for the medical assistant to perform the quality controls at the beginning of each day and log the results prior to reporting any patient results to preserve the integrity of the test results. - Always instruct patients in preparation for testing and have clear, concise, written instructions available. *Do not* presume that patients know all about a procedure even if they have had the test before. - The erythrocyte sedimentation rate is also known as the ESR or the sed rate. - Many types of glucometers are on the market; make sure always to check the manufacturer's instructions prior to testing. - Fasting means that the patient has had nothing to eat or drink for at least 12 hours prior to having specific testing drawn. Emphasize that they should not eat mints, chew gum, drink coffee or juices, or smoke. - Always remember to follow policy and procedure for proper collection and follow standard precautions---treat all patients as if they are or could be infected with HIV or hepatitis to protect yourself and others. - Panic values require immediate intervention by health care providers. Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **45-1**Electrocardiography =========================== Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **45-1aElectrical Impulses of the Heart** ----------------------------------------- **Figure 45--1** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **45-1bReasons for Performing an Ecg** -------------------------------------- **Figure 45--2** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **45-1cElectrocardiograph Equipment and Supplies** -------------------------------------------------- ### **Electrocardiograph Machines** **Figure 45--3A--C** (A), (B) Courtesy of Spacelabs Medical, Inc. **Figure 45--4** Courtesy of Spacelabs Medical, Inc. Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **45-1dElectrocardiograph Paper** --------------------------------- **Quick Tips** ### **Practical Application** **Figure 45--5A--B** ### **Electrocardiograph Leads** **Figure 45--6** Courtesy of Spacelabs Medical, Inc. **Figure 45--7** **Figure 45--8** **Table 45--1** ### **Anatomical Positioning of the Chest or Precordial Leads** -- -- -- -- Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **45-1ePerforming the ECG** --------------------------- ### **Preparing the Patient** ### **Standardization** **Figure 45--9** **Figure 45--10** **Procedure 45--1** ### **Perform Electrocardiography** +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | **Figure 45--11A--D** | | | | | | | | \(A) A male patient | | | | with electrodes | | | | placed properly for | | | | a standard 12-lead | | | | ECG. (B) Lead wires | | | | attached to the | | | | patient's legs. (C) | | | | A female patient | | | | with electrodes | | | | placed properly for | | | | a standard 12-lead | | | | ECG. (D) When | | | | placing electrodes | | | | for a standard | | | | 12-lead ECG on a | | | | female with a | | | | larger breast, | | | | elevate the breast | | | | using the back of | | | | the hand. | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ Charting Example **Patient Education** 1. Remind them to eat a low-fat, low-cholesterol diet and keep their salt and sodium intake at a minimum. 2. Advise them to get proper rest, perform provider-approved exercise, and keep their weight at an acceptable level. 3. Instruct cardiac patients to take their prescribed medication regularly and immediately to report to the provider any problems they might experience. Remind them not to take OTC medications without the permission of the provider. 4. Remind them to keep their scheduled appointments and make a list of questions for the provider to review with them at that time. 5. Urge them not to use tobacco and to avoid alcoholic beverages. 6. Advise them to practice stress-reducing behaviors. ### **Artifacts** **Figure 45--12A--D** Courtesy Quinton Cardiology, Inc. ### **Cardiac Arrhythmias** **Figure 45--13A--B** - *Pacemaker arrhythmias:* Pacemaker spikes or pacer spikes show up as vertical signals that represent the electrical activity of the pacemaker. Usually these spikes are more visible in unipolar than in bipolar pacing. Interpreting paced rhythms may not always be simple, and the biggest obstacle to interpreting pace rhythms is identifying the paced beats. Modern pacemakers provide low-voltage spikes on the ECG that may go unnoticed. Once pacemaker activity is identified, the next step is to determine if the activity is a normal or abnormal function ([[Figure 45--14A]](javascript://)). **Figure 45--14A** - *Premature atrial contractions (PACs):* Can be seen in healthy individuals and people who smoke or use stimulants such as caffeine. Can indicate a serious cardiac problem. On the ECG, they are indicated by a cardiac cycle that occurs before the next cycle is due, with the P waves shaped differently than on a normal ECG ([[Figure 45--14B]](javascript://)). **Figure 45--14B** - *Paroxysmal atrial tachycardia (PAT):* Can be seen in both healthy individuals and in those with cardiac disease. It is an episode during which the heart rate ranges from 160 to 250 BPM and lasts