EkG interpratation

p wave(created by SA node)

Artial depolarization(artial contraction)

QRS Segment

Ventricular depolarization ,(and atrial repolarization), not seen.

T wave

Ventricular repolarization.

PR interval(represents the AV node is , created)

0.12-0.20(Measuring of the PR interval represents the AV node is created and it acts as an gatekeeper, giving atria, time to dump blood into the ventricle.

PR segment is after the P wave

and the PR interval is before P wave.

This PR interval demonstrates the artia signal to go from artia to AV node.

QRS

<0.2

Each small square on the EKG paper.

0.04

Every big box on the Ekg paper

0.20

EKG Interpretation

Determining, the rate of Ekg

Count R ‘s in an EKG paper.

Count R’s with a 6-second strip and multiply by 10.

R-method

Count small boxes between R”s divide that number by 1500

Count big boxes between R s divide tht number by 300

Analyzing the PR interval ?

If are they present or they upright?

Count number of boxes between p and R interval and multiply by 0.04

For example: 3 boxes so 3×0.04 =0.12

If 4 boxes 4×0.04=0.16

Measure QRS interval

If 2 boxes then

2×0.04=0.08

3×0.04=0.12

J point

Represents ,where the QRS complex meets the ST segment.

ST segment

Represents the ventricular depolarization, and the beginning of the

ventricular repolarization.

ST segment need to be flat , without no depressions or elevations.

Isoelectric point

Describes of a straight line of the PQRST complex representing the resting of the heart cell.

U wave

Doesn’t seem in all patents

may be due to low potassium, hypokalemia.

QT interval

It represents the time it takes for electrical signals cause the ventricle to contract and then rest

Ventricular

Augmented

The right leg grounds the augmented leads in the course of an ECG procedure.

PR interval

The PR interval normal range is 0.12-0.2 seconds, the QRS complex range is 0.06-0.10 seconds (greater than 0.12 is considered abnormal and you would need to consider a bundle branch block), the QT interval is approximately 40% of the heart rate. The choice in this question that meets all of these criteria is "C" (PR interval of 0.14 second, QRS complex of 0.10 second, QT interval of 0.40 second and HR of 78).

patient for deterioration of symptoms.

This rhythm is considered a second degree AV-block due to the extra P-waves. The AV-node will select either to conduct or block the impulses from the SA node. This causes more P-wave than QRS complexes. The medical assistant needs to monitor the patient after notifying the physician. The rhythm strip is a Lead II strip, which means it is from the limb leads, therefore the technician does not need to check the precordial leads V1-6.

normal sinus rhythm

The strip shows normal sinus rhythm because the rate is normal and arrhythmia is not noted. Bradycardia would occur if the rate is slower than 60 and tachycardia is not correct because the rate would need to be faster than 100.

P wave

atrial contraction.

Baseline

baseline is the heart at rest.

QRS complex

ventricular contraction,

T wave

ventricular relaxation.

ventricular fibrillation 

A ventricular fibrillation is the most life threatening arrhythmia, requiring immediate shock (defibrillation) and BLS intervention to reverse. Though the other choices in this scenario can be important, the ventricular fibrillation could lead to the most dire patient outcome, hence the need for immediate notification of the physician.

Lead II

Lead II records tracings between the right arm and left leg. This is the lead recorded on a rhythm strip at the bottom of a 12 lead ECG.

27 G

The larger the number, the smaller the gauge.

Povidone-iodine (Betadine)

Povidone-iodine (Betadine) is the antiseptic used to collect blood cultures

A patient with blood thinners.

non-adhering bandage

Non-adhering bandage material would be helpful for patients on anticoagulant therapy who may bleed more extensively than typical patients after venipuncture. It is necessary to contain the bleed with a bandage, but adhesive might bruise once removed from a patient who has anticoagulated blood.

