General - NHA CCMA

Needle lengths and gauges for intradermal

3/8 inch, 27-28

Needle lengths and gauges for subcutaneous

1/2 or 5/8 inch, 25-26

Needle lengths and gauges for intramuscular

1-3 inches, 20-23

Needle gauge for venipuncture

21 or 22

Syringe parts

Common surgery procedures

-Mole/cyst removal
-Colposcopy/hyperoscopy (view inside of vagina)
-Toenail removal/ingrown
-Crytosurgery (involves cold probe to freeze and kill abnormal cells)
-Endoscopy (view internal parts such as gastrointestinal)
-Electrosurgery

Sanitization

reducing the number of micro-organisms by removing debris with soap and water prior to disinfecting

Disinfection

to clean something (work area, equipment) using chemicals that kill pathogens but not their spores

Sterilization

a technique for destroying pathogens and their spores on inanimate objects, using heat, water, chemicals or gases

Medical asepsis

clean technique; the practice designed to reduce the number and transfer of pathogens; also helps in breaking the chain of infection
(hand hygiene, sanitization, disinfection)

Surgical asepsis

complete removal of microorganisms and their spores from the surface of an object
(surgical scrub, sterilization techniques, autoclave, order of cleaning, packaging, quality control)

Autoclave

Piece of equipment used to sterilize articles by way of steam under pressure and/or dry heat
-When spots are left on instruments its is caused by mineral deposits from tap water
-Instrument corrosion occurs when improper cleaning of the chamber occurs and exposure to hard chemicals
-Damp linens are caused by a clogged chamber drain

Common laboratory test values

Also:Urine
pH=4-6.8
specific gravity=1.001-1.035
urobilinogen=0.1-1
all other values=negative

point of care testing

Tests performed at the patient's bedside or work of area, using a portable instrument.

-pregnancy, rapid strep, urinalysis, hemoglobin, spun hematocrit, blood glucose, cholesterol, helicobacter pylori, mononucleosis screening, nasal smear for influenza a and b, drug testing, and fecal occult blood

CLIA (Clinical Laboratory Improvement Amendments)

-CLIA-waived, moderate-high complexity (non waived), provider-performed microscopy procedures

-ensure quality of diagnostic testing through lab regulations ex. Pap test, blood typing and crossmatching (high-complexity), fecal leukocyte test (moderate-complexity)

-CLIA-waived (low-complexity) ex. human chrionic gonadotropin test (HCG)-> pregnancy

Venipuncture needles

Evacuated tube, syringe, and butterfly needle

Order of draw

1. Yellow, 2. Light Blue, 3. Red, 4. Gold, Tiger Top, Red/Yellow/Black, 5. Green, Light Green, Green/Gray, 6. Purple/Lavender, 7. Pink, 8. Gray, 9. Royal Blue, 10. Tan

"You Better Remember Gods Loving Grace"

Tube colors and additives

BCNHES

Blood culture-yellow
Citrate-blue
No additives-red
Heparin-green
EDTA-lavendar
Sodium fluroride-gray

CBC (complete blood count)

lavender, EDTA additive should be used when performing CBC

SPS

for bacterial studies

Lithium heparin

Proper additive for chemical studies

Sodium citrate

Proper additive for coagulation studies

Chest Lead Placement

- V1: 4th intercostal space, right of sternum.
- V2: 4th intercostal space, left of sternum.
- V3: left side of chest, midway between V2 and V4 (V4 if place before V3)
- V4: 5th intercostal space, left side of chest, midclavicular line
- V5: 5th intercostal space, left side of chest, horizontal to V4, anterior axillary
- V6: 5th intercostal space, left side of chest, horizontal to V5, midaxillary.

(electrode tabs downward on the arm)

EKG waveform

-P wave=atrial depolarization/contraction
-QRS wave=ventricular depolarization/contraction (atrial repolarization)
-T wave=ventricular repolarization/relaxation
-U wave=not visible but represents repolarization of bundle of His and Purknje fibers

Bipolar leads

Leads I, II, III
they record impulses that travel from - to + pole

I=records impulses b/t left and right arm
II=records right and left leg
III=records left arm and left leg

Unipolar leads

Leads aVR, aVL, aVF

AVL, the left leg and right arm assist with the left arm tracing. In AVR, the left arm and left leg assist with the right arm tracing. In AVF, the right and left arms assist with the left leg tracing.

