MA 201 Clinical Duties

• 1. To protect body against invaders
• 2. Recognize things as SELF or Non-SELF
• 3. Attempts to destroy non-self things (protection)

• 1. bacteria
• 2. viruses
• 3. fungi
• 4. parasites
• 5. foreign matter

• 1. Cell
• 2. Tissue
• 3. Protein
• 4. Food
• 5. Air Particles

• 1. antigens
• 2. blood or tisue from transplant
• 3. foreign material
• 4. food we eat
• 5. particles in the air
• 6. allergens

• BARRIERS
• 1. Anatomical barriers
• -skin / mucose membranes
• 2. Biological barriers
• -sweat / oil on skin
• 3. Mechanical barriers
• -dead skin sloughs off
• -vomiting
• -coughing

• INFLAMMATION
• When exterior barriers broken
• -injury or invasion
• Results in warm, red, swollen skin

• ANTIBODY DEFENSE
• specific cells that attack antigen

• 1. Identify self non-self
• 2. Maintain Homeostasis
• 3. Continual surveillance

• 1. Red blood cells (RBC) Erythrocytes - carry O2 to the cells
• 2. Platelets Thrombocytes - clot blood
• 3. White blood cells (WBC) Leucocytes - fight disease as part of the immune system

• Granulated
• -Eosinophils
• -Neutrophils
• -Basophils

• Non-Granulated (most common)
• -Lymphocytes
• -Monocytes

Immature cells grow/develope into large cells

Macrophages - help fight infection through phagocytosis (engulf and destroy)

Recognize specific antigen target

• 2 Types
• 1. T-Lymphocytes mature in Thymus gland (T for T)
• 2. B-Lymphocytes mature in bone marrow (B for B)

• Located in anterior portion of chest
• Dissapears over time by late ages
• Older people get sick easier without it.

• 1. Bone marrow
• -fight invaders that reach circulatory system
• 2. Thymus Gland
• -where t-lymph mature
• 3. Lymph Nodes
• -filters antigens for destruction
• 4. Spleen
• -fight invaders that reach circulatory system
• -carries tons of red blood cells (RBC)
• -if gone, will get sick easier
• 5. Tonsils
• -fight invaders of the respiratory system
• 6. Adenoids
• -fight invaders of the respiratory system
• 7. Appendix
• -fight invaders of the digestive system (vestigal organ / not needed)
• 8. Peyer's Patches
• -in intestinal track (the ilium)
• -fight invaders of the digestive track
• -where they grow

How immune cells determine if encountered cells if self non-self

This is the self marker for all cells

Any cell without the MHC marker

Will be destroyed by immune system

• Most abundant of all WBC.
• Acts directly on invading cells.

• 1. Helper T-cells
• - helps other cells perform functions
• - act as security and detecs invaders
• - have a CD4+ marker (checked during HIV infection)

• 2. Suppressor T-cells
• - keep virus at bay (no flare-ups)

• 3. Killer T-cells
• - directly kill non-self cells
• - aka Cytotoxic T-cells

• 4. Memory T-cells
• - injury (will remember what did last time and act faster)
• - muscle memory from repitition

• Produce antibodies
• - cell markers that fit specific antigen and make useless. (Virus)
• - known as
• - Humoral Response (B-Cell) or
• - Antibody-mediated (T-Cell) response

• 1. CBC most common blood draw
• 2. Elevated WBC count = internal infection
• 3. Sarc=flesh
• 4. Oma=tumor/mass
• 5. Hep C most deadly, no cure
• 6. Erytheme "means red"

• - cells release histamine
• - dialates blood vessels
• - slows blood flow, allows vessel walls to be more permiable
• - results in warm, redness, and swelling

• - deliberate introduction of specific antibody
• - allows cells in body to learn to kill that type of cell
• - may need boosters later on (tetnis)

Makes own immunity with a vaccines

Another source injected to counter imediate attack (Tetanus)

Caused by Human Immunodeficiency Virus (HIV)

• 1. Blood (WBC)
• 2. Semen
• 3. Vaginal Secretions

• 1. Contains RNA vs DNA
• 2. RNA changes DNA to RNA (no changing back)
• 3. Once RNA outnumbers T-cells, body can no longer protect itself

• 1. No longer able to protect self with T-cells
• 2. Can get an "opportunistic infection"

• 1. Unprotected sex
• 2. Sharring needles
• 3. Mother to fetus / infant
• 4. Blood products

• Headache
• Fever
• Fatigue
• Enlarged Lymph Nodes

• weight loss
• yeast infection
• memory loss
• rashes

• Lymph nodes reacting to internal infection.
• If lasts too long, have checked out.

