NHA Clinical Medical Assistant Study Guide (Virginia College)

Depolarization
Contraction of the heart (-)
Repolarization
Relaxation of the heart (+)
Sympathetic Nervous System (SNS)
Affects both the atria and the ventricles by increasing heart rate. conduction, and irritabilty.
Autonomic Nervous System (ANS)
Is subdivided into the sympathetic and parasympathetic nervous system.
Parasympathetic Nervous System
Affects the atria only by decreasing heart rate, conduction and irritability.
Atrioventricular Valves (AV)
Located between the atria and ventricles.
Tricuspid Valve
Located between the right atrium and the right ventricle.
Mitral Valve
Located between the left atrium and the left ventricle (also called the bicuspid valve).
Murmurs
Caused by diseases of the valves or other structural abnormalities.
S1
The first heart sound that occurs with the closure of the AV valves and signals the beginning of systole.
S2
The second heart sound which occurs when the semilunar valves (aortic and pulmonic) close.
Aortic Valve
Located between the left ventricle and the aorta
Pulmonic Valve
Located between the right ventricle and the pulmonary trunk
Right Atrium
Receives deoxygenated blood
Superior Vena Cava
Carries the blood from the upper body
Inferior Vena Cava
Carries the blood from the lower body
Pulmonary Arteries
Arteries that carry deoxygenated blood from the heart to the lungs (left and right)
Left Atrium
Receives oxygenated blood returning from the lungs via the right and left pulmonary veins.
Pulmonary Veins
Only veins that carry oxygenated blood.
Left Ventricle
The chamber on the left side of the heart that receives arterial blood from the left atrium and pumps it into the aorta
Upper Chambers of the Heart
Left and right atria (atrium is singular)
Lower Chambers of the Heart
Left and right ventricle.
Endocardium
The innermost layer of the heart.
Myocardium
The middle layer of the heart.
Epicardium
The outermost layer of the heart.
qd
every day
bid
twice a day
tid
three times a day
qid
four times a day
qod
every other day
pc
after meals or not on an empty stomach
qhs
every night
prn
as needed
mg
milligram
mcg
microgram
g
gram
po
by mouth or orally
pr
by way of the rectum
sl
sublingual
IV
intravenous
IM
intramuscular (in the muscle)
SQ
short for subcutaneous (meaning under the skin)
Transmission-Based Precautions
The second tier of precautions and are to be used when a patient is known or suspected of being infected with a contagious disease.
Contact Precautions
Are designed to reduce the risk of transmission of microorganisms by direct or indirect contact.
Airborne Precautions
are measure that reduce the risk for transmitting airborne infectious agents.
Isolation Precautions
A method of infection control that assumed that all human blood and body fluids were potentially infectious.
Standard Precautions
An infection control method designed to prevent direct contact with blood and other body fluids and tissues by using barrier protection and work control practices.
Handwashing
The most importanat means of preventing the spread of infection.
Barrier Protection
Refers to placing a physical barrier between the patients body fluids (such as blood and saliva) and the healthcare personnel (HCP) to prevent disease transmision.
Disinfection
A procedure used in medical asepsis using various chemicals that can be used to destroy many pathogenic microorganisms.
Surgical Asepsis
All microbial life, pathogens and nonpathogens, are destroyed before an invasive procedureis performed.
Gas Sterilization
Often used for wheelchairs and hospital beds. Useful in hospitals, but costly for offices.
Dry Heat Sterilization
Requires higher temperature than steam sterilization, but longer exposure times. Used for instruments that easily corrode.
Chemical Sterilization
Uses the same chemical used for chemical disinfection, but exposure time is longer.
Steam Sterilization
Uses steam under pressure to obtain high temperature of 250 – 245F with exposure times of 20 – 40 minutes depending on the item being timed as it hits the correct temperature listed above-maximum shelf life is 30 days for a sterile pack.
Medical Asepsis
Invovles enviromental hygiene measures such as equipment cleaning and disinfection procedures.
AMS
Agent…Mode of Transmission…Susceptible Host
Agent (Portal of Exit)
The method by which an infectious agent leaves its reservoir.
Mode of Transmission (Portal of Entry)
Specific ways in which microorganisms travel from the reservoir to the suseptible host.
Suseptible Host
The infectious agent enters a person who is not resistant or immune.
Types of Mode of Transmission
Contact of direct and indirect, Droplet, Airborne, Common, Vectorborne
External Hemorrhage
Controlling the bleeding is most effectively accomplished by elevating the affected part above the heart level and applying direct pressure to the wound.
Sim’s position
Lying on the side with the right knee and thigh drawn upward toward the chest.
Dorsal Lithotomy position
Like dorsal recumbant (patient flat on back) but feet are in stirrups, placed farther apart and abducted (pelvic exams).
Prone position
Lying on the abdomen with the head turned to one side.
Dorsal Recumbent positoin
Patient in on his/her back with knees flexed and soles of the feet on the bed.
Fowler’s position
A sitting or semi-sitting position; the head of the bed is raised between 45 and 90 degrees.
Horizontal Recumbent position
The patient is positioned lying flat on the back with the legs close together.
