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Phlebotomy Chapter 8

Terms

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Anchor.
Using the thumb to pull the skin taunt below the vein to keep the vein from moving on needle entry.
Arm/Wrist/ID band.
Special band or bracelet attached to a patient's arm in the area of the wrist that contains identification information.
ASAP.
Test collection priority that means results are needed to respond to a serious situation, but the patient is not in critical condition.
Barcode.
Black and white stripes of varying widths that correspond to letters and numbers.
Beside Manner.
The way in which an individual conducts himself or herself when interacting with a patient.
Concentric Circle.
Beginning in the center and moving outward in ever-widening circles.
Fasting.
Going without food or drink, except water, for 8-12 hours before specimen collection.
Id Card.
Clinic-or other healthcare organization-issued identification cards that contain a patient's name and other information identifying them as that organization's patient.
MR Number.
Medical record number, a unique number assigned to a patient for identification purposes.
Needle Sheath.
Cover or cap of a needle.
NPO.
From Latin (null per os) meaning nothing by mouth, or no food or water.
Palpate.
Examine by feel or touch.
Patient ID.
Process by which a patient's identity is verified and matched with the information on a test requistion.
Pediatric Tube.
Small-volume evacuated tube designed to be used for small veins or in situations in which only small amounts of blood can be collected.
Pre-op/Post-op.
Before and after an operation, respectively.
STAT.
Term derived from the Latin word statim, meaning immediately.
Requistion.
The form on which test orders are entered.
What individuals has legal authority to authorize patient testing?
Patient's physician.
Information on a test requistion must include the:
Ordering physician's name, patient's medical record number, and patient's name and date of birth.
What requistion often serves as a test request, report, and billing form?
Manual.
A barcode can represent a(n):
Identification number, laboratory test, and patient's name.
Outpatient requistions are typically of this type.
Manual.
When received by the laboratory, inpatient requistions are typically sorted according to:
Date and time of collection, location of the patient, and priority of collection.
Steps taken to unmistakably connect a specimen and the accompanying paperwork to a specimen:
Accessioning the specimen.
What is an example of a common timed test?
Cortisol.
A test that is ordered STAT should be collected:
Immediately.
What tests is commonly ordered STAT?
Electrolytes.
If a test is ordered STAT, it means that the patient is in:
Critical Condition.
When a test is ordered ASAP, it means that the:
Results are needed soon to respond to a serious situation.
A pre-op patient:
Will soon be going to surgery.
Tests are classified as routine if they are ordered:
In the course of establishing a diagnosis.
This term means the same as STAT.
Med Emerg.
A patient who is NPO.
Cannot have Food or Drink.
An example of a test that is commonly ordered fasting is:
Glucose.
What liquid is acceptable to drink when fasting?
Water.
What is a common post-op test?
Hemoglobin and hematocrit. (H&H)
You arrive to draw a specimen on an inpatient. The patient's door is closed. What do you do?
Knock softly and open the door slowly, checking to see if it is all right to enter.
There is a sign above the patient's bed that reads, "No blood pressures or venipunture, right arm." The patient has an IV in the left forearm. You have a request to collect a complete blood count on the patient. How should you proceed?
Collect the specimen from the left hand by a fingerstick.
A code is a way to:
Convey important inforamtion without alarming the general public, transmit messages over the public address system, and use numbers or words to represent important information.
DNR means:
Do not call a code if the patient stop breathing, do not resuscitate, and do not take heroic measures if the patient stop breathing.
You greet your patient in the following manner: "Hello, my name is John and I am here to collect a blood specimen if that is all right with you." The patient responds by saying, "OK, but I would rather not." Do you have permission to
No
What is part of informed consent?
Letting the patient know that you are a student phlebotomist.
Your inpatient is asleep when you arrive to draw blood. What do you do?
Call out the patient's name softly and shake the bed gently.
Laboratory results can be negatively affected if the phlebotomist:
Startles a sleeping patient when arriving to collect a specimen.
How would you handle a blood draw on an unconscious patient?
Have someone assist you in case the patient moves, identify yourself and inform the patient of your intent, and talk to the patient as you would an alert patient.
What do you do if the aptient's physician is in the room and the specimen is ordered stat?
Politely introduce yourself, explain why you are there, and ask permission to proceed.
What is the best thing to do if family or visitors are with a patient?
Ask the visitors to step out of the room until you finish.
Your patient is not in the room when you arrive to collect a timed specimen. The patient's nurse states that the patient will be unavailable for several hours. What should you do?
