Phlebotomy - CIA 2024 Past Paper PDF

Phlebotomy - Draw blood Vein to cut open Purpose - analytic/ diagnostics - Therapeutics why not vein puncture? -> Originally, bloodletting was only for therapeutic purposes. Etheric Universe is surrounded by evil spirits which cause disease who? Barbers / Barbersergens cup - blood collect...

Phlebotomy - Draw blood Vein to cut open Purpose - analytic/ diagnostics - Therapeutics why not vein puncture? -> Originally, bloodletting was only for therapeutic purposes. Etheric Universe is surrounded by evil spirits which cause disease who? Barbers / Barbersergens cup - blood collection red - bloodletting white - bandages Blue - haircutting Body Organization Cell - base functional unit of life Tissue - group of cells put together to perform particular function Organ - “ Organ system / body system - “ color, order matters. RBC - Erythrocytes body system anatomy -> physiology -> pathology Blood vessiles - Artery - Arterole - Vein - Venule - Capillary Artery - Thick walled - No Valve - Oxynated - Carry away from heart - Bright red blood - Higher pressure - Pulse Vein - Thin Walled - Valve present -> prevent the backflow / keep blood flow in one direction - Deoxynated - Carry towards the heart - Dark red blood - Less Pressure - No pulse Thrombus / embolus Capillary - smallest blood vessels - called exchange blood vessels - Both Oxygenated & deoxygenated blood - more of Oxygenated blood - Bright red blood 3 layers of wall of artery and vein Tunica Intima Tunica Media Tunica External / Tunica Adventitia Deeper the veins from skins, bigger the angles Stepes of Venipuncture - Introduce your self - Identified the patient -> ask patients (Name & DOB) - Explein prosedure - When was the last blood dows / how did it go - Check requisition slip - Any allergies - Assemble supplies - needle, tubes, bandaids, tourniquets, alcohol wipes, globes, sharps container - Position the patient - Select the site - no bruise / hematoma, no scar, no Injuries, no IV lines, no mastectomy - Apply tourniquets -> 2~4in absolve the site - Palpate the vein -> feel by touch - Cleanse the site -> circular motion, inside out - let it dry - Anchor the vein -> pull skin down - Insert the needle with bevel up - Push the tube onto the needle - Blood flows into tube - Release tourniquet - Remove the tube - Place the gauze over the site - Remove the needle - Ask patient to apply pressure - Lock and dispose the needle - Invert the tubes and label tubes - Check for bleeding / Apply Bandaid - Instruction to the patient - Thank them - Dispose everything use - Document Hart Hollow muscular organ Located in the thoracic cavity Space between the lungs = mediastinum Extends from 2nd to 6th rib Size - clenched fist Anterior - Sternum | Hart | Posterior - vertebral column = breast bone Q. Hart is posterior to the vertebral column? -> False Midclavicular line Chambers of the heart - total of 4 - 2 Upper = Atria (Right / Left Atrium) = Receiving chamber - 2 Lower = Ventricles (Right / Left Ventricles) = Pumping Chambers Valves of the heart - 2 AV (Atrio - venticulums) valves - Tricuspid valve - Between Right Atrium and Right Ventricles - Bicuspid valve = Mitral valve - Between Left Atrium and Left Ventricles - 2 Semlunar valves - Pulmonary valve - Between Right Ventricles and Pulmonary Artery - Aortic valve - Between left Ventricles and Aorta Septum - Divides heart to two sides - Upper Part = Inter Atrial Septum - Lower Part = Inter Ventricular Septum  - Right side is Deoxygenated blood - Left side is Oxygenated blood murmur - abnormal heart sound -> faulty valves tricuspid regurgitation Pericardium - suc like structure that surrounds the heart - outer - fibrous layer - Inner - serous layer - parietal Pericardium Space = pericardial space - contain pericardial fluids - visceral (means organ) Pericardium / epicardium Myocardium Endocardium Blood Circulation Deoxygenated blood (body) -> SVC - Superior Vena Cava ->IVC - Interior Vena Cava -> Right Atrium -> Tricuspid valve -> Right Ventricles -> Pulmonary valve -> Pulmonary Artery (trunk) -> Lung -> Pulmonary Vein -> Left Atrium -> Bicuspid valve -> Left Ventricles -> Aortic valve -> Aorta -> Entire body Automaticity - the ability to generate its own electricity Electrolytes - Sodium / Potassium / Chloride Electrical Conduction system of the heart SA Node - Sino Artiral Node = Pacemaker -> Normal Heart Rate = 60-100 bpm AV Node - Atrial Venticular Node Bundle of His - AV bundle RBB - Right Bundle Branch LBB - Left Bundle Branch Purkinje Fibers - Myofibers Tachy (Faster) / Brady (Slower) Cardia (Heart rate) Blood - Living Tissue / Fluid of the body - pH of blood 7.3 ~ 7.45 - Plasma - 55% - Liquid part of blood - 90% water - 10% solutes - Nutrients - carbohydrates/proteins/fats - Waste material- urea/uric acid/nitrogenous waste - gases O2/CO2  - Enzymes/hormones/electrolytes - Special proteins - albumin - help retain water - globulin - Help to form antibody - fibrinogen - helps in clotting - Formed elements - 45% - Red Blood Cells = Erythrocytes - produced in bone marrow - hematopoiesis - Life span - about 120 days - Numbers of RBCs - 5~6 million / mm3 - Contains Hemoglobin (Hb/Hgb) - each Hgb can carry up to 4 O2 - Shape - biconcave - Anucleated = no nuleus - Anemia - Iron deficiency anemia - most common - Pernicious anemia - due to lack of intrinsic (helps to absorb Vit B12) - Aplastic anemia - affected bone marrow - White Blood Cells = Leukocytes - produced in bone marrow, Spleen, Thymus, Lymph nodes - Life span - A few minutes ~ several years - Types - Glanolocytes - neutrophil - most number of WBCs - almost 60% - Forming the first line of defense - Phagocytic action - eosinophils - Help fight parasitic infection - the count is high in the allergic reaction - basophils - produce histamine and heparin - Agoanulocyrte - monocytes - largest WBC - form macrophages - have phagocytic action - lymphocytes - smallest WBC  - help to form Antibodies - 5000~1100 / mm3 - Platelets = Thrombocytes - produced in bone marrow - Life span - 9-12 days - 150,000 - 400,000 / mm3 - fragments of the largest cells called megakaryocytes - help in clotting = coagulation = hemostasis Steps of coagulation 1. Vasoconstriction 2. Platelet plug formation a. temporary clot formation 3. Activation of the clotting factors a. fibrinogen -> fibrin b. secondary clot formation 4. fibrinolysis Thrombocytopenia (Penia = low) Venipuncture most commonly used vein Bend of elbows - antecubital space 1. Medial cubital vein 2. Cephalic vein 3. Basilic vein 4. Dorsal veins / Metacarpal veins Fasting Specimen (NPO - Nothing by mouth) -> Glucose Random specimen Needle - Gauge (DIameter) The bigger the number, the smaller the diameter 21G, 22G, 23G, 25G 21G is preferred because cells might be destroyed due to the fast flow Bevel - facing up fast moves are important Angle - 15°~20° -> depends on the depth of the vein Hemolysis - Breakdown or destruction of RBC - Cause - Bigger gauge needle (Smaller diameter) - Excess alcohol - Vigorous shaking Tourniquet Apprication - Not more than 1min Hemoconcentration - more formed elements -> mimics leukocytosis Hematoma - Swelling due to collection of blood most common complication of phlebotomy - Cause - Improper technique Tubes - Non-additive Tube - Red - Bottom - clot / Top - Serum - Additive Tube - Clot Activator  - SST (Serum separator tube) - Gold top, speckled, marbled, gray-black, tiger top - have gel and clot activator - Bottom - clot / Middle - gel / Top - Serum - Anti-coagulant (Chemical or substance that prevents the blood from clotting) - Yellow, blue, green, lavender, gray - Bottom - RBCs / Middle - Buffy coat (WBCs + Platlets) 1% / Top - Liquid = Plasma Specimen types - Serum - Plasma - Whole blood Order of draw Additive Inversion Department Test of tube B - Blood Culture SPS (Sodium 5-6 Microbiology BC, C&S Yellow Polyanethole Sulfonate) C - Coagulation Sodium Citrate 3-4 Hematology PT, PTT, APTT, light blue Fibrinogen N - Non-additive None 0 Blood Bank T&S, Red T&Crossmatch Serology ANA, ASO, RPR, STS, VDRL, monostop Chemistry Enzymes, Hormones, Electlytes, Drags A - Additive SST Clot Activator 5-6 Serology 同上 Chemistry Green Heparin 8-10 Chemistry ABG, StaT Plasma Studies Ammonia Lavender EDTA 8-10 Hematology CBC, RBC, WBC, (Ethylenediaminetetr Plt, Diff count, aacetic acid) ESR, Hb/Hgb, Hematocrit, Retic count Gray Potassium Oxalate 8-10 Chemistry Lactic Acid, (Anti-Coagulater) + Alcohol testing, Sodium Glucose (FBS, Fluoride(preserve GCT, GTT, PP, glucose) PC) What test is done to measure the O2 carrying capacity? HbG Which color is used to obtain serum? Red, SST What chemistry lab identifies unknown drugs? Toxicology What action is to be taken if there is a flash of chemicals in the eye? Rinse 15-20mins A wet floor is what type of hazard? physical When operating electrical equipment, what way to reduce electrical hazards? by standing on antistatic mats What is the term for invasion and growth of microorganisms? infection Most frequent route of infection in hospitalized patient is _____ contact When removing PPE, what is last thing that is done? wash hands What type of precautions are to be used for patients with tubercluosis and meseales? airbone What is the procedure, if there is a spill of blood on the countertop? 