momentarily. Patients often describe it as a flutter in the heart ([[Figure 45--14C]](javascript://)). **Figure 45--14C** - *Atrial fibrillation (A-Fib):* Although relatively rare in healthy individuals, it still can be seen in both healthy individuals and those with cardiac disease. It causes rapid multiple electrical signals that fire from areas in the atria other than the SA node. The heart rate can range from 400 to 500 BPM. Some causes are myocardial infarction, hypertension, mitral valve diseases, heart failure, thyroid disorders, pulmonary emboli, and excessive alcohol consumption. On the ECG, it looks like small, irregular complexes that are hard to interpret because the P waves can't be identified ([[Figure 45--14D]](javascript://)). **Figure 45--14D** - *Premature ventricular contractions (PVCs):* Can be seen in healthy individuals who use tobacco and other stimulants as well as in patients with hypertension, coronary artery disease, and lung disease. Other causes include myocardial infarction, electrolyte imbalances, lack of oxygen, and certain medications. They are indicated on the ECG by a beat that occurs early in the cycle and is followed by a pause before the next cycle occurs ([[Figure 45--14E]](javascript://)). **Figure 45--14E** - *Ventricular tachycardia:* This is seen in patients with cardiac disease. It often occurs when a patient is having a myocardial infarction. This is a life-threatening condition. On the ECG, it is identified by three or more PVCs occurring at a rate of 150 to 250 BPM. There are no P waves, and the QRS complexes are imprecise ([[Figure 45--14F]](javascript://)). **Figure 45--14F** - *Ventricular fibrillation (V-Fib):* This is seen in patients with cardiac disease or those who are experiencing a myocardial infarction. The ventricles appear to tremor, and there is no cardiac output. Some providers refer to this jagged rhythm as a sawtooth rhythm. This is a life-threatening condition that appears on the ECG as an erratic, jagged rhythm ([[Figure 45--14G]](javascript://)). **Figure 45--14G** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **45-2**Holter Monitor ====================== **Figure 45--15** **Procedure 45--2** ### **Holter Monitoring** +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | **Figure 45--16** | | | | | | | | Correct placement of | | | | the Holter monitor on | | | | a patient. | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | Charting Example | | | +-----------------------+-----------------------+-----------------------+ Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **45-3**Stress Tests ==================== - Reaches a target heart rate. - Develops chest pain or a change in blood pressure that is concerning. - Seems not to be getting enough oxygen to the heart muscle, as indicated by changes on the ECG. - Is too tired or has other symptoms, such as leg pain, that keep them from continuing. **Figure 45--17** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **45-4**Echocardiography ======================== Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **45-5**Other Cardiovascular Equipment ====================================== **Figure 45--18** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) Chapter Review ============== **45-6a**Chapter Summary ------------------------ - Many types of electrocardiographs are available for use in the medical field today. Multichannel, 12-lead instruments can record the electrical activity of the heart simultaneously from 12 views; single-channel instruments measure only one lead and one view of the heart at a time. Computerized electrocardiographs offer simultaneous 12-lead interpretive analysis, while digital computer-based machines and software allow for paperless ECGs that are transmitted from the computer screen directly into the EHR. - The heart is a four-chambered pump that produces a tiny electrical current by muscular contraction. An electrical impulse originates in the modified myocardial tissue of the sinoatrial (SA) node, also known as the sinus node or pacemaker of the heart, causing the atria to contract. This contraction is the beginning of atrial depolarization, which is the first part of the cardiac cycle. The impulse continues through the heart tissue to the atrioventricular (AV) node, to the bundle of His, and spreads to the Purkinje fibers. The heart then recovers, representing the repolarization of the ventricles before another contraction. This is considered a normal ECG cycle. - The ECG can detect damage from previous heart attacks, enlargement of the heart muscle, disturbances in the rhythm, and other abnormal conditions. - Each machine comes with an operating manual, many with a DVD as well, providing step-by-step instructions, maintenance information, and troubleshooting tips for the unit. Look over the lead wires and cables to make sure there are no cracks or damage; check to be sure the clips are attached correctly and are in proper working order; check the paper in the machine to be sure you will not run out, and restock any materials that will be needed such as electrodes, alcohol wipes, and disposable razors (in case shaving is