Anticoagulation therapy

PT and PTT

PT and PTT are coagulation tests (collected in blue top tubes)

They are routinely collected to monitor a patient's anticoagulant drug therapy (to make sure that the dose the patient is taking provides the proper effect, but does not dangerously over-anticoagulate and introduce a critical risk of bleeding)

In short, these tests monitor a patient’s blood clotting time.

T3 and T4

Are thyroid tests.

Hgb and Hct

Reflect the amount of hemoglobin in the red blood cells and the number of red blood cells per volume of whole blood (hematocrit)

ABO and Rh

ABO and Rh are blood typing tests that determine a patient's blood group.

PICC line

PICC line draws are outside an entry level MA's scope of practice. It should be noted that a facility may offer special training for PICC line draws, but specific training must be completed and competency assessed before any personnel collect such specimens

DVT

deep vein thrombosis

Blood thinners are a common treatment for DVT.

A foot draw would not be recommended in this case.

Von Willebrand’s disease

PT/aPTT test is used.((Von Willebrand disease is an inherited condition that can cause extended or excessive bleeding.)

Those affected have deficient amounts or impaired von Willebrand factor, a protein important to the clotting process. Thus, the phlebotomist must hold steady pressure on the venipuncture site until all bleeding has stopped.)

The collection site does not need confirmation from anyone, as the disease would not affect site selection.

Edema

Edema is not a problem

blood pressure cuff

blood pressure cuff could force more bleeding if applied after the draw.

Fistula

The AV fistula requires the surgical connection of a vein and artery, typically in the forearm.

It is predominately used for patients in renal failure who may need long term dialys.

To avoid any complications, blood draws are contraindicated

Central venous access devices/catheters are small, flexible tubes placed in large veins for people who require frequent access to the bloodstream. They are more easily created than the arteriovenous fistula, and there are more available locations for placement.

Draw from the right arm distal to the I.V. site

Collecting blood distal to the I.V. site prevents contamination of the sample by the intravenous solution. Medical assistants are not permitted to collect samples from an I.V. line and may not draw from an ankle vein without physician’s approval.

Blood pressure cuff

The only acceptable choice among the listed options is the blood pressure cuff. Occlusion pressure may be adjusted as needed as an alternative to ensure circulation. In compliance with CLSI (Clinical and Laboratory Standards Institute) standards, the blood pressure cuff can provide uniform constriction, as long as the phlebotomist doesn't inflate the cuff beyond 40 mm of mercury.

gel separators

Gel separators create a barrier between the serum and formed elements of the blood. Prolonged contact of serum with formed elements can lead to pre-analytical variations in certain tests (such as serum glucose levels).

Tubes with clot activators

Tubes with clot activators, such as thrombin, actually expedite the clotting process.

Anticoagulant tubes

Anticoagulant tubes keep the blood from clotting, yielding plasma instead of serum

Sulfosalicylic acid

Sulfosalicylic acid is used in urine testing to precipitate proteins.

Green-top

A green top tube contains hearin. Green tops are used for collection of heparinized plasma or whole blood for special tests.

After the tube has been filled with blood, the tube is inverted several times to prevent coagulation. Note: Green top tubes can contain ammonium, lithium, and sodium in addition to the heparin

. In this instance, lithium heparin would be the green-top of choice (and sodium heparin would NOT be used for an electrolyte test). Electrolytes can also be collected in a red-top tube.

heel stick lancet

The heel stick lancet (e.g., Tenderfoot) is required for infants. If a heelstick in an infant is being performed, the phlebotomist should apply a warming device for approximately 3-5 minutes to the heel to increase blood flow to the area, which will facilitate the collection of the capillary specimen. The bones of the distal phalanx (located in the thickest part of the finger) may be injured or damaged by a traditional finger stick lancet puncture.

plantar surface of the heel

A heel stick should be performed on the lateral or medial portions of the plantar surface of the heel-skin surface (left and right). Never stick the center area of heel, the arch, or the back of the heel. Avoid puncturing the bone by targeting the plantar surface. Draw an imaginary line starting in the middle of the big toe to the back of the heel. Then draw another imaginary line between the small toes to the back of the heel. The proper collection sites will be the fleshy portions outside those lines and below where the arch meets the heel. The anteromedial aspect, lateral surfaces and plantar curvature do not provide good flesh for a proper collection.

