NHA CCMA TESTING AND LABORATORY PROCEDURES

Hemoglobin (Hgb)

Males: 13-18 g/dL

Females: 12-16 g/dL

Hematocrit (Hct)

Males: 42-52%

Females: 36-48%

Fasting blood glucose (FBS)

60-110 mg/dL

Total cholesterol

< 200 mg/dL

Low-density lipoprotein (LDL)

< 130 mg/dL

High-density lipoprotein (HDL)

> 40 mg/dL

Triglycerides healthy levels

< 150 mg/dL

Erythrocyte sedimentation rate (ESR)

Males: 0-20 mm/hr

Females: 0-30 mm/hr

International normalized ratio (INR)

0.8-1.2

Prothrombin time (PT)

10.4-15.7 seconds

Urine pH

4.5-8

Urine urobilinogen

0.1-1

Urine specific gravity

1.005-1.030

Urine all other values

Negative

Urine bilirubin container

Dark b/c light sensitive

Sodium

135-145 mEq/L

Platelets

130-400/mm3

RBC

Male = 4.7-6.1/mm3

Female = 4.2-5.4/mm3

Calcium

8.5-10.5 mg/dL

Potassium

3.5-5.1 mEq/L

BUN

7-25 mg/dL

Chain of custody

A written record of people signing to show who have had possession of an item of evidence

Seal with red label strip in front of the patient; want to ensure that it is packaged as directed and nothing has been tampered

Send specimen and lab requisition to lab on same day

Drug screening, court subpoena, parentage

Chain of custody for urine

Require volume 30-45 mL

Record temperature within 4 minutes

Near vision testing (Jaeger test)

Screens for presbyopia and hyperopia

Read printed material of various sizes 14-16 in away from the eye WITHOUT corrective lenses

Distance vision testing

Screens for myopia

Stand 20 feet (older than 6) or 10 feet (5 yrs or younger) from chart with letters/shapes/Es

CAN wear corrective lenses

20/20 vision

Can see an object 20 feet away as if a normal person would see at 20 feet

"Normal vision"

20/30 vision

Can see an object 20 feet away as if a normal person would see at 30 feet

"Below average"

20/10 vision

Can see an object 20 feet away as if a normal person would see at 10 feet

"Above average"

Testing for color blindness

Ishihara plates

11 plates; miss 4 = potential color deficiency, indicates further testing

Stand 30 in away

Visual field testing (perimetry)

Flashing lights or manual test

Detects diseases such as glaucoma

Tympanometry

Mvmt of tympanic membrane affected by increased pressure in middle ear, using small earbud to determine and record using air pressure. Normal = peak, abnormal = flat line

Normal adult hearing

Should hear up to 25 decibels

Normal child hearing

Should hear up to 15 decibels

Weber test

Tests for conductive or sensorineural hearing loss

Places tuning fork on top of head and ask where they hear it and if it's louder in one ear or the other

Should normally be both sides but if not it localizes to the good ear

"Weber it's R or L ear"

Rinne test

Evaluates hearing loss by comparing air conduction to bone conduction

Position vibrating tuning fork over pt's mastoid process and ask if pt can hear it, then invert it to the outside of the ear near the ear canal at a distance of 2.5 cm (1 in) and ask if they can hear again and signal when sound goes away (i.e. raise hand)

Air conduction should be better than bone conduction

"Rinne under the pinne"

Allergy skin testing

Noninvasive

Forearm or back

Allergy scratch testing

Diluted allergen is applied to a scratch or prick on surface of the skin

1.5-2 in apart

Wheal in 15 minutes = possible allergen and consider ID testing

Larger wheal = more significant allergy

Allergy intradermal testing

Diluted allergen is injected intradermally 2-3 finger widths below antecubital space

Initial wheal is expected

Wheal becomes inflamed with induration (raised, hard area) = allergen

Allergy radioallergosorbent test (RAST)

Checks blood for antibodies that could indicate allergy

More invasive because requires blood draw but is safer b/c avoids potential allergic rxn

Allergy challenge testing

Sometimes used to detect specific allergies (i.e. food allergies)

Not 1st choice but prescribed if scratch/ID tests are positive and if a life-threatening allergy is suspected