Augmented

A unipolar recording that requires assisting in magnifying the tracing by drawing from other poles

Precordial

Located on the chest in front of heart

To calculate pt's heart rate from EKG tracing

Divide 1,500 by the # of small boxes b/t 2 R waves

Abnormal EKG Readings

-Arrhythmias: Sinus bradycardia, tachycardia, and arrest
-Atrial flutter and fibrillation
-Ventricular fibrillation
-Asystole
-Abnormal waves: P wave negative deflection, and premature ventricular contraction

Sinus bradycardia

Sinus tachycardia

Sinus arrest

Atrial flutter

Ventricular fibrillation

Atrial fibrillation

Asystole

P wave negative deflection

Positive deflection

Upward curvature of waves in an EKG tracing

Negative deflection

Downward curvature of waves in EKG tracing

Premature ventricular contraction (PVC)

Where do cardiac electrical impulses originate in the heart?

sinoatrial node

Papules

solid, elevated spot or area on the skin that are less than 0.5cm in diameter, a common cause is allergic eczema

Macules

flat spots on the skin that are different color than surrounding skin, such as freckles

Vesicles

small, fluid-filled lesions/blisters, common cause is herpes viral infection

Pustules

pus-filled sacs such as those seen in acne, or pimples

Problem-focused examination

Limited examination of the single affected body area or organ system mentioned in chief compliant

Expanded problem-focused examination

Limited examination of the affected body area or organ system mentioned in chief compliant and other symptomatic or related organ system(s)

Detailed examination

Extended examination of the affected body area(s) and other symptomatic or related organ system(s) as well as patient's present and past medical history

Comprehensive examination

A general multisystem examination or complete examination of a single organ system.

Farenhiet to Celcius

C=(F-32)*5/9

Units of metric system

micro=÷1,000,000
mili=÷1,000
centi=÷100
base unit=1
kilo=x 1,000
ex. 1 g= 1,000 mg
1 mg= 1,000 mcg

Household measurements

inches to feet

12 inches = 1 foot
divide by 12

feet to inches

multiply by 12

inches to cm

multiply 2.54

Convert pounds to kilograms

divide the weight in pounds by 2.2

to convert kilograms to pounds

multiply by 2.2

Body Mass Index (BMI)

a measure of body weight relative to height

18.5-24.9=normal

intramuscular injection

90 degree angle
ex. corticosteroid like dexamethasone

subcutaneous injection

45 degree angle
(slowly inject the medication)
90 degree angle for obese patients
ex. insulin

intradermal injection

10-15 degree angle
locate the area two to three finger widths below antecubital space
ex. PPD (Mantoux test for tuberculosis)

venipuncture injection

15 degree angle

Apply tourniquet…

3-4 inches above venipuncture site, don’t leave it on longer than 1 min

Blood pressure measurement for children

60/30 to 100/80 mm Hg

Normal blood pressure measurement

100/60 to 140/0 mm Hg

Elevated blood pressure

128/78 mm Hg

systolic pressure b/t 120-129 and diastolic is less than 80 mm Hg

Stage 1 hypertension

120-135/80-85 mm Hg

Stage 2 hypertension

150/95 mm Hg

Systolic pressure greater than 140 and diastolic pressure greater than 90

Pre-hypertension

120-139/80-89 mmHg

If pt faints from injection...

Elevate legs above heart, apply cool washcloth to forehead, observe pt for 15 mins, and place in supine position

Checking allergy prior to administration of meds

Wait 10-15 mins before leaving for observation

Medication routes

Oral (in mouth), Buccal (b/t cheek and gums), Topical (locally and systematic absorption minimal, skin), Mucosal (mucous mems), Sublingual (under tongue), Transdermal (continuous slow absorption), Inhalation

Immunizations

Varicella and polio vaccine for children, HPV vaccine for adolescents, andpneumococcal and zoster vaccine for adults.

These vaccines are given on a particular schedule,meaning that they require a certain number of doses given at certain intervals to be effective. Some aregiven yearly, while others confer immunity once the series is complete

Common tissue injuries

Abrasion, incision, laceration, puncture, contusion, concussion

Common limb injuries

strain, sprain, fracture

Common emergencies

Anaphylaxis, acute abdominal pain, bleeding emergencies, burns, choking, diabetic emergencies, ear and eye injuries, seizures, stroke

5 stages of grief

1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance

Providers that practice general medicine

- general practitioners
- family practitioners
- internists

Internists

provide comprehensive care of adults, often diagnosing and treating chronic, long-term conditions. They also offer treatment for common illnesses and preventive care.