21.

The 21 gauge needle is long enough and thin enough to access most veins and the internal diameter (bore size) is wide enough to permit blood collection with little concern about mechanical hemolysis when using evacuated tubes. Butterfly collection sets (wing sets) typically use needles of a higher gauge, and blood donation centers typically use needles of a lower gauge. Remember, the higher the gauge, the smaller the bore (opening).

Use a smaller tube because the vein has collapsed.

Since blood was once filling the tube, the needle was once in the vein. Since the phlebotomist knew this was a small vein at palpation, the fragility of the vein may have caused the vein to collapse if the vacuum of a regular size collection tube was too strong. Putting a smaller tube on the multi-sample needle would decrease the force of the vacuum pulling blood from the vein. If blood flowed easily again, problem is solved! Presuming the phlebotomist had a steady hand during the draw, the other causes could be ruled out. Since blood filled the tube normally for a time and slowed to a stop, there is no reason to believe the needle had been moved. And if the bevel was still in the vein at all, blood would still be able to trickle into the tube.

ESR

The Erythrocyte Sedimentation Rate (ESR) is a common test to detect inflammation by measuring the rate at which red blood cells settle to the bottom of a tall, thin tube. Since inflammation can cause cells to clump, these clumps are heavier than single cells and settle more quickly. The test measures the distance settled in one hour. This test is most useful in combination with other more specific laboratory tests.

EBV(Epstein bar virus)

Epstein Barr Virus (causes a number of diseases, including infectious mononucleosis)

CRP

C-Reactive Protein ( appears with inflammation in the body)

INR

INR = International Normalized Ratio (a measure of coagulation)

capillary using heel puncture lancet

PKU is a neonatal screening test collected on a blot card. The recommended method of blood collection on infants less than a year old is via capillary (thus eliminating the venipuncture choices)

Venipuncture on the foot is performed in which of the following locations?

dorsal pedis

Blood collection

Patients with central lines would be candidates for specimen collection from dorsal side of the hand. Venous samples are not collected from the palmar side of the wrist; veins are accessible from the dorsal side. Fingersticks are not performed on newborns as the blade depth could injure nerves in the fingertips and blood would be difficult to extract. Heel sticks may be performed on newborns, but not in the central section of the plantar surface. Nerve and/or tissue damage could result.

amber tube to protect from light.

Bilirubin is a photo-sensitive analyte (can degrade by as much as 50% with an hour of light exposure). A specimen submitted for bilirubin testing should be collected in an amber tube which will protect it from light (a regular tube wrapped in aluminum foil could also be acceptable). It is not necessary to keep the specimen warm with a heel warmer, nor is it necessary to chill the specimen to slow metabolism and stabilize the specimen. As long as the specimen is properly collected, protected from light, and handled according to normal serum protocol, it can be run as routine, thus Stat analysis is not necessary.

heel of the foot

The heel of the foot is the recommended site to obtain a capillary sample on infants less than one year. The lateral (outside) or medial (inside) planter surface of the heel should be used for heel stick puncture. Never puncture other areas on the heel, as injury and /or nerve damage can occur.

light blue

A light blue top tube contains sodium citrate to prevent blood from clotting.

This tube contains sodium citrate as an anticoagulant and is used when blood is drawn for coagulation studies. Note: It is imperative that the tube be completely filled. The ratio of blood to anticoagulant is critical for valid prothrombin time results. Immediately after the draw, the tube needs to be inverted 6 to 10 times to activate the anticoagulant.

EDTA tube

An EDTA tube contains the anticoagulant sodium ethylenediamine tetra-acetic acid, which prevents clotting.

Red top tubes

Red top tubes can be plain or have gel separators.

Plastic red top tubes

Plastic red top tubes can contain a clot activator to expedite the clotting process.