necessary). - The standardization of the ECG is necessary to enable a provider to judge deviations from the standard. Most machines used today perform automatic standardization. The usual standardization mark is 2 mm wide and 10 mm high. - During the time you spend with patients in performing electrocardiographic testing and its instruction, you will have ample opportunity to provide patients with education regarding diet, exercise, rest, and living a healthy lifestyle. - The routine ECG consists of 12 leads, or recordings, of the electrical activity of the heart from different angles. The first three leads are called standard or bipolar leads and are labeled with Roman numerals I, II, and III. Lead I records the electrical voltage difference between the right arm and left arm. Lead II records the difference between the right arm and the left leg. Lead III records the voltage difference between the left arm and left leg. The augmented leads are also known as aVR, aVL, and aVF. aVR is the recording of the heart's voltage difference between the right arm electrode and a central point between the left arm and the left leg. aVL is the recording of the heart's voltage difference between the left arm electrode and a central point between the right arm and the left leg. aVF is the recording of the heart's voltage difference between the left leg electrode and a central point between the right arm and left arm. The six standard chest or precordial leads are unipolar leads; each precordial lead monitors one electrode and a point within the heart. The leads are labeled with a letter and a number, to. - Many artifacts can occur during the ECG tracing and cause interference. They are known as somatic interference, AC interference, wandering baselines, and interrupted baselines. You must understand the causes and be able to eliminate them. - You must be able to recognize a variety of arrhythmias such as pacemaker spikes, premature atrial and ventricular contractions, atrial and ventricular fibrillation, and paroxysmal atrial and ventricular tachycardia and alert the provider of these rhythms. - Patients who have routine normal ECGs but still have intermittent or irregular chest pain or discomfort are often tested over a period of 24 hours or more by a device known as a Holter monitor. The ECG electrodes are attached to the patient's chest wall. A portable cassette recorder (monitor) is attached to a belt worn around the patient's waist; the patient's heart action is recorded. The patient is asked to keep a diary of all activities and note any pain or discomfort experienced during this monitoring. The patient is instructed to press the event button when any cardiac symptoms are experienced. - ECG stress tests are performed by some providers on a routine basis for patients with a high risk of developing heart disease and are more often done in a limited manner for patients interested in starting a strenuous exercise program or those who continue to have chest pain even after a routine ECG has been read as normal. - Echocardiography is a noninvasive diagnostic tool that tests the structure and function of the heart through the use of sound waves, or echoes reflected through the heart. - Many medical offices, clinics, and emergency centers are equipped with a defibrillator. These units are designed to provide countershock by a trained individual to convert cardiac arrhythmias into regular sinus rhythm. Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **47-1**Scheduling Minor Office Surgery ======================================= Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **47-2**Preparing the Room ========================== Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **47-2aInstruments** -------------------- **Patient Education** 1. Surgical procedure, by providing printed education materials. 2. Approximate length of time for procedure. 3. Appropriate clothing to wear at appointment. 4. Amount of time to fast as instructed by provider if applicable. 5. Arrangements necessary for someone to accompany the patient and drive them home if necessary. 6. Anticipated time off work or arranging for home care. 1. Ascertain whether the patient has any allergies to any medications, including topical preparations, latex products, and adhesive tapes. 2. Provide written instructions regarding the surgical procedure and follow-up care. 3. Ensure that the patient has signed a surgical consent form. 4. Answer any questions concerning procedure. ### **Instrument Care and Handling** 1. Blood, tissue, and other body fluids must not be allowed to dry on an instrument. 2. Instruments should be rinsed and then soaked in a room-temperature solution containing a detergent and a blood solvent immediately after each use. 3. The detergent in the soaking solution should be of a neutral pH, which will help prevent corrosion of the surfaces of the instrument. 4. The soaking solution should contain a special protein that breaks down blood and body fluids on the surface of the instrument. 5. Instruments should be placed in a plastic container for soaking to prevent damage to their points and cutting edges. 