MA Certification Exam

CLIA-waived tests

• properly identify patient

• use proper personal protection equipment (including wearing gloves) when handling bodily fluids

• read manufacteur’s directions

• follow directions for processing specimen

• retain product insert for instructions and further referral

• record patient results before clearing equipment display

• do not mix supplies

• follow instructions for storage

sharps container

needles, anything with sharp edge or blade

must be puncture proof, leak-proof, and labeled w/ biohazard symbol

biohazard bag

gloves, gauze, bandage, anything that does not have sharp edges of needles

when is soap and water necessary?

patient suspect of having diarrhea that could be caused by highly-infectious agent, such as Clostridium difficile

patient’s temp

97.6-99.6 F (36.4 to 36.7 C)

fever range

above 100 (or 37.8) for oral or rectal/ear above 101 (38.3).

pediatric, rectal temp 100.4 (38) or above

normal BP

<120/<80 (systolic/diastolic)

prehypertension

120-139/80-89

Hypertension S1

140-159/90-99

Hypertension S2

>160/>100

hypertensive crisis

>180/>110

hypotensive stage

<90/<60

HR

60-100 bpm

athletes HR

40 bpm

tachycardia

>100 bpm, fainting, dizziness, SOB

bradycardia

<60 bpm, fainting, dizziness, SOB

respiration rate

12-20 resp/min

cyanotic skin

below or above normal resp rate; cold to the touch

vital signs

BP, temp, pulse, resp

systolic

contract

diastolic

relax

sphygmomanometer

used to measure patient’s BP

uses mmHg

has a bladder, a bulb to inflate, valve to open/close bladder, connecting tube, and Velcro

patient position to take BP?

seated position with feet flat on floor

prepare BP reading

1. palpate the brachial artery in the antecubital fossa

2. palpate both arm regions

3. position in outstretched relaxed position

4. 1 inch above elbow bend

5. gauge at eye level

6. don steth

7. bell between first and second fingers

reading BP

first beat you hear is the systolic, the second you no longer hear is diastolic

why is HR important?

provides info about rhythm, volume, and vessel elasticity

what do you use for HR

radial artery in wrist

either measure for 30 sec or 1 min

where to take temp?

tympanic membrane (aurally → in ear), orally, temporally artery, axillary

rectal is most accurate

what should the MA ask patient before performing temp?

if they have drinken/eaten, smoked cig, or exercised in past 30 min

why no rectal temp?

potential risks, uncomfy, patient has hemorrhoids, rectal bleeding, or surgery, tendency of bleeding, recent prostate surgery, diarrhea, colostomy, severe heart disease, or rash in rectal area

rectal temp instructions

remove pants, provide drape, wash hands and don gloves, grab supplies (including water-based lubricant), guide into Sims’ position

insert probe around 1 inch (1/2 inch if pediatric)

Sim’s position

anthrompometric measurements

height/weight

remove coat, no purse or heavy weights

weight to nearest ¼ inch

additional pediatric anthropometric measurements

head circumference (up until 3 yrs) and length (until child can stand)

Supine

head circumference measurement

Celsius to Fahrenheit

(Cx9/5) + 32

F to C

(F-32) x 5/9

lb to kg

1 lb = .45 kg

kg to lb

• 2.2

inch to cm

*2.54

cm → in

x0.39

dorsal recumbent

Fowler

Semi-Fowlers is 45*

prone

types of medication administration

oral, topical, parenteral

oral medication

liquid, tablet, capsule

topical med

applied on skin for local effect

lotions, liniments, ointment, also transdermal patch

for transdermal patch, med transfered slowly through skin → write date on patch for administration

parenteral medication

injections

Intramuscular

deltoid (2-3 finger widths below acromial process), vastus lateralis (outer side of thigh), gluteus maximus, gluteus medius

90*, 2.5-5 cc syringe, 20-22 gauge, 1-1 ½ inch needle

**aspirate

intradermal

upper chest, upper back, volar (back of hand side) forearm

15-20*, 1 cc, 25-27 gauge, 1/4-1/2 in needle

allergy testing, patient in prone (upper back)

TB, form wheal check 48-72 hours

subcutaneous

posterior upper arm, lateral upper arm, abdomen, anterior thigh

45*, 2.5-3 cc, 23-25 gauge, 1/2-7/8 in needle

Pulmonary Function Test (PFT)

• when patient’s lung volume/strength in question

• refrain from nebulizers (turns liquid me into mist) and bronchodilators (meds that widen airways in lungs) for 6 hrs prior

• spirometer - measures airflow: patient takes a deep breath and blows as hard as possible into tube

  • 3 acceptable tests goal

Snellen chart

typical chart with letters, patients 20 ft away with spoon over one eye

• start with 20/70 row, then 20/60, so on

• exam stops when they cannot read or make two mistakes— last accurate line is recorded as vision for given eye

