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Hemoglobin (Hgb or Hb)
Allosteric PROTEIN found in every erythrocyte (RBC) that carry O2 and CO2
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Normal Hemoglobin ranges
Males: 14-18g/dl
Females: 12-16g/dl
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Hemoglobin Low Count
Enemia
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Hemoglobin Below 10g/dl
- Shortness of breath
- Tiredness
- Pale skin
- PANIC VALUE
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Hemoglobin Below 5g/dl
No LIFE
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Hemoglobin TOO High
- Polycythemia - bone marrow makes too many RBC
- Weakness and fatigue results
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Hemoglobin Test
- 1. Lancet finger, place large drop blood on reagent card
- 2. Place card in machine, read / record results
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Hematocrit (Htc)
Measures PERCENTAGE sample of blood (RBC)
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Normal Hematocrit Range
- Males: 40-54%
- Females: 37-47%
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Hematocrit Collection and Process
- 1. Use lancet to draw blood out
- 2. Micro tubes placed at blood sight to draw into capillary tube (no bubbles)
- 3. Plug with clay card
- 4. Draw 2 tubes, place in machine, spin
- 5. Use machine scale to read/record results
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Hematocrit Tube Contents
- 1. Bottom Layer RBC (heaviest)
- 2. Buffy Coat (Leukocytes / Platelets)
- 3. Plasma top layer
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Hemoglobin / Hematocrit Conversion
- Hgb to Hc = Hgb x3 +- 3 estimate
- Hc to Hgb = Hc /3 +- 3 estimate
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Erythrocyte Sedimentation Rate (Sed-