Essay q’s ch 1-17, additional – Flashcards

. Most health care workers interact with numerous individuals in the health care setting as they perform their job functions. For phlebotomists, interactions occur prior to, during, and after the actual phlebotomy procedure takes place. At each stage, there are factors that can affect the quality of the laboratory test results and hence, the outcome of care given to pa-tients. It is essential that all members of the health care team share the goal of providing qual-ity care to patients. This is accomplished by teams who demonstrate the following attributes: • Know and understand the mission, goals, and objectives of the team • Understand group processes and team dynamics • Be reliable and dependable • Communicate effectively • Respectfully participate in decision making • Manage conflicts in a constructive manner • Actively contribute to the cohesion of the team • Contribute to problem solving • Support and encourage team members 2. Professionalism is the skill, competence, or character expected of someone in a particular pro-fession. The four categories that can be used to interpret one's perspective of professionalism are: • Respecting others (i.e., confidentiality, courteous behavior, tolerance of differences, effec-tive communication) • Service and commitment to job duties • Supporting organizational policies/procedures • Personal growth 3. Examples of stress-inducing scenarios may include dealing with terminally ill patients or an-gry patients/visitors, uncomfortable peer relationships, excessive overtime, pressure to work faster, excessive changes in policy/procedure. Box 1-7 lists tips for dealing with stress, in-cluding finding time for privacy, planning rest/relaxation periods, associating with gentle people, seeking out humor, physical exercise, nutritious diet, taking vitamins, finding hobbies or enjoyable social activities, rearranging schedule, keeping a journal, reading interesting books or articles to get new ideas, avoiding harmful habits, or seeking professional advice if needed.

There are a variety of practical strategies that could facilitate communication in this scenario. Distractions such as the television could be handled by asking the patient if he or she would mind turning the television off or putting the volume on Mute for a short while. (The phlebotomist should remember to turn up the volume at the completion of the interaction.) If the patient does not want to miss the program, and if the timing of the interaction is not im-portant, then the phlebotomist can offer to come back at a time when the program is over. Regarding the relatives, it is acceptable for the phlebotomist to ask them, "Would you mind if Mr. Smith (the patient) and I have a few minutes together; you may wait outside during the procedure and I will call you in as soon as we finish." The patient may prefer to have a rela-tive in the room; this is acceptable if it does not interfere with the interaction. There are sev-eral options to cope with the patient's hearing loss, including speaking slightly louder (but not shouting) while facing the patient directly, or using written instructions. 2. Individual answers will vary but are likely to include some of the following bothersome be-haviors: • Wandering or rolling eyes during a conversation • Staring at the ceiling • Squirming, pencil or foot tapping • Peering over glasses • Deep breath, sighs • Wrinkled forehead • Having someone point a finger at you • Stretching, yawning Individuals also react differently to these "negative" behaviors, ranging from being intimidat-ed, to having hurt feelings, to defensive anger.

. Implied consent occurs when the patient's nonverbal behavior indicates agreement, whereas informed consent is voluntary permission by a patient to allow touching, examination, and/or treatment by health care personnel only after signing a legal informed consent form. 2. • Patient falling after blood is collected • Hematoma (hemorrhage caused by inadequate pressure to the vein) • Abscess or other infections at the venipuncture site • Injuries from fainting before, during, or after blood collection • Nerve damage due to poor venipuncture technique • Complications from collecting blood from the same side as a mastectomy (removal of breast) Wristband or identification error leading to wrong diagnosis and treatment and injury or death in some cases

1. Gloves should be placed on hands first. Then a dilute solution of chlorine bleach (1:100) can be used for routine cleaning of surfaces. All dilute solutions of chlorine bleach need to be made weekly to prevent the loss of germicidal activity. 2. A protective isolation facility is a hospital room that is completely sterile. All food and arti-cles are sterilized before they are taken into the patient's room. These areas are for immuno-compromised patients.

1. Class B fires include liquid, grease, and chemical fires; an ABC extinguisher or carbon dioxide extinguisher should be used. 2. • First, the electrical power source must be shut off. If this is impossible, carefully remove the electrical contact from the victim, using something that does not conduct electricity. For example, place your hand in a glass beaker and push the power supply away from the victim. The rescuer should not attempt to touch the victim without heeding these precau-tions. .• Next, medical assistance should be called and cardiopulmonary resuscitation (CPR) started immediately. The victim should not be moved prior to the arrival of medical assistance. A fire blanket or warm clothing should be put over the victim to keep him or her warm until medical help arrives.