10% bleach and keep 20-30mins Suffix for surgical removal ectomy What does NPO mean? Nothing by mouth Homeostasis Another name for non-striated involuntary muscle smooth mascle PHI (Protective Health information) Heart and lungs are located in ____ cavity thoracic Bone is formed by _____ cells osteoblast A duty associated with routine blood collection includes ___ Transport the sample What do you do if the patient refuses a blood draw? notify physician Peristalsis - wave-like motion of smooth muscle Anatomical position The system responsible for thermoregulation Integumentary system Sound heard with a stethoscope when placed over the heart Closing of the valves Structures that bring blood back to the heart Veins A major artery that takes oxygenated blood from the heart to the tissue Aorta Chamber that receives blood from the body Right atrial Smallest blood vessels Capillaries What is the first step taken after withdrawing the needle? Apply pressure Color tube for CBC ____ Lavender Completely filling up the blue tube will give a ratio of ____ 9:1 Angle of needle ____ 15-30 Most commonly used gauge for butterfly needle ____ 23G Where do you apply the tourniquet ____ 3-4 inches Steps of venipuncture % of plasma in whole blood ____ Another term for RBCs Erythrocytes Most number of WBCs are ____ Neutrophils Neutrophils Lancet needle - Ideal depth 2.0mm (heel stick) ch1-10 Ante-cubital space Hematopoiesis - production of the blood cells Plasmin (enzyme that breaks down the fibrin into clots) gold top tube (SST) ____ serum Capillary puncture = Dermal puncture / skin puncture Epidermis Dermis its contaminated with tissue fluid Quiz2 What condition can be caused by removal of lymphoid tissue in mastectomy? lymphostasis What is the recommended needle gauge for arterial puncture? 21G During OGTT, what is the patient allowed to consume? Water only What is the volume of a unit of finer blood? 450ml When preparing blood smears, what angle the spreader slide be ? 25-30 degree Has soon after collection must a urine sample be delivered to lab? WIth in 1h What type of specimen is tested in diagnosis of meningitis? CSF (Ceribro spinal fluid) How many times you invert the tubes after collection? 5-10 times What problem are caused by extreme temperature with blood samples? Hemolysis Blood levels of ___ analytes are increased in CHF(conjusted heart failure) BNP What group of streptococcus is detected by rapid strep test? A Quantitative methods to monomer the quantity of procedure to ensure accurate test result QC Which ___ medications causes prolonged bleeding time Aspirin Anxiety can increase which of the hormones ___ Cortisol How many unsuccessful puncture before calling for assistance 2 times What is the term for medical information that is linked to specific patient PHI Infants should not have greater than what % of the blood removed in 24h period 5% The organization that mandates quality assurance programs The Joint Commission (TJC) Medical term for fainting ___ Syncope When you are unable to locate the vein in one arm after thoroughly examination, what is next step Other arm Which of test is most affected by hemolysis ___ Potassium After 12hr fasting and abstention of strenuous exercise, the body is said to be in a state of ___ Basal What test is used to diagnose gestational diabetes 1hr OGTT What is the term for blood donation that is intended to be used later on the donor What condition might be treated by therapeutic phlebotomy Hemochromatosis / poluchytomi\a What is the common name for antibodies formed in response to infection by mycoplasma pneumoniae cold agglutinis What body organ form urine Kidney Unique identifying number used for cataloging samples in lab is ___ Accession What is the major safety risk in removing stoppers from blood collection tubes Aerosols Which test most affected by glycolysis in tube after collection glucose Blood smears from EDTA specimen must be made within what time period after collection to prevent distortion of cell morphology 1hr Smaller portion of specimen transferred to specific container is called ___ aliquots Which of the following types of laws is created by a legislative body statutory law Which of the following is not a penalty for HIPAA violation liability An unjustifiable attempt to touch another person can lead to what charge Assult Which blood parameter measures the acidity or alkalinity of blood ___ pH A patient has seizure while performing venipuncture. What shall you do Remove tourniquet A large amount of bleeding into tissues surrounding a puncture site (inpatient talking anticoagulant medication) can cause what condition Compartment syndrome What is the maximum time a tourniquet can be left for ___ 1min If there is Iv line and there are no accessible site where should blood specimen be collected ___ Distal to IV What is the approximate blood volume of an average 150lb adult 5L What effect does hemolysis of specimen have of bilirubin levels ↓bilirubin levels If patient has a Iv line in one arm, what is the preferred site for venipuncture opposite arm What is the normal pH of blood 7.35-7.45 Where is the tourniquet placed for arterial puncture no tourniquet Organ that processes bilirubin Liver Term for build up of bilirubin in blood and skin is ___ jaundice