Food challenge test = pt receives increasing amounts of food suspected of causing an allergy (must be controlled, have meds and treatment available)

What to do for allergic rxns

Wheezing/sneezing = continue

Severe rxn = alert provider

Never administer on sites with wheals or hives

Peak flow testing

Used to monitor lung function in the home, esp for pts who have chronic respiratory diseases like asthma

Measures forced expiratory volume = effectiveness of airflow out of lungs

-Wear non-restrictive clothing or remove restrictive clothing (jackets, ties)

-Begin with marker at the bottom of the scale on the meter (0)

-In an upright sitting or standing position, take a deep breath and forcefully blow out of the mouth, which is secure around the mouthpiece of the machine

-Record the number where the marker is located at the end of the test

-Repeat the test 2-3x and record the results

Pulmonary function test

Assesses ability of lungs to take in and expel air and evaluates gas exchange across respiratory membrane

Check vitals before and after, not during

Can admin meds before but not necessary for the performance of the test

Do not need an inhaler

MA coaches pt through the test

Spirometry

Automated test that produces graphic result

Similar to peak flow testing

Wear loose clothing, sit in an upright/standing position, and breathe through the mouth, pursing the lips around the mouthpiece

Apply clip to pt's nose to avoid nose-breathing

Lift chin slightly and extend neck to reduce breathing resistance

Want a quick and forceful start, fast and steady flow with no variability and no coughing

Exhalation duration must be 6 seconds

Consistent with 2 other maneuvers

*NO large meals 2 hr before the test, NO smoking 1 hr before the test, and discontinue use of bronchodilators, inhalers, nebulizers for at least 6 hr before the test

Clinical chemistry department

Performs assays on serum, urine, and cerebrospinal fluid

Testing for presence and amount of specific chemicals substances like glucose, cholesterol, electrolytes

Pathology department

Study and diagnose disease through examining surgically removed organs, tissues (Bx), bodily fluids, whole body (autopsy)

Cytology department

Microscopic examination of cells to detect cancer/disease (i.e. Pap smear)

Blood bank department

Immuno-hematology department

Typing/cross matching blood for transfusion

Blood and its components separated/stored until needed

Specialized tests for antigen-antibody rxns

Hematology department

Studies of formed elements of blood (WBCs, RBCs, platelets)

Determine % of cell types in blood and observe size/shape

Coagulation studies to look for bleeding disorders

Microbiology department

Grow/identify microorganisms to see which pathogen is causing symptoms before prescribing appropriate methods

Sensitivity tests

Urinalysis department

Physical, chemical, microscopic analysis of urine (i.e. leukocytes, nitrites)

Random urine

Pt urinates in a clean, non-sterile container; used for screening

First morning urine use

Pt collects 1st specimen of the morning in a clean container; more concentrated, used for pregnancy testing or when other analytes (protein, nitrites) need to be evaluated

Clean-catch midstream urine specimen

Pt performs perineal cleaning using moist wipes, begins to urinate, and then collects the specimen midstream in a sterile urine container; used for cultures or when non-contaminated specimen is desired

24-hour urine collection

A diagnostic test where a patient discards the first morning urine, then collects all urine for the next 24 hours—including the first void of the second day—using a container with preservatives, to quantitatively analyze substances like protein for kidney function assessment.

Catheterized urine collection

Sterile urine sample is needed/pt unable to provide specimen on their own; insert catheter through the urethra into the bladder

Fecal occult blood test

Stool specimen to screen for presence of blood

No NSAIDs 1 week before (can cause false positive), no more than 250 mg vitamin C (can cause false positive), and no red meat/raw fruits and veg for 3 days before the test and NO LAXATIVES

Collect 3 separate specimens on filter paper in a clean container, Guaiac test uses Hemooccult cards and spread a small amt on the paper

Keep away from heat, light, chemicals (keep in envelope)

-Wait 3-5 min before developing

-Apply 2 drops of developer to the back of the card (not on the specimen)

-Interpret results 1 min after developer is applied

-Blue = positive test, reacts with hydrogen peroxide

Tape test

Detects pinworms (children)

Give parents a slide w/ tape on it, place tape over child's anus before getting up in the morning and then back on the slide, and bring to provider

Ova and parasites (O&P)