Essay Questions 1. Refer to Figure 6-8 (p. 174) in the textbook. 2. Refer to Figure 6-8 (p. 174) in the textbook.

1. • Vascular phase: injury to a vessel wall occurs • Platelet phase: platelets begin to aggregate at the site of the injury and adhere to the site • Coagulation phase: clotting factors are released and clot formation takes place • Clot retraction phase: after complete clotting has occurred, the clot begins to retract • Clot destruction phase: eventually, as healing takes place, the body enzymatically destroys the clot. 2. Axillary lymph nodes are in the armpit area near the breast. They are frequently removed dur-ing a mastectomy (surgical breast removal). Thus, these patients lose drainage ability on that side. Phlebotomists should not collect blood specimens from the mastectomy side due to the accumulation of additional fluids resulting from the lack of lymph nodes in the area.

1. If a purple-topped tube is underfilled, the test results will show: • Falsely low blood cell counts • Falsely low hematocrits • Staining alterations on blood smears • Erroneous morphologic changes to RBCs 2. Oxalates, citrates, and EDTA prevent the coagulation of blood by removing calcium and forming insoluble calcium salts. These three anticoagulants cannot be used in calcium deter-minations; however, citrates are frequently used in coagulation blood studies. EDTA prevents platelet aggregation and is therefore used for platelet counts and platelet function tests. Fresh EDTA-anticoagulated blood allows preparation of blood films with minimal distortion of white blood cells (WBCs). Heparin, a mucopolysaccharide used in assays, such as ammonia and plasma hemoglobin, prevents blood clotting by inactivating the blood-clotting chemi-cals—thrombin and Factor Xa.

1. The phlebotomist needs to place the patient's arm in a downward position and the tube stop-per (top) in the uppermost position to avoid the risk of backflow of an anticoagulant from a blood vacuum tube into the patient's circulation during venipuncture. 2. The patient should be moved from a seated position to a lying position to avoid the possibility of falling during the blood collection procedure.

1. Blood volume losses due to phlebotomy can be a significant problem for hospitalized pa-tients, especially for pediatric patients. All phlebotomists should be sensitive to the total number of daily venipunctures/phlebotomy procedures for patients. Strategies for reducing the liklihood of iatrogenic anemia include: • Maintain a log of the frequency and volume of blood collected for each patient • Organize laboratory orders to try to coordinate draws • Monitor the number of times a patient can be punctured • Coordinate TDM tests with other testing requirements if possible • Coordinate other timed tests with routine specimens, if possible • Be aware of patient transfers and if other tests are ordered after the transfer • Follow procedures for discarding blood from IV lines or for butterfly draws; do not dis-card too much • Participate in educational programs with nurses and physicians to remind them of volume requirements for panels of tests, how to coordinate timing of tests, etc. 2. It is understandable that some patients may not allow you to have another chance at their veins. This is particularly true for patients who are sensitive to pain or become faint during such procedures, since their level of anxiety is already higher. Individuals have a right to re-fuse, and most health care facilities have procedures for documenting a patient's refusal. However, a phlebotomist can politely, calmly, and professionally explain to the patient that the lab results are used to help the physician make an accurate diagnosis, establish proper treatment, or monitor the patient's health status so his or her cooperation would be appreciat-ed. If you honestly feel that you can get the specimen with another try, you might explain that if you don't get the blood specimen on the second try, you will not try again. On the other hand, if you do not feel confident, you should not attempt a second time; instead, you should tell the patient that you will seek out someone else who may be able to perform the puncture. If the patient continues to refuse, the phlebotomist must remain professional and acknowledge this refusal, and document the situation. The physician should also be notified of the situation. Keep in mind that in some facilities and depending on the tests ordered, you may be able to offer the patient a fingerstick in lieu of a venipuncture. However, it is important to follow your employer's procedures in these cases.

1. Alcohol that has not dried on a skin puncture can prevent a round drop from forming, cause hemolysis of blood cells, and/or cause erroneous results for some laboratory tests. 2. Venous blood is deoxygenated; arterial blood is oxygenated; and capillary blood is a mixture of both arterial and venous blood plus some interstitial tissue fluid. Capillary blood is thought to be slightly more arterialized (i.e., contains slightly more arterial blood than venous blood), because the pressure in the arteries is greater.

1. Excessive agitation causes hemolysis of the specimens when the RBCs rupture as a result of the rough handling. Hemolysis causes numerous chemical interferences with the laboratory test results. 2. Blood specimens should be loaded in a balanced orientation; each tube is loaded directly across from another tube of a similar volume/size. If they are not properly balanced, it can result in numerous consequences, including breakage, inadequate separation, and excessive vibrations that can potentially damage cells.

