things i don't know

don’t take rectal temp if patient has…

• heart disease

• rectal disorders

• recent rectal surgery

• diarrhea

Holter monitor lead placement

5 lead

• black lead on left chest

7 lead

• black lead on left clavicle

antiseptics for different uses

cleaning skin before surgical procedure

• povidone iodine

cleaning skin before med procedure

• isopropyl alcohol and chorihexidine

clean wounds and incision sites

• 3% hydrogen peroxide

types of fever

specific blood culture steps/differences

• clean with alcohol then another antiseptic (chorheixinde gluconate)

  • clean for 1 min with alcohol doing back and forth strokes

  • clean at least 2.5 inches of site

• usually use butterfly needle but can use syringe

• need to fill two types of 10 mL bottles —> aerobic and anearobic

  • if using butterfly, fill aerobic first

  • if using syringe, fill anaerobic first

• allow to incubate for 5 days

volumes of ICD manual

• 1

  • has tabular list —> tells code for the disease

  • has chapters based on disease

• 2

  • has instruction manual

  • guide on how to use system

• 3

  • alphabetical index —> where to find disease in tabular list

subcutaneous vaccines

MMR, Varicella, Polio (IPV)

diseases spread by direct and indirect transmission

• Direct contact

  • MRSA, varicella, scabies, mono,

• Indirect (fomite)

  • C diff spores can live on surfaces for a long time

diseases spread by droplet and airborne transmission

• Droplet

  • Influenza, Pertussis, Meningococcal meningitis

• Airborne 

  • Measles, Tuberculosis (TB), Varicella

diseases spread by vector transmission

• Vector borne

  • Mosquitoes: Carry West Nile Virus, Malaria, Zika Virus.

  • Ticks: Carry Lyme Disease, Rocky Mountain Spotted Fever

diseases spread by common vehicle transmission

• Foodborne

  • Salmonella

• Waterborne

  • Cholera

• Bloodborne

  • HIV or Hepatitis B

blood sample different storages

• bilirubin —> in foil or amber colored tube

• arterial blood gas —> on ice slurry

• cold agglutinins —> keep warm at 37 C

what tests need basal state

Glucose, Cholesterol, Triglycerides

what tests need fasting (no food, only water 8-12 hrs)

 Fasting Blood Sugar (FBS), Lipid Panel, Basic Metabolic Panel

bipolar leads

• Lead I

  • RA to LA

  • Views lateral wall of left ventricle

  • grounding lead —> doesn’t produce waveform

• Lead II

  • RA to LL

  • one most used for tracking basic waveform and rate

• Lead III

  • LA to LL

unipolar leads

• records current from one reference point

• limb:  aVR, aVL, aVF

• chest: V1-V6

QRS complex length

 0.12 sec, 3 small boxes

PR interval length

0.12 - 0.20, 3-5 small boxes

parts of a prescription

• Superscription

  • Where Rx is shown → indicates beginning of prescription

• Subscription

  • Instructions for pharmacist

• Inscription

  • Body of prescription

  • Has med name and dosage

• Signatura

  • Providers instruction to patient

  • Name, dosage, frequency, specific directions (ex: with food)

12 CLIA waived tests (just list 5 ones you didn’t know before)

Ones i didn’t know before

• flu

• hemoglobin

• spun hematocrit

• cholesterol

• h pylori

1. Pregnancy tests (hCG)

2. Rapid Strep test (Streptococcus A)

3. Blood glucose (blood sugar)

4. Dipstick, tablet, or multi-stick urinalysis

5. Nasal swab for Influenza A and B (Flu)

6. Hemoglobin (Hb)

7. Spun Hematocrit (Hct)

8. HbA1c (Glycated hemoglobin)

9. Cholesterol testing

10. Helicobacter pylori (H. pylori)

11. Fecal occult blood (stool test)

12. Drug testing (rapid screening)

types of health information exchange (HIE)