Providers that specialize

allergists, anesthesiologists, cardiologists, dermatologists, endocrinologists, gastroenterologists, gynecologists, hematologists, neonatologists, nephrologists, obstetricians, oncologists, ophthalmologists, otolaryngologists, neurologists, pathologists, pediatricians, psychiatrists, radiologists, urologists

Hepatologists

specialize in the study of body parts such as the liver, biliary tree, gallbladder, and pancreas

Pathologists

specialize in body tissues, blood, urine, and other body fluids to diagnose or treat medical conditions.

Obstetricians

specialize in the care of women during and after pregnancy

Rheumatologist

specialist in the treatment of diseases of joints, muscle, and bones including fibromyalgia

Pulse oximetry

-An assessment tool that measures oxygen saturation of hemoglobin in the capillary beds
-Used when pt experiencing symptoms of pneumonia, asthma, bronchitis
**Nail polish interferes w/ results, can be clipped to earlobe instead, cold fingers can also give low reading while hyperventilation syndrome and carbon monoxide poisoning can give elevated readings

Glucose cuvettes

test strips that automatically takes precise amount of blood needed.

assistant should check coding everytime glucometer is used to ensure most accurate results therefore the cuvettes should be compared to the code on the glucometer before a pt is tested

Glucometer

device for measuring blood glucose levels from a drop of blood obtained by a fingerstick

Blood sample should be obtained after inserting a test strip in glucometer

Specials needs/accommodations for certain conditions

-weight control=weight monitoring, exercise, diet
-diabetes=blood sugar monitoring, diet, exercise
-cardiovascular disease=weight monitoring, low sodium diet, chest pain
-hypertension=BP monitoring, low sodium diet
-cancer=preventative care monitoring (Pap smears, prostate exams, etc.)
-lactose sensitivity/intolerance=lactose-free diet, signs and symptoms
-gluten-free=gluten free diet
-food allergies=food labels, allergy testing

Dietary modifications for postoperative and medical impediments

-clear liquid=broth, gelatin, plain tea, apple juice
-full liquid=juices, milk, ice cream, custard, cooked eggs
-pureed=blenderized fruits, vegetables, meats
-soft=cooked/canned foods like fish and fruits, no chewy stringy or tough foods
-mechanical soft=cooked, chopped cauliflower, soft meatloaf

Common dietary modifications

+
-malabsorption syndromes=low fiber, supplements, low fat, small meals frequently
-gastroesophageal reflux disease (GERD)=low fat, not spicy, no coffee/mints/chocolate, lactose sensitivity, no dairy, chronic constipation, high fiber

Nutrition benefits

\-carbohydrates=used for energy -fats=essential healthy fats (omega 3 fatty acids) -proteins=aid in wound healing, used for energy -minerals/electrolytes=magnesium, potassium, sodium, etc. -vitamins= B, C, K, etc. -fiber=fruits, veggies, grains -water=transporting nutrients and oxygen throughout the body, remove wastes, regulate body temp (drink 2-3L)

Major nutrients

water, carbohydrates, lipids/fats, proteins, fiber, vitamins, minerals

Proteins

-Soy=complete protein
-Incomplete proteins can form complementary proteins such as black beans and rice, pea soup w/ toast, PB sandwich, wheat and soybeans, corn and beans
-5-6oz recommend daily
-Sources (animal protein): meat, seafood, poultry, milk, eggs, and cheese
-Sources (plant protein): legumes, grains, nuts, seeds, and vegetables

Carbohydrates

the starches and sugars present in foods
-Simple sugars: honey, candy, cane sugar
-Complex carbohydrates: fruits, vegetables, cereal, pasta, rice, beans, whole-grain products->starch (potatoes, wheat, rice, corn, barley, oats, fiber)

Fats/lipids

Long molecules made up primarily of carbon and hydrogen; used to store energy in the body
-Unsaturated fatty acids less dense and heavy
-Trans and Saturated fats raises LDL cholesterol levels

Fiber

A tough complex carbohydrate that the body cannot digest
-Prevents constipation, gallstones, hemorrhoids, IBS, diverticulosis
-Whole grains, beans, nuts, fruits, and vegetables

Vitamins

Fat soluble: A, D, E, K
Water soluble: B1, B2, B3, B6, folate, B12, pantothenic acid, biotin, C

Minerals

Inorganic substances body needs in small quantities for building and maintaining body structures
(musculoskeletal, neurological, and hematological)
-Calcium, magnesium, phosphorus, potassium, sodium, iron