Legal & Lab Values (Intro to Sono)

Autonomy

Right to act independently

Pt has right to choose or refuse treatment

Beneficence

Practitioner should act in best interest of patient

Justice

Moral rightness / fairness

Ex: Who gets treatment with scarce resources?

Nonmaleficence

Avoidance of evil acts

Veracity

Truth telling; not lying to patients

Governs pts right to learn about their diagnosis

Consequentialism

Risk benefit analysis

Decisions based on consequences & outcome of decision (aka utilitarianism)

Deontology

Decisions based on individual motives/morals despite consequences

How to promote patient well-being?

Respect patients autonomy & right to refuse procedure

Provide care in non-judgmental & non-discriminatory manner

Proper draping techniques

Maintain sonography credentials

Practice within scope of practice

What is EMTALA?

Requires hospital to treat ER patients regardless of ability to pay for treatment

Must provide exam & treatment to stabilize patient, but don’t provide final diagnosis

Common law

Law based on custom & usage

MOST MALPRACTICE CASES ARE BASED ON COMMON LAW

What law is most malpractice cases based on?

Common law

Tort

Actions leading to person injury or property damage; Compensation can be sought

May result from negligence or intentional misconduct

Ex: assault, battery, defamation

Lawsuits include what steps?

Pleading: complaint issued

Discovery: evidence (audio/video/images)

Trial: may be called to testify (sonographer or student)

Decision: case dismissed or settled

Appeal: request to review decision

What is discovery?

Process in lawsuit where evidence / facts are discovered

May include audio/video & study images

Should you use white out or stickers over errors in medical records/documents?

No! Incomplete, inaccurate, altered records cast doubt on quality of care

Medical record documentation is most important defense in lawsuit

What should you do if attempt to obtain images fail?

Label the attempts

(Ex: attempted to image patient, but was not able to due to ____)

Sensitivity

True positive rate

When people have the disease & we correctly find it

Includes TP (true positive) & FN (false negative)

Specificity

True negative rate

When people don’t have disease & we correctly find no disease

Includes TN (true negative) & FP (false positive)

Components of blood

RBC (erythrocytes)

WBC (leukocytes)

Platelets

Plasma

Serum

Difference between plasma & serum?

Plasma = liquid part of blood (water, ions, nutrients, proteins, etc.)

Serum = clotting factors within blood clot

What is CBC?

Complete blood count

What is included in CBC?

• Red blood cell count (RBC)

• Hematocrit (Hct): % of blood that is rbc

• Hemoglobin (Hgb or Hb)

• WBC count

• Platelet count

Most common blood cell? Function?

RBC

Delivers O2 to tissues via blood

What is it called if you have Decreased RBC?

Anemia

What is Hematocrit?

How concentrated RBC is in blood

Another name for Hematocrit?

Packed cell volume (PCV)

What does low hematocrit suggest?

Anemia or bleeding

What is Hemoglobin A1C?

Test for person suspected or known to have diabetes

Measures what % of hemoglobin is coated with sugar (glycated)

What is a high WBC count (leukocytosis) a sign of?

Viral bacteria, fungal, or parasitic infection

What is Prolonged Prothrombin Time (PT)?

Indicates tendency to bleed

Vitamin K may be administer to ensure normal clot time

What is Jaundice?

Increased level of bilirubin

Bile pigment stays in blood which yellows skin & eyes

What to look for when someone has jaundice?

Acute or chronic liver disease

Common bile duct blockage (ex: gallstones)

What is infiltrative liver disease?

Liver disease invaded or replaced by abnormal proteins

Alanine Transaminase (ALT)

Protein most commonly associated w/ Liver

Normally released into blood by normal liver cell death

Increased levels may indicate hepatocellular injury

Elevated ALT levels suggest alcohol, diabetes, liver or bile duct problems, etc

What does increased Alkaline Phosphatase (ALP) indicate?

Obstructive disorder

Ex: gallstones

What enzyme does the pancreas produce?

Amylase & lipase

Function of amylase

Breaks down starch

Function of Lipase

Breaks down fats

What is Urea Nitrogen?

Waste product produced in liver; excreted by kidneys

Blood urea nitrogen (BUN) measures amount remaining in blood

Reasons for increased & decreased levels of urea nitrogen?

Increased levels : poor renal function

Decreased levels : liver disease or damage

Normal components found in urine?

Creatinine

Nitrate

Abnormal components in urine?

Blood

Glucose

What does a urine test positive for nitrates indicate?

UTI

What is Serum Alpha Fetoprotein (AFP)?

Produced in fetal liver

Levels can be tested during pregnancy to determine likelihood of disorders

(Ex: down, NTD, spina bifida)

What is Beta hCG?

Human chorionic gonadotropin

Produced early in pregnancy

Also produced by tumors (test in females suspected w ovarian cancer & males for testicular cancer)

Inhibin-A

New addition to the quad screen test

Levels of inhibin-A related to potential for Down syndrome

Is the screening test diagnostic?

No.

Elevated levels of CA-125 may indicate?

Benign tumor