6. Separate delicate instruments from heavier ones to prevent damage. 7. Separate sharp instruments from others when cleaning and storing. 8. All surfaces and crevices must be scrubbed with a brush to remove any foreign material. 9. A careful visual inspection should be conducted during each cleaning to check for any nicks, dullness, or warping of the surfaces. 10. Damaged instruments should not be used and should be either repaired or replaced. ### **Instrument Components** - *Thumb handle* ([[Figure 47--1A]](javascript://)): A handle similar to that of a tweezer that is squeezed between the thumb and finger. - *Ring handle* ([[Figure 47--1B]](javascript://)): Designed so that the thumb and finger can be inserted into the rings. - [**Ratchet**](javascript://) ([[Figure 47--1B]](javascript://)): Locking mechanism designed to close in varying degrees to hold the instrument closed, used to clamp tissue and vessels. - **Serrations** ([[Figure 47--1C]](javascript://)): Little fissures engraved into the surface of the blades of hemostats and forceps designed to prevent slippage and provide a firm grip when clamping a tissue. Instruments can have serrations, cross serrations, or longitudinal serrations. - *Teeth* ([[Figure 47--1C]](javascript://)): Very sharp projections designed to hold the tissue when grasping. Teeth can be heavy or delicate, and some are classified as nontraumatic. **Figure 47--1A--C** ### **Instrument Classification** - *Cutting and dissecting*: Includes scissors, scalpels, and curettes - *Clamping and grasping*: Includes [**hemostats**](javascript://), clamps, [**forceps**](javascript://), and [**needle holders**](javascript://) - *Dilating, probing, and visualizing*: Includes [**retractors**](javascript://), scopes, [**specula**](javascript://), probes, and dilators **Table 47--1** ### **Instruments Used in Minor Office Surgical Procedures** -- -- -- -- -- -- Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **47-2bSupplies** ----------------- - Scalpel handle and blades or disposable scalpel - Hemostats - Needle holder - Needles and suture material (absorbable or nonabsorbable) - Suture scissors - Thumb forceps - Probe - Gauze squares - Vial of [**[anesthetic]**](javascript://) medication - Needles and syringes - Towels - Bandages Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **47-2cPreparing Trays** ------------------------ **Figure 47--2** **Procedure 47--1** ### **Prepare a Sterile Field** +-----------------------+-----------------------+-----------------------+ | | **Figure 47--3A** | | | | | | | | Adjust the Mayo stand | | | | to the proper height. | | +-----------------------+-----------------------+-----------------------+ | | **Figure 47--3B** | | | | | | | | Sanitize and | | | | disinfect the tray. | | +-----------------------+-----------------------+-----------------------+ | | **Figure 47--3C** | | | | | | | | Open the pack to | | | | expose the sterile | | | | drape with the | | | | corners facing toward | | | | you. | | +-----------------------+-----------------------+-----------------------+ | | **Figure 47--3D** | | | | | | | | Unfold the drape, | | | | without touching or | | | | reaching over it. | | +-----------------------+-----------------------+-----------------------+ | | **Figure 47--3E** | | | | | | | | Grasp the opposite | | | | corner of the | | | | unfolded drape and | | | | place the drape over | | | | the Mayo tray, | | | | without reaching over | | | | the drape. | | +-----------------------+-----------------------+-----------------------+ | | **Figure 47--3F** | | | | | | | | To properly open a | | | | fanfolded sterile | | | | pack onto the sterile | | | | field, begin by | | | | grasping the tape on | | | | the top flap and | | | | opening the flap away | | | | from you. | | | | | | | | **Figure 47--3G** | | | | | | | | Gently unroll the | | | | pack in the palm of | | | | your hand, being | | | | careful not to touch | | | | the inside of the | | | | pack. | | | | | | | | **Figure 47--3H** | | | | | | | | Grasp the tips of the | | | | side flaps and unfold | | | | them by reaching | | | | around the side or | | | | under the pack. Do | | | | not reach over the | | | | pack. | | | | | | | | **Figure 47--3I** | | | | | | | | Gather all the flaps | | | | together in the palm | | | | of your hand so they | | | | are back out of the | | | | way when the item is | | | | dropped onto the | | | | field. | | | | | | | | **Figure 47--3J** | | | | | | | | Drop the instrument | | | | onto the sterile | | | | field. | | | | | | | | **Figure 47--3K** | | | | | | | | To properly open a | | | | sterile peel-apart | | | | pack onto the sterile | | | | field, begin by | | | | grasping the flaps. | | | | | | | | **Figure 47--3L** | | | | | | | | Turn the pack so that | | | | the instrument will | | | | fall easily onto the | | | | sterile field when | | | | released. Drop the | | | | instrument onto the | | | | sterile field. | | +-----------------------+-----------------------+-----------------------+ | | **Figure 47--3M** | | | | | | | | Transfer forceps (or | | | | sterile gloves) may | | | | be used to arrange | | | | the instruments on | | | | the tray in