Palpitation
The examiner uses the sense of touch to determine the characteristics of an organ system.
Percussion
This involves tapping or striking the body, usually with the fingers or a small hammer to determine the position, size and density of the underlying organ or tissue.
Auscultation
This invovles listening to sounds produced by internal organs.
Common errors in blood pressure measurement
Improper cuff size / The arm not at heart level / Cuff not completely deflated before use / Deflationof the cuff is faster than 2 – 3 mmHg per second
Tachypnea
This is a respiration rate of greater than 40/min.
Bradypnea
Decrease in numbers of respirations.
Respiratory rhythm
Refers to the pattern of breathing.
Cheyne Stokes (Death Rate)
A regular pattern of irregular breathing rate.
Orthopnea
Difficulty or inability to breath unless in an upright position.
Axillary temperature
Temperature taken at the armpit.Tympanic te
Tympanic temperature
Temperature near tympanic membrane, ear.
Oral temperature
The temperature reading obtained by placing the thermometer in the patient’s mouth under the tongue.
Rectal temperature
A temperature taken in the rectum.
Pulse
Ranges from 60 and 100 beats per minute.
Pulse
The site most commonly used, found in the wrist on the same side as the thumb.
Apical Pulse
A more accurate measurement of the heart rate and it is taken over the apex of the heart by auscultating using the stethoscope.
Respiration
The normal range for adults is 12 to 20 per minute.
4 Vital Signs of Body
Temperature / Pulse / Respiration / Blood Pressure
Intermittent Fever
Fluctuating fever that returns to or below baseline then arises again.
Remittent Fever
Fluctuating fever that remains constant above the baseline; it does not return to baseline temperature.
Continuous Fever
A fever that remains constant above the baseline; it does not fluctuate.
Automaticity
The ability of the heart to generate and conduct electrical impulses on its own.
Excitability
The ability of the heart muscle cells to respond to an impulse or stimulus.
Conductivity
The ability of an object to transfer heat or electricity to another object.
Contractility
The ability of the cardiac muscle to shorten in response to an electrical impulse.
SA Node
the pace-maker of the heart; where the impulse conduction of the heart usually starts; located in the top of the right atrium.
AV Node
Located at the posterior septal wall of the right atrium just above the tricuspid valve.
Bundle of His
Located at the superior portion of the interventricular septum, it is the pathway that leads out of the SA node.
Lead I
The left arm is positive and the right arm is negative. (LA, RA)
Lead II
The left leg is positive and the right arm is negative. (LL, RA)
Lead III
The left leg is positive and the left arm is negative. (LL, LA)
Augmented Unipolar Lead
Are designated as aVR, aVL, aVF. These unipolar leads that require one elctrode from one limb to make a lead.
Lead aVR
The right arm is positive and the other limbs are negative.
Lead aVL
The left arm is positive and the other limbs are negative.
Lead aVF
The left leg (or foot) is positive and the other limbs are negative.
V1
Fourth intercostal space, right sternal border.
V2
Fourth intercostal space, left sternal border.
V3
Equidistant between V2 and V4.
V4
Fifth intercostal space, left midclavicular line.
V5
Fifth intercostal space, anterior axillary line.
V6
Fifth intercostal space, midaxillary line.
25mm/sec
The running speed of the EKG.
Horizontal Axis
Represents the time: 1mm
Vertical Axis
Represents amplitude measured in millivolts.
Complex
Several waveforms
P-Wave
The deflection produced by atrial depolarization.
QRS Complex
Represents ventricular depolarization (activation).
Q-Wave
The initial negative deflection produced by ventricular depolarization.
R-Wave
The first positive deflection produced by ventricular depolarization.
T-Wave
The deflection produced by ventricular repolarization.
S-Wave
The first negative deflection produced by ventricular depolarization that follows the first positive deflection, (R) wave.
Segment
The line between two wave forms.
Waveform
Refers to movement away from the isoelectric line either upward (positive).
Interval
Waveform plus a segment.
Wandering Baseline
Muscle movement and mechanical problem
Flatline
Loose disconnected wire or don’t have a heart beat.
Stress Test
A noninvasive diagnostic procedure to determine the prescence and severity of coronary artery disease.
Normal Sinus Rate
60 – 100 beats per minute
Ischemia
Decreased amount of blood flow.
Angina
Chest pain and discomfort (give nitroglycerin).
Myocardial Infarction
Area of dead (necrotic) tissue in the heart muscle; heart attack.
Holter Monitor
Has 5 electrodes.
Liters of Blood
The average adult has 5 – 6 liters.
3 Major Veins Located in the Antecubital Fossa
Median Cubital Vein / Cephalic Vein / Basilic Vein
Median Cubital Vein
The first choice – large vein in the middle of the upper arm; most commonly used for venipuncture and doesn’t tend to move.
Cephalic Vein
The second choice – usually more difficult to locate and has a tendency to move, however it is often the only one that can be palpated in the obese patient.
Basilic Vein
The third choice – it is the least firmly anchored and located near the brachial artery.
Activated Partial Thromboplastin Time (APTT)
A test used to evaluate the intrinisic pathway; also used to monitor heparin therapy.