• Pneumocystis pneumonia (fungal in lungs)
• Kaposi's Sarcoma

• 1. ELISA (enzyme-linked immunosorbent assay)
• - most common / least expensive
• - can give false positive

• 2. Western Blot
• - used to confirm HIV diagnosis

1. Requires positive HIV test and one of the following:

• - CD4+ count less than 200
• - Opportunistic infection
• - AIDS related cancer, severe wasting, dementia

Secomdary response to normally harmless substance

Cause mucose membranes to secrete and capillaries to become permiable

A group of diseases characterized by uncontrolled growth or abnormal cells

New growth forming tumor

Cells break away from tumor and spread

Slow growing, doesn't invade other tissue

Fast growing, invades surrounding tissues

• 1. Carcinomas - from epithelial tissue
• 2. Sarcomas - from connective tisues
• 3. Lymphomas - from blood and blood forming organs

• 1. T - size and extent of spread of primary tumor
• 2. N - presence of regional lymph node metastasis (local or moving)
• 3. M - presence or absence of distant metastasis (where local or distant)

• 1. Altered cell structure
• 2. Lack normal growth controlling mechanics
• 3. Will grow and invade other tissues
• 4. Lack contact inhabitions - keep growing
• 5. Do not respond to growth factors
• 6. Are invasive, causing distruction of normal tissue

• 1. Chemical
• 2. Viral
• 3. Physical
• 4. Familial

• 1. Change in bowel / bladder habits
• 2. A sore not healing
• 3. Unusual bleeding / discharge
• 4. Thickening / lump anywhere
• 5. Indigestion / difficulty swallowing
• 6. Obvious change in wart / mole
• 7. Nagging cough / hoarseness

• 1. Biopsy
• 2. Tumor Markers
• 3. Genetic Testing
• 4. Tumor Imaging

Removal of sample, microscopic exam

• Blood test to detect proteins
• CA125 - Ovarian Cancer (W)
• PSA - Prostate Cancer (M)

Blood test sampling to detect genes of cancer from family history on both sides

• Radiological / imaging test to detect
• Pep Scan - Thermal image for hot spots that mean cancer, quite accurate

• 1. Cure
• 2. Control
• 3. Palliation - control symptoms (no cure)

Radioactive material placed at tumor

• 1. Radiation
• 2. Chemotherapy
• 3. Surgery

Use of radiation to damage DNA of the cancer cell

Brachytherapy use of local radiation therapy

Use of trong chemicals / medications to change cell division of cancer cells

Systemic treatment, kills all fast dividing cells (including hair, skin, nails)

Surgical removal of malignant tissue

Effects depend on response of healthy immune system

Group of symptoms thought to be caused by Epstien-Barr Virus

• Cronic disease causing inflammation of body parts
• Body attacks itself
• Treat by rest when needed, limit activity and sun exposure

• Extremeties are always purple at the tips during cold weather
• Butterfly rash on face

• Ulnar deviation (toward ulnar side / pinky)
• Swan neck of fingers

- Swelling in tissues caused by acumulation of lymphatic fluid

- Treated with elevation, gentle pressure massage, and or wrapping with bandages

• 1. Anthrax - Bacillus Anthracis
• 2. Botulism - Clostridium Botulinum
• 3. Yetanus - Clostridium Tetani
• 4. Pneumonia - Streptococcus Pneumoniae
• 5. Whooping Cough - Bordetella Pertussis
• 6. Urinary Infection - Escherichia coli
• 7. Gonorrhea - Neisseria Gonorrhoeae
• 8. Food Poisoning - Salmonella
• 9. Typhoid Fever - Salmonella Typhi
• 10. Syphilis - Treponema Pallidum
• 11. Plague - Yersinia Pestis
• 12. Chickenpox - Vericella Zoster

• 1. Blood test cheap and easy
• 2. Not accurate in first 4-6 weeks of infection
• 3. 25% will be false negative

4. Completely accurate in second phase

• Avoid direct contact
• Avoid fecal contaminated food / water

• 1. Date
• 2. Time
• 3. What Happened
• 4. Staff members involved
• 5. Witnessed
• 6. Injuries
• 7. Action taken

72 degrees

• Occupational Safety and Health Administration
• Can close lab

• Clinical Laboratory Improvement Amendments
• Sets standards for lab testing

Center for Disease Control

• Method used to control spread of disease
• Protect patient and self

• 1. wash hands
• 2. use PPE
• 3. dispose sharps immediately
• 4. properly dispose medical waste

Any bodily fluid from any source

• glass
• needles
• slides
• blades

Assume all is contaminated

• 1. need a germ
• 2. need a host (carrier)
• 3. transmission (vector)
• 4. way into body (cut, mucosa, etc...)