Fill out a delay slip stating why you were unable to collect the specimen.
Misidentification of a specimen for this test is most likely to have fatal consequences.
Type and Screen.
You arrive to collect a specimen on a patient named John Doe in 302b. How do you verify that the patient in 302b is indeed John Doe?
Ask the patient to please state his name and date of birth before proceeding.
What requistion information must match information on the patient's ID band?
Medical Record Number.
The medical record number and ID band matches the number on your requistion, but the patient's name is spelled differently than the one on your requistion. What should you do?
Do not collect the specimen until the discrepancy is resolved.
An unconscious patient does not have an ID band. The name on the door agrees with the requistion. What should you do?
Do not draw the patient until the nurse has applied an ID bracelet.
Waht would be the system of choice to identify laboratory specimens from an unconscious woman in the emergency room?
Use a three-part identification band with special tube labels.
What type of inpatient is most like likely to have more than one ID band:
A newborn.
What is the most critical error a phlebotomist can make?
Misidentifying a patient specimen.
Your patient is not wearing an ID band. You see that the ID band is taped to the night stand. The information matches your requistion. What do you do?
Ask the patient's nurse to attach an ID band before proceeding.
The patient's nurse or a relative may be needed to confirm the identity of this type of patient.
Child, mentally incompetent,and non-English-speaking.
The laboratory receptionist finishes checking in a patient and hands you the test request. The request is for a pateint named Mary Smith. You call the name, and the woman who was just checked in responds. She is also the only patient in the waiting room.
Ask the woman to state her name and date of birth to confirm her identity.
A cheerful, pleasant bedside manner and exchange of small talk help to:
Divert attention from any discomfort associated with the draw, gain a patient's trust and confidence, and put a patient at ease.
Your patient is cranky and rude to you. What do you do?
Informing the patient that you are a student.
The patient asks if the test you are about to draw is for diabetes. How do you answer?
Explain that it is best to discuss the test with his or her physician.
A patient vehemently refuses to allow you to collect a blood specimen. What should you do?
Notify the patient's nurse.
You arrive to draw a fasting specimen. The patient is just finishing breakfast. What do you do?
Check with the patient's nurse first; if the specimen is collected, write "non-fasting," on the lab slip and the specimen label.
Why is it sometimes best to assemble equipment after selecting and cleaning the blood collection site?
You will be more apt to allow sufficient time for the alcohol to dry, you will have a better idea of what equipment to use, and you will waste less equipment.
When performing venipuncture, hand washing is necessary:
Before and after each patient.
Proper hand washing involves:
Creating friction to dislodge surface debris and bacteria, scrubbing downward from wrists to fingertips, and using a clean paper towel to shut off the water faucet.
You must collect a specimen on a 6 year old. The child is a little fearful. What do you do?
Explain what you are going to do in simple terms and ask the child for cooperation.
If the patient asks you if the procedure will hurt, you should say that it:
May hurt a little but only for a short time.
What is the proper arm position for routine venipuncture?
Straight from shoulder to wrist and in a downward position with the palm up.
Outpatients who have previously fainted during a blood draw should be:
Asked to lie down, or the drawing chair should be reclined if possible.
What acts can lead to liability issues?
Lowering a bed rail to make access to the patient's arm easier.
Never leave a tourniquet on for more than:
1 minute.
Where is the best place to apply the tourniquet?
3-4 inches above the venipuncture site.
What happens if the tourniquet is too tight?
Arterial flow may be stopped, hemoconcentration, and it hurts the patient.
What can be used to enhance the vein section process?
Lowering the arm,palpating the antecubital area, and using a warm towel to increase blood flow.
When selecting a venipuncture site, how can you tell a vein from an artery?
An artery has a pulse.
Waht does a sclerosed vein feel like?
Hard and cord-like.
It is acceptable to use an ankle vein if:
The patient physician give permission.
To avoid inadvertently puncturing an artery during venipuncture:
Do not select a vein that overlies or is close to an artery, do not select a venipuncture site, and avoid drawing the basilic vein.
You must collect a light blue top for a special coagulation test from a patient who has an IV in the left wrist area and dermatitis all over the right arm and hand. The veins on the right arm and hand are not visible. What is the best way to proceed?
Apply a tourniquet on the right arm over a washcloth or towel and proceed as usual.
What is the best thing to do if the vein can be felt but not seen, even with the tourniquet on?
Look for visual clues on the skin to help you remember where it is.

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