Prothrombin Time (PT)
A test used to evaluate the extrinisic pathway; also used to monitor coumadin therapy.
Antecubial Fossa
The preferred site for venipuncture.
25 Gauge Needle
The smallest needle.
Winged Infusion Sets
Used for venipuncture in the elderly and pediatric patients.
Tourniquets
Prevents the venous outflow of blood from the arm causing the veins to buldge thereby making it easier to locate the veins.
Gloves
Must be worn when collecting blood specimens.
Hemolysis
When the tournique is left on the arm too long.
Edema
Is the accumulation of fluid in the tissues.
Bevel Facing Upward
Insertion of the needle at an angle of 15 – 30 degrees.
Order of Draw
Blood Cultures (yellow) / Sodium Citrate (light blue) / Serum (red or tiger strip) / Heparin (green) / EDTA (lavendar) / Glucose (gray)
Hematoma
The collection of blood that has escaped from the blood vessels into tissue.
Hemoconcentration
The increase in proportion of formed elements to plasma caused by the tourniquet being left on too long.
Phlebitis
Inflammation of a vein as a result of repeated venipuncture in that vein.
Petechiae
These are tiny non-raised red spots that appear on the skin from rupturing of the capillaries due to the tourniquet being left on too long or too tight.
Thrombus
This is a blood clot usually a consequence of insufficient pressure applied after the withdrawal of a needle.
Thrombophlebitis
Inflammation of a vein with formation of a clot.
Fasting Specimens
This require collection while the patient is is the basal state,(patient has fasted and refrained from strenuous exercise for 12 hours prior to the drawing).
Timed Specimens
Blood is drwan at specific times for different reasons.
PKU
This test is orderedfor infants to detect phenylketonuria, a genetic disease that causes mental retardation; peformed doing the heel stick.
Lavendar Top-tube
Ethylenediaminetetraacetic Acid (EDTA) / Anticoagulant
Light Blue Top-tube
Sodium Citrate / Anticoagulant
Red / Gray Tiger Strip Top-tube
Serum / Non-Additive
Green Top-tube
Heparin
Gray Top-tube
Glucose / Additives
Yellow Top-tube
Blood Cultures / Sterile
Culture & Sensitivity
Is the primary test done to detect the prescence and identify the microorganisms in body fluids and issues.
Urinalysis
Performs physical, chemical, and microscopic examination of urine.
Urinalysis Physical Exam
Assesses the color, clarity, and specific gravity of the specimen.
Urinalysis Chemical Exam
Is done using chemical reagent strips to screen for substances such as sugar and protein.
Urinalysis MIcroscopic Exam
Is done to detect prescence of blood cells, bacteria, and other substances.
Bateriology
The study of bacteria.
Parasitology
The study of parasites.
Mycology
The study of fungi.
Virology
The study of viruses.
Serology (Immunology)
Uses serum to analyze prescence of antibodies to bacteria, viruses, fungi, and parasites.
Meter
The basic unit of length.
Liter
The basic unit of capacity or volume.
Gram
The basic unit of weight or mass.
Kilo
1000.00 (One-thousand)
Deci
0.1 (one-tenth)
Centi
0.01 (one-hundredth)
Milli
0.001 (one-thousandth)
Micro
0.000,001 (one millionth)
Nano
0.000,000,001 (one billionth)
Gram Stain
Is used to classify bacteria on the basis of their form, size, cellular morphology and gram stain reaction.
1st Morning Sample
Is the type of specimen most commonly used for routine urinalysis.
HCG
Human Chorionic Gonadotropin–hormone produced by placenta. This is what is tested for in urine pregnancy tests since the only time it is present is during pregnancy.
Anuria
The absence of urine.
Hematuria
The prescence of blood in urine.
Polyuria
The passage of large volume of urine.
Proteinuria
The prescence of excessproteins in urine.
Components of the Urinary System
Consists of two kidneys, two uterers, urinary bladder, urethra.
Mid-Stream Specimen
Is one that is collected not at the beginnng or end of voiding, but in the middle of urination.
Clean-Catch Specimen
In collecting this specimen it requires special cleaning of the external genitalia.
Urine Output
Normally averages 1200 – 1500ml every 24 hours.
Examination of Urine
Physical, chemical, microscopic
Sputum Specimen
A specimen of expectorant material from the mouth – forcefully expelled from the lungs and placed in a sterile container.
Informed Consent
This is a consent given by the patient who is made aware of any procedure to be performed, its risks, expected outcomes, and alternatives.
Patient Confidentiality
The key concept is HIPAA; patients rights to privacy and all information should remain personal.
4 Elements of Negligence (4 D’s)
Duty / Derelict / Direct Cause / Damage
Duty
Duty of care.
Derelict
Breach of duty of care.
Direct Cause
Legally recognizable injury occurs as a result of breach of duty of care.
Damage
Wrongful activity must have caused the injury or harm that occured.
Good Samaritan Law
This law deals with the rendering of first aid by health care professionals at the scene of an accident or sudden injury.
Throat Cultures
Are used to detect a baterial, fungal, or viral infection in the throat.