Detects presence of parasites and their eggs

Sputum collection

Pt produces a deep, productive cough

Best done early in the morning before eating or drinking

Avoid mouthwashes

Sterile container

CLIA-waived tests

Most common designation for ambulatory care, lowest level of complexity; home environment or medical office

Moderate- and high-complexity tests

Non-waived; must have CLIA certificate and undergo inspections to ensure standards are being met; reference or hospital lab

Provider-performed microscopy tests

Moderate-complexity testing that allows screening of urine or body excretions microscopically, allowing the provider to develop a preliminary diagnosis and begin treatment as warranted

Commission on Office Laboratory Accreditation (COLA)

Independent accreditor for laboratories; focuses on meeting CLIA regulations with a goal of providing the best care to the patient

Quality assurance

Comprehensive, relates to policies/procedures that must be implemented for reliability of test results

Example = policies related to rotating stock to put newest containers in the back of storage, checking the temperature and maintaining it between 39-41 °F

Pregnancy test

Urine screened for presence of human chorionic gonadotropin (hCG) antibodies

Can detect hCG 8 days after ovulation

Negative = blue line in control

Positive = blue line in control and test area

Quality control

Included in quality assurance but is more specific; related to test reliability and accuracy while attempting to uncover errors and eliminate them

Controls and use quantitative result range (i.e. calibration standards) and qualitative descriptor (i.e. fecal occult turns blue, pregnancy test has control strip)

Example = reviewing expiration of urine multi-sticks, checking temperature of laboratory refrigerator and documenting it on a log

Rapid Streptococcus test

Throat swabs obtained to screen for Group A Streptococcus

-Make sure all reagents/devices are at room temp for minimum of 30 min before test

-Use tongue depressor and swab the tonsils to get 2 samples

-Dispense reagents into the tube as free-falling drops (don't touch tube with reagent bottle)

-Leave swab in the tube for 1 min

-Express liquid from the swab by squeezing the tube, NOT the swab, to get most specimen from swab

Dipstick, tablet, multi-stick urinalysis

Screening tool for analytes excreted in the urine

Hemoglobin test

Machine used to screen for oxygen-carrying protein in whole blood

Performed using capillary blood from a fingerstick (capillary puncture)

Spun hematocrit

Fingerstick collection of blood in microcapillary tubes that is centrifuged and evaluated for the % of RBCs

Blood glucose test

Whole blood is analyzed in a glucometer for a quantitative glucose level and is screening for diabetes, performed using capillary blood from a fingerstick (capillary puncture)

Hemoglobin A1c test

Capillary blood test that shows diabetes control over ~3 month period

Cholesterol testing

Lipids are evaluated using capillary blood

Helicobacter pylori tests

Blood sample that screens for H. pylori, main cause of gastric ulcers

Mononucleosis screening

Tests for presence of Epstein-Barr virus in capillary blood

Nasal smear for influenza types A and B

This screening is a qualitative test for influenza antigens using a swab that is inserted into the nostril

Drug testing

Substances can be detected in urine or blood samples

When should you label a specimen?

After the time of collection

Lab requisition form

Patient demographics, provider's signature/authentication, billing information, ICD-10 coding, testing information, source of specimen plus date and time of collection

Specimen label

Pt name and DOB, date and time of collection

Also possibly provider's name, initials of person collecting

Label the CONTAINER, NOT THE LID

Temperature for transporting urine specimens

Refrigeration

Must refrigerate within 2 hours

If not done, bacteria consume more glucose and pH increases (alkaline)

Temperature for transporting swabs for STIs

Room temperature

If cooled, will kill the microorganisms

NAACLS (National Accrediting Agency for Clinical Laboratory Sciences)

Accrediting body for laboratory schools

POL

Physician Office Laboratories

Glucose tolerance tests

1-hour = gestational diabetes

2 hour pp = diabetes (hyperglycemia)

3-hour = hyperglycemia

5-hour = hypoglycemia

Administering oxygen

Fully open the tank

12-15 L/min

Insert cannula into nose

NO SMOKING! Fire hazard

How often should refrigerator and freezer temperature be recorded

At least daily

Ammonia or putrid smell in urine may indicate what?

Infection

Storing blood

Each has its own requirement (ice, body temp, foil for light sensitivity)

Melena

Black tarry stool