Suture removal

after prepping, grab knot on suture with forceps, cut suture close to skin, gently pull suture through the skin and place on gauze pad

Obtain/Label Specimens for Diagnostic Purposes

bodily fluids: urine, sputum (salive and mucus), feces, semen, blood

Urinary Analysis

random collection, midstream (urinate little, collect, then continue), clean-catch (area around urethral opening cleaned by patient prior), timed, first of morning, tasting

• Physical characteristics: foamy, color

• chemical analysis: pH (6), specific gravity (urine density 1.002-1.035), glucose, ketones (diabetic ketosis), nitrate (bacteria), protein, human chorionic gonadotropin (hCG) (pregnancy), leukocyte esterase (clean-cath, midstream)

catherization

enables you to drain bladder contents, decompress bladder, obtain specimen, and introduce passage into genitourinary tract

• indicates kidney fucntion

• sized in French units (1 FR = ½ mm)

• vary from 12 FR (small) - 48 FR (large)

complications: urethral trauma, blood at meatus of urethra, scrotal hematoma, pelvic fracture, high riding prostate

alternatives: suprapubic catheterization and external condom catheters

sputum

3-5 mL collected in morning or 1 hour after meal

• to detect lower respiratory traction infections (TB)

saliva

used to monitor hormone/drug/alc levels

fecal

presence of parasites, blood, bacteria

semen

fertility testing/future insemination

eye irrigation

inflammation, drainage, chemicals, foreign bodies in patient’s eye

• after prepping (usuls prep stuff, container holding irrigation fluid, and collection container), open eyes with first finger and thumb an aim solution into lower conjunctiva sac

• begin flow at inner canthus of eye

ear irrigation

impacted w/ cerumen (earwax)

• after prepping (container holding irrigation fluid, drainage basin, and otoscope (shines beam of light to help visualize)), pull ear up and back (patients younger than 3 pull ear down and back) and rotate between using otoscope to check progress and squirting irrigation fluid

surgical aspesis

removal/absence of microorganisms and pathogens along w/ maintaining elimination of all microorganism and pathogens

• sterile techniques, invasive activities

• autoclave

• sterilization

autoclave

used to sterilize some items

250-320 degrees F

sterilization

process of eradicating the presence of growth of microorganisms and pathogens

medical aspesis

reduction of number and prevention of growth of microorganisms and pathogens

• handwashing and disinfecting (Cidex or bleach and water in 1:10 ratio)

venipuncture verification

1. name of physician ordering test

2. patients name

3. patients DOB

4. type of test being performed

5. date of test being performed

6. test status: fasting, basal state, or timed test

7. any special precautions: patient latex allergy, mastectomy, or other information that may affect the blood draw

blood draw for inpatient

patient’s medical record number, room number, bed number

blood draw for outpatient

billing info and ICD-9 codes must be present

veins in antecubital fossa

median cubital, basilic, cephalic

• if not, dorsal of hand

• veins should be spongy and bouncy

syncope

fainting

blood draw in younger than 2

capillary preferred

• blood draw - scalp, wrist, medial ankle

• capillary collection - preferred medial or lateral plantar portions of heel

EKG placement

RA (white) — right arm

LA (black) — left arm

RL (green) — right leg

LL (red) — left leg

V1 (red) — 4th intercostal space on right

V2(yellow) — 4 IS on left

V3 (green) — b/w V2 and V4 (place after them)

V4 (blue) — 5th IS left midclav line

V5 (orange) — b/w V4 and V6 (anterior axillary)

V6 (purple) — midaxillary in line w/ V4

• precordial leads and limb leads?

12-lead

Holter monitoring

for placing electrodes for Holter monitor, important to determine if monitor 3-channel, 5- or 7- lead model

pg 41?

ambi-

both

olig-

scanty (insufficient)

infra-

below, beneath

meta-

change

supra-

excessive, outside

super-

excessive, more

ultra-

excessive

para-

along, beside

per-

through

retro-

backward, behind

corp-

body

cost-

ribs

hemat-, hem-

blood

muscul-, myo-

muscle

nephr-, ren-

kidney

neur-

nerve

-meter

measure

-scope

instrument for viewing

-graph

record

-lactric

treatment

-tripsy

crushing

HIPAA

Health Insurance Portability and Accountability Act

• governs sharing or disclosure of patient information

• patients must sign a ROI (release of information) stating what info can be released

• privacy rule: minimum necessary standard to protect patient info is applied

  • applies to medical records being forwarded to insurance for payment requirements

• security rule: requires specific tech precautions be taken to ensure that patient info stored/transmitted in electronic format remains confidential, accessible, and of high quality

Chain of Command

• office manager = physician’s representative (changes adhered to)

  • responsible to provide/arrange training necessary for subordinates to fulfill required tasks

• relays info to subordinates