the | | | | proper order. | | | | | | | | **Figure 47--3N** | | | | | | | | Pour any solutions as | | | | appropriate. | | +-----------------------+-----------------------+-----------------------+ | | **Figure 47--3O** | | | | | | | | Grasp another sterile | | | | drape by the corners | | | | and cover the sterile | | | | tray until the | | | | procedure begins. | | +-----------------------+-----------------------+-----------------------+ **Quick Tips** ### **Practical Application** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **47-3**Surgical Asepsis ======================== Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **47-3aMethods of Asepsis** --------------------------- Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **47-3bSterilization Techniques** --------------------------------- - *Autoclave*: The autoclave renders sterility by a combination of steam and pressure. - *Dry heat*: Dry heat sterilization is accomplished by raising the temperature of surgical instrumentation to the designated temperature that renders it sterile. - *Gas sterilization*: Sterilization by gas occurs with ethylene oxide. - *Chemical agents*: Chemicals can be used as sterilants for certain surgical instruments. Common chemical agents are glutaraldehyde, chlorine dioxide, and sodium hypochlorite. During sterilization, it is important for all parts of the surgical instrument to be equally exposed to the sterilant. Clamps, needle holders, and scissors should be sterilized in open position. All other instrumentation should be fully emerged and sterilized according to manufacturer instructions. Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **47-3cScrubbing** ------------------ **Procedure 47--2** ### **Hand Washing for Surgical Asepsis** -- -- -- -- -- -- Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **47-3dGowning** ---------------- **Figure 47--4A--C** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **47-3eGloving** ---------------- **Procedure 47--3** ### **Sterile Gloving** +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | **Figure 47--5A** | | | | | | | | Open the package by | | | | pulling on the center | | | | paper folds. | | +-----------------------+-----------------------+-----------------------+ | | **Figure 47--5B** | | | | | | | | Grasp the fold of the | | | | inside cuff of the | | | | gloves with the thumb | | | | and fingers of your | | | | nondominant hand. | | | | Insert your dominant | | | | hand, carefully | | | | pulling the glove on | | | | with the other hand, | | | | keeping the cuff | | | | turned back. | | +-----------------------+-----------------------+-----------------------+ | | **Figure 47--5C** | | | | | | | | Place gloved fingers | | | | under the cuff of the | | | | other glove. | | | | | | | | **Figure 47--5D** | | | | | | | | With palm up, insert | | | | your nondominant | | | | hand. | | | | | | | | **Figure 47--5E** | | | | | | | | Put on the glove by | | | | pulling on the inside | | | | fold of the cuff. | | +-----------------------+-----------------------+-----------------------+ | | **Figure 47--5F** | | | | | | | | Place your fingers | | | | under the cuffs to | | | | smooth the gloves | | | | over the wrists and | | | | smooth out the | | | | fingers for better | | | | fit. | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | **Figure 47--5G** | | | | | | | | Remove gloves by | | | | grasping the gloved | | | | palm of the dominant | | | | hand. | | | | | | | | **Figure 47--5H** | | | | | | | | Pull the glove off, | | | | turning the glove | | | | inside-out as it is | | | | being removed. | | +-----------------------+-----------------------+-----------------------+ | | **Figure 47--5I** | | | | | | | | Insert the ungloved | | | | hand inside the top | | | | cuff of gloved hand. | | | | | | | | **Figure 47--5J** | | | | | | | | Remove the glove, | | | | turning it inside-out | | | | as it is being | | | | removed. | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **47-4**Preparing the Patient for Minor Surgery =============================================== **Figure 47--6** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **47-4aPositioning the Patient** -------------------------------- 1. Horizontal recumbent or supine 2. Prone 3. Sims' 4. Fowler's 5. Knee-chest 6. Lithotomy 7. Dorsal recumbent 8. Proctologic Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **47-4bDraping** ---------------- **Figure 47--7** 1. Always drape from the sterile to the unsterile. 2. Do not reach across a sterile area to drape. 3. Do not move drapes after they are placed. 4. Do not shake, flip, or fan drapes. Drapes should be unfolded and carefully placed in position. 5. Discard any drapes that become contaminated. Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **47-4cSkin Preparation** ------------------------- **Figure 47--8** **Figure 47--9** **Procedure 47--4** ### **Prepare Skin for Minor Surgery** -- -- -- -- -- -- Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) Chapter Review ============== **47-5a**Chapter Summary ------------------------ - When scheduling minor surgery, advise the patient of the approximate length of time for the procedure, appropriate clothing to wear, fasting instructions, whether someone should accompany the patient, and whether the patient should anticipate time off from work or arrange for home care. The patient should be given printed education materials at this time as well. - Be sure the patient understands the procedure and the instructions regarding preoperative and postoperative care. Provide the patient with printed materials. - Surgical instruments might have thumb or ring handles, ratchets, serrations, and teeth (see [[Figure 47--1A--C]](javascript://)). - Most instruments are classified according to their function, including: - Proper setup of the surgical tray is a vital part of the surgical process. The room where the surgery will take place and the sterile tray should be set up before the patient is escorted to the area to be prepared for the procedure. - Surgical asepsis is obtained through sterilization, which is the process of destroying all disease-causing microorganisms. Sterilization can occur by autoclave, dry heat, gas, and chemical agents. Steam is the most widely used method of sterilization. - Skin carries many microbes, and a thorough surgical scrub should be performed for six minutes before taking part in any sterile surgical procedure. - It is also important to know how to apply a surgical gown and gloves properly. The medical assistant might also be required to assist the provider in donning sterile attire. - When the patient arrives for surgery, a consent form must be completed and filed in the patient's chart. Allow the patient time to ask any questions about the procedure and answer them adequately. - During skin prep, the affected area is cleansed, and an antiseptic is applied in a circular motion. The area might also be shaved prior to cleansing if appropriate. To protect yourself and the patient from possible disease transmission, wear gloves during the skin prep procedure. Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **43-1**Capillary Blood Collection ================================== **Figure 43--1** **Figure 43--2** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **43-1aPerforming a Capillary Puncture** ---------------------------------------- **Figure 43--3** **Procedure 43--1** ### **Puncture Skin with a Sterile Lancet** +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | **Figure 43--4A** | | | | | | | | Wipe the desired site | | | | with an alcohol-prep | | | | pad and let dry. | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | **Figure 43--4B** | | | | | | | | Puncture the site | | | | quickly with a firm, | | | | steady, down-and-up | | | | motion to | | | | approximately a 2-mm | | | | depth. | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | **Figure 43--4C** | | | | | | | | When the procedure is | | | | complete, remove | | | | gloves, wash hands, | | | | and discard used | | | | items in the proper | | | | receptacle. | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | Charting Example | | | +-----------------------+-----------------------+-----------------------+ **Quick Tips** ### **Practical Application** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **43-2**Venous Blood Collection =============================== Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **43-2aSite Selection** ----------------------- **Figure 43--5** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **43-2bApplying the Tourniquet** -------------------------------- **Quick Tips** ### **Practical Application** **Figure 43--6A--D** Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **43-2cPreparing the Site** --------------------------- Change font size [**[help]**](javascript://) [[Main content]](https://ng.cengage.com/static/nbreader/ui/apps/nbreader/nbreader.html#header) **43-2dVenipuncture Methods** ----------------------------- **Quick Tips** ### **Practical Application** ### **Needle and Syringe Method** **Procedure 43--2** ### **Obtain Venous Blood with a Sterile Needle and Syringe** +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | **Figure 43--7A** | | | | | | | | Venipuncture by | | | | syringe and needle | | | | method series. Apply | | | | a tourniquet to the | | | | patient's upper arm. | | | | Clean the site and | | | | let it air-dry. | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | **Figure 43--7B** | | | | | | | | Insert the needle tip | | | | into the vein with a | | | | quick and steady | | | | motion; holding the | | | | barrel of the syringe | | | | in one hand, pull the | | | | plunger back slowly | | | | with the other hand. | | +-----------------------+-----------------------+-----------------------+ | | **Figure 43--7C** | | | | | | | | Apply a gauze square | | | | over the site after | | | | the needle is | | | | withdrawn. | | | | | | | | **Figure 43--7D** | | | | | | | | Discard the needle | | | | (with safety device | | | | activated) into a | | | | sharps container. | | +-----------------------+-----------------------+-----------------------+ | | **Figure 43--7E** | | | | | | | | Attach a blood | | | | transfer device to | | | | the syringe. | | | | | | | | **Figure 