• 1. infectious agent
• 2. reservoir
• 3. portal of exit
• 4. mode of transmission
• 5. portal of entry (feet, mouth, nose, etc)
• 6. susceptible host

• 1. Skin
• 2. Mucos Membranes
• 3. Mechanical (cough, sneeze, tears)
• 4. pH (sweat, urine, stomach, secretions)

Disease causing agents (Pathogens)

• 1. Bacteria
• 2. Viruses
• 3. Protozoa
• 4. Fungi
• 5. Parasites

• 1. Normal body temp
• 2. Darkness
• 3. Moisture
• 4. Low pH

• Aerobic - survives in O2
• Anaerobic - can't survive in O2

Smallest of pathogens

Single-celled, attach to other organisms

Simple plants, depend on other life forms for nutrition

Type of organism that depends on other organism for nutrition

• Cocci - round
• Baccili - rod
• Spirochete - spiral

• Diplo - pairs
• Strepto - chains
• Staphylo - groups

• - Possitive - purple / violet
• - Negative - pink / red

• 1. Crystal Violet
• 2. Gram's Iodine
• 3. Rinse with Acetone
• 4. Safranin

Capsule like covering to protect self

Most common used to clean skin for injection / surgery

• 1. Sanitation
• 2. Disinfection
• 3. Sterilization

• Process of washing and scrubbing to remove material
• - hand washing

• Process to remove disease producing microorganisms (pathogens)
• Used on instruments with chemicals

• Process of destroying all forms of living organisms (including spores)
• Steam autoclave (good for 30 days)

• Wash hands with soap and water
• Inspect for holes, rips, tares

State of being free of all pathagenic microorganisms

Method used to keep areas free of pathogens

Way to protect patient from infection (sterile)

• Uses steam and pressure
• 15 psi
• 250 degrees for 15-20 minutes
• Must sanitize first
• Good for 30 days

• 1. Muslin wraps secured with indicator tape
• 2. Masking tape that changes color (stripes) when run through autoclave
• 3. Place paper indicator inside with instruments and outside first wrap.

• Do not allow body fluids to dry on intruments
• Soak immediately in detergeant solution
• - use solution of neutral pH to prevent corrosion
• - should contain special protein to break down body fluids
• Scrub all surfaces with brush to remove material

• Separate delicate from heavy ones
• Sharp ones from others

Check for:

• Nicks
• Dullness
• Warping

• 1. Cutting
• 2. Clamping / Grasping
• 3. Dilating / Probing

For grasping - for control during dissection / suturing

Pick up dressing and delicate tissue

• 1. Soak in detergent with proteins to break down body fluids (zephrin chloride)
• 2. Scrub with brush
• 3. Dry
• 4. Hinges / handles open - sterilize in autoclave

• 1. Ring Handles - thumb and finger like scissors
• 2. Thumb Handles - like tweezers
• 3. Ratchets - back by handle, allows holding
• 4. Serrations - fissure engraved for grabbing / holding when clamping
• 5. Teeth - sharp, hold tissue

Also called grasping intrument

• Hold cavities / wounds open
• Used to explore wounds

• Named by size
• CC = cubic centimeter
• ML = milliliter

1cc = 1ml

• Named by length and Lumen (gauge)
• Gauge - bigger the number, smaller the lumen
• 16g is larger than 28g

• Hub - back
• Shaft
• Bevel
• Point

• Bandage
• Utility
• Suture (hook for under suture)

• Confirm appointment
• Get all necessary surgical intruments

• Obtain consent form
• Answer any questions
• Vital signs
• Verify known allergies
• Empty bladder

• 1. Wash and glove hands
• 2. Gauze squares in soap solution
• 3. One gauze at a time, soap area to be shaved
• 4. Use scissors to cut long hair first
• 5. Shave area with razor at 30 degrees
• 6. Shave in direction of hair
• 7. Apply antiseptic solution to site with transfer forceps
• 8. Begin in center and work out in circular pattern
• 9. Cover with sterile drape

• 1. Description of procedure
• 2. Date and time
• 3. Signed consent form
• 4. Vital signs
• 5. Any complications
• 6. Meds ordered
• 7. Findings
• 8. Instructions for home care
• 9. Number of sutures
• 10. Where sutures located
• 11. How long stay in

Waist level

• General - unconscious
• Local - localized to area, loss of feeling

• Made from organic material
• Will be absorbed by body
• Used deep in body

• Made from man-made products
• Must be removed from skin
• Used superficially on body

• Larger sizes - number only
• - bigger the number - bigger the suture
• 3, 2, 1, 0

• Smaller size - number -0
• - bigger the number - smaller the suture
• 1-0, 2-0, 3-0

• 1. Laceration repair
• 2. Sebaceous cyst removal
• 3. Incision and drainage (I&D)
• 4. Biopsy
• 5. Needle biopsy
• 6. Cryosurgery
• 7. Electrosurgery and cautery
• 8. Chemical destruction
• 9. Laser surgery

• 1. Assemble equipment and supplies
• 2. Set up sterile tray and cover
• 3. Instruct patient as needed
• 4. Assist patient positioning
• 5. When ready, remove drape from tray
• 6. Wash hands, sterile gloves, assist

Six Minutes under hottest water you can handle

• Grasp the knot
• Place scissors next to skin under suture and cut
• Pull suture toward incision to prevent re-opening

• 1. Remove gloves, wash hands
• 2. Assist patient sitting up and dressing
• 3. Review postop instructions
• 4. Give written instructions
• 5. Clean room / instruments - soak
• 6. Restock exam room
• 7. Dry instruments, package for autoclave