1. • Blood specimen not properly dried before mailing; • Filter paper circles not completely filled, not saturated with blood, or not ALL circles filled • Contamination of filter paper circles before or after blood collection by substances such as hand lotion, powder, alcohol, antiseptic hand solution; touching of areas with gloved or ungloved hands • Blood applied to both sides of filter paper • Excess blood applied (usually occurs with a capillary tube) • Heel stick is squeezed or milked, resulting in tissue-diluted specimens • Alcohol is not wiped off of heel stick site before puncture is made. 2. • Sterile, automatic, disposable pediatric skin-puncture safety devices in different manufac-turers' incision depths (0.65-0.85 mm for premature neonates, 1.0 mm for larger infants). Please see Chapter 8, Blood Collection Equipment, for photo examples • 70% percent isopropyl alcohol swabs • Sterile 22 gauze sponges • Newborn screening cards—appropriate collection cards are kept in the hospital laboratory or the nursery (do not use if beyond expiration date on filter paper!) • Puncture-resistant sharps container • Disposable gloves (non-latex if child is allergic) • Compress (towel or washcloth) to warm heel if necessary • Marking pen • Laboratory request slips or labels

1. Monitoring blood coagulation (i.e., PT/prothrombin time and INR/International Normalized Ratio) through point-of-care testing provides immediate results that can be used to control bleeding or clotting disorders in patients. 2. The high density lipoprotein (HDL) cholesterol is referred to as the "good cholesterol" since increased blood values are protective for the patient from heart disease. The low density lipo-protein (LDL) cholesterol is referred to as the "bad cholesterol" since high values usually are linked to heart disease.

1. A fingerstick is commonly used to collect blood for such determinations. The health care worker may either collect blood in a plastic hematocrit tube for centrifuging and reading, measure hemoglobin spectrophotometrically, or use the copper sulfate method, in which the hemoglobin is qualitatively determined. The hematocrit value must be no less than 38 percent for donors and the hemoglobin value must be no less than 12.5 g/dL. 2. Therapeutic phlebotomy is the intentional removal of blood for therapeutic reasons. It is used in the treatment of some myeloproliferative diseases, such as polycythemia and hereditary hemochromatoisis, or other conditions in which there is an excessive production of blood

1. The routine UA includes a physical, chemical, and sometimes microscopic analysis of the urine sample. The physical properties include color, transparency vs. cloudiness, odor, and concentration as detected through a specific gravity measurement. The chemical analysis for abnormal constituents is determined by using plastic reagent strips that test for the presence of glucose, protein, blood, hemoglobin, white blood cells, ketones, bacteria, bilirubin, and other constituents. 2. Sputum is collected in a sterile container for microbiology specimens to test for pathogenic organisms including TB. Also, sputum is collected for cytology testing.

1.As a supervisor it is important that your workforce be as fit and able as possible to conduct their work duties in a professional and competent manner. Employers should have definitive guidelines for when and how drug testing may occur for employees and you should be in-formed of these. Drug tests are sometimes required to comply with contract or grants, or to identify users in order to refer them for counseling and guidance, to investigate the reasons for an incident or accident, and most importantly to help avoid harm to patients or to the workers themselves. Do not ignore suspicious behaviors among employees. If there are reasons to suspect that an employee is impaired due to drugs, follow procedures for referring the employee before he or she injures themself or someone else. 2.It is sometimes hard to separate your own feelings about a patient from your professional duties; however, regardless of what you think about this patient, you must always act profes-sionally and with respect for every individual, including the drunk driver. It is not appropriate to judge the circumstances, but it is important to fulfill your job duties efficiently and effectively so that further investigations can take place knowing that the test specimen and laboratory results are accurate. Every hospital has SOPs for handling this type of emergency and for the appropriate requests to take place. Once you are authorized to collect the specimens, and assuming that a blood alcohol level is ordered, it is vitally important that identification proce-dures be followed and that the venipuncture or skin puncture sites be carefully prepared. Re-member to use alternative skin cleansing products to avoid alcohol contamination of the specimen from an alcohol pad.

1. Biohazard labels should be placed on containers of regulated waste, refrigerators, and freezers that contain potentially infectious material. In addition, containers used to store, transport, or ship blood or infectious materials should be labeled. 2. There are detailed figures of the correct packing materials and labeling requirements in Appendix 9, page 582. Make sure you consider all the requirements for the primary container and the secondary container.