43--7F** | | | | | | | | Allow the blood to | | | | transfer using the | | | | tube's vacuum; do not | | | | depress the plunger | | | | of the syringe. Fill | | | | the tubes with blood | | | | from the syringe | | | | according to the | | | | correct order of | | | | draw. | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | **Figure 43--7G** | | | | | | | | Deposit the entire | | | | syringe and blood | | | | transfer device | | | | intact into a sharps | | | | container. | | +-----------------------+-----------------------+-----------------------+ | | **Figure 43--7H** | | | | | | | | Apply a bandage over | | | | the puncture site. | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | **Charting Example** | | | | | | | | Courtesy of Harris | | | | CareTracker PM and | | | | EMR. | | | +-----------------------+-----------------------+-----------------------+ **Quick Tips** ### **Practical Application** - Explain to the patient that there will be minimal pain or discomfort, similar to how it feels when you stick yourself with a pin accidentally. Normally, this slight pain lasts only momentarily. - Explain to the patient that relaxing helps speed up the procedure. Occasionally, there is some bruising at the venipuncture site, but this does not last long. Even if the patient has had previous venipunctures, explain the procedure and answer questions. The patient will feel more relaxed if you display confidence in your ability. - If the patient expresses concern about contracting an infection from the needle puncture, reassure the patient that the needle is sterile, is used once, and then is discarded. - If the patient has questions concerning the diagnosis, the medical assistant must refer the patient to the provider. ### **Vacuum Method** **Procedure 43--3** ### **Obtain Venous Blood with a Vacuum Tube** +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | **Figure 43--8A** | | | | | | | | Venipuncture by | | | | vacuum tube method | | | | series. Apply a | | | | tourniquet to the | | | | patient's upper arm. | | +-----------------------+-----------------------+-----------------------+ | | **Figure 43--8B** | | | | | | | | Clean the site and | | | | let it air-dry. | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | **Figure 43--8C** | | | | | | | | Insert the needle tip | | | | into the vein with a | | | | quick and steady | | | | motion. | | +-----------------------+-----------------------+-----------------------+ | | **Figure 43--8D** | | | | | | | | Push the vacuum tube | | | | completely into the | | | | adapter with your | | | | thumb, allowing the | | | | needle to puncture | | | | the stopper. | | | | | | | | **Figure 43--8E** | | | | | | | | As you observe blood | | | | flow into the tube, | | | | ask the patient to | | | | open the fist slowly, | | | | and then release the | | | | tourniquet. When the | | | | tube is filled, | | | | remove it from the | | | | adapter. | | +-----------------------+-----------------------+-----------------------+ | | **Figure 43--8F** | | | | | | | | Fill the required | | | | number of tubes | | | | according to the | | | | correct order of | | | | draw. When the last | | | | tube has been filled, | | | | smoothly remove the | | | | needle. Place a gauze | | | | square over the site; | | | | have the patient | | | | apply gentle pressure | | | | and slightly elevate | | | | the arm. | | +-----------------------+-----------------------+-----------------------+ | | **Figure 43--8G** | | | | | | | | Activate the needle | | | | safety device and | | | | discard along with | | | | entire Vacutainer | | | | holder into a sharps | | | | container. | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | **Figure 43--8H** | | | | | | | | Label all tubes and | | | | complete a lab | | | | request form. | | +-----------------------+-----------------------+-----------------------+ | | **Figure 43--8I** | | | | | | | | Place a bandage over | | | | the puncture site. | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | Charting Example | | | +-----------------------+-----------------------+-----------------------+ ### **Butterfly Needle Method** **Figure 43--9** **Procedure 43--4** ### **Obtain Venous Blood with the Butterfly Needle Method** +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | **Figure 43--10A** | | | | | | | | Venipuncture by | | | | butterfly method | | | | series. Apply a | | | | tourniquet about | | | | three inches above | | | | the insertion site. | | +-----------------------+-----------------------+-----------------------+ | | **Figure 43--10B** | | | | | | | | Clean the site and | | | | let it air-dry. | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | **Figure 43--10C** | | | | | | | | Insert the needle tip | | | | into the vein with a | | | | quick and steady | | | | motion. | | +-----------------------+-----------------------+-----------------------+ | | **Figure 43--10D** | | | | | | | | Pull back on the | | | | plunger of the | | | | syringe slowly until | | | | an adequate amount of | | | | blood is obtained. | | | | | | | | **Figure 43--10E** | | | | | | | | Vacutainer method: | | | | Press the appropriate | |