Common blood collection tubes are already sterile, thus don't contain antimicrobial additives.

lavender top, ethylenediaminetetraacetic acid additive

A CBC is performed on a whole blood sample. It should be collected in a lavender top tube containing ethylenediamine tetracetic acid additive as an anticoagulant

Blue top tubes

Blue top tubes contain sodium citrate anticoagulant and are commonly used for coagulation studies (PT, PTT, etc.).

Green top

Green top lithium heparin tubes are commonly collected for chemistry tests that can utilize plasma.

Red top tubes

Red

top tubes containing no additive will clot and form serum (commonly used for chemistry and serology testing requiring serum).

light blue top 

Sodium citrate (light blue top tube) is the anticoagulant of choice for coagulation studies such as PT/INR (Protime/International Normalization Ratio) because it does not bind to calcium or inactivate heparin, which may be required to be present in such testing

Lavender top tubes

Lavender top tubes contain EDTA as the anticoagulant, which does bind calcium.

Green top tubes

contain heparin and could lead to inaccurate coagulation studies.

Complete Blood Count (CBC)

lavender top tube((EDTA))

light blue top tube((sodium citrate))

Prothrombin Time (PT)/INR = light blue top tube (sodium citrate)

green top tube (heparin)

Metabolic Panel (BMP) = green top tube (heparin); since the centrifuge is not functional and there is a bit of a delay between draw time and courier pickup/delivery to the laboratory,

gray top tube

gray top tube would best preserve the glucose value within the BMP.

Lavender top tube

EDTA

Light blue top tube

sodium citrate

Green (dark) top tube

heparin

Gray top tube

potassium oxalate

additive to blood

Blood collection tubes are medical devices and manufacturers’ directions for use must be followed as for any other medical devices. This is particularly crucial with respect to any stated minimum fill line for tubes with additives. If too little blood is drawn in a tube with an additive, the ratio of additive to blood is higher than expected. Insufficient sample volumes produce “relatively” elevated levels of the additives in the sample collected. There is simply too much additive for the amount of blood in the tube. Here are just a few examples of problems: Relatively elevated levels of EDTA (which binds calcium to prevent clotting) can bind too much calcium and begin binding other elements in the blood, which can affect several laboratory tests. Too much heparin per blood volume can produce negative anion gaps, slow antigen-antibody reaction rates, falsely low albumin levels, and significantly higher CK (creatinine kinase) levels.

HGB

HGB is an abbreviation for Hemoglobin, typically measured as part of a Complete Blood Count and collected in an evacuated tube containing Ethylenediaminetetraacetic acid (EDTA). Hemoglobin is a protein inside red blood cells that carries oxygen to organs and tissues, while also transporting carbon dioxide back to the lungs.

BMP = basic metabolic panel

BMP = basic metabolic panel (common screening panel with tests for renal function, electrolyte balance, glucose, and more)

HCG

human chorionic gonadotropin (pregnancy test)

PTT

partial thromboplastin time (a common test for coagulation abnormalities or to monitor patients on heparin therapy)

They can also be used for toxicology and nutritional studies.

The most common tubes that contain EDTA are lavender top/light pink tubes.

Royal blue

Royal blue blood Collection tubes may be purchased with EDTA, sodium heparin, or no additive at all. They are used for trace element testing via plasma or whole blood.

Share the plain red top specimen for the SST test.

A plain red tube and an SST tube both will yield serum once clotted and centrifuged. Therefore, it is possible to share the plain red top specimen for the SST test. There is no need to re-stick the patient.

The lavender and blue top tubes

both contain anticoagulant, thus they produce plasma (not serum) when centrifuged. They would not be good substitutes for an SST specimen.

Alanine aminotransferase (ALT) or Aspartate aminotransferase (AST)

gray-topped tubes

Term

Image

The sodium fluoride in gray-topped tubes can destroy many enzymes. Since ALT and AST are enzyme tests, sodium fluoride should be avoided.