• consumer mediated

  • patients can control and manage their info at home

• query based

  • providers can request or access patient data from other providers

• directed exchange

  • secure transmission of info between healthcare entities

  • like for referrals or lab results

preanalytical phase activities

• Ordering appropriate lab tests

• correctly identifying the patient

• choosing the right sampling method and time

• accurately labeling samples

• properly storing specimens

• filling out the requisition form correctly

errors

• Wrong sampling method

• wrong sampling time

• sample mislabeling

• incorrect storage

analytical phase activities and errors

• Analyzing the specimen using correct methods

• using calibrated instruments and equipment

• ensuring reagents and samples are not contaminated

errors

• Contaminated reagents

• contaminated sample

• uncalibrated machine

• wrong procedure

• sample mix-up

post analytical activities

• Accurately interpreting results

• communicating results effectively to healthcare providers

• correctly archiving test data

• discarding samples

errors

• Misinterpretation

• miscommunication to hospital

• doctor misinterpreting results

3 components of urinalysis and examples

1. Physical

   1. -Volume

      - Color

      -Clarity

      - Odor

      - Specific gravity (concentration)

2. Chemical

   1. pH

   2. Glucose

   3. Ketones

   4. Protein

   5. Blood

   6. Bilirubin

   7. Urobilinogen

   8. Nitrites

   9. Leukocytes

1. Microscopic

   1. Casts

   2. Crystals

   3. Bacteria

   4. Yeast

   5. Parasites

ICD number of characters

3-7

1 is always letter, 2-3 are always number, rest is mix

CPT number of characters

5 and numeric, can have 2 digit modifier

accountable care organization

• network of providers

• emphasis on quality and reducing cost of care with preventative and coordinated care

  • get better reimbursement based on quality and low cost

EPO vs POS

EPO —> exclusive provider org

• does not cover out of network

• don’t need referral for in network

• like a blend between HMO and PPO

POS

• still needs referral but lets you see out of network providers

suppuration

production of pus

gray tube additive

• has potassium oxalate (preserves glucose) and sodium flouride (anticoagulant)

erythrocyte sedimentation rate

tests level of inflammation —> inflammation caused RBCs to stick together and sink faster

how long to analyze ABG draw

analyze after no longer than 15 min

abbreviations you don’t know

• hx = history

• vs = vital signs

• 
  

range for sodium

135-145 mEq/L

range for blood urea nitrogen (BUN)

7-25 mg/dL

what does calcium play a role in

coagulation

what does zinc play a role in

many processes, including wound healing and immunity

if a family has an income too high for medicaid what can they do?

apply for Child Health Insurance Program (CHIP) for their children under 19

CHAMPVA vs Tricare

CHAMPVA

• for dependents of veterans who are dead or disabled

Tricare

• for people in service, retirees, and their families

epistaxis

nosebleed

the joint commission

ensures that offices meet certain standards and ensure high quality care

has information about office accreditation

how long to wait to take axillary temperature

5-10 minutes

areas to put transdermal patch

fleshy, hairless, not below elbow or knees

shoulder, upper arm, lower abdomen

solid skin lesions, smallest to largest

papule (less than 0.5 cm) , nodule, plaque (rough)

fluid filled lesions, smallest to largest

vesicle, bulla —> small vs large

many sizes: cyst (fluid) and pustule (pus)

flat skin lesions

macule = small, patch = large

when is capillary puncture contraindicated

hypothyroidism

fee types by providers

usual

• what the provider themselves usually charge

customary

• the price range that providers in the area usually charge

reasonable

• if an additional fee is reasonable due to the additional effort that was required

accepted

• fee that is usually deemed fair by insurance and patients and is usually paid

malfeasance

Illegal or wrongful act by a person in a position of trust, done knowingly

ex: Falsifying records, stealing from patients, accepting bribes

misfeasance

Improper performance of a lawful act

ex: Administering wrong medication, wrong dosage

misdemeanor

category of crime —> minor crime

ex: Stealing drugs, falsifying records

malpractice

Professional misconduct resulting in harm to patient

ex: Operating on wrong body part, wrong diagnosis, negligence

how to change EKG for patient with breast implants

place V1 and V2 at 2/3rd intercostal space —> higher up = less interaction with implants

red glass tube use

for chemistry has no additive, red plastic does have additive

Used for…

• Routine blood donor screening

• Diagnostic testing of serum for infectious diseases

• Complete metabolic panel (CMP)

• Drug test

assignment of benefits form

form patient signs that allows insurance to pay directly to provider

point of service billing

billing done at time and place of service —> like x-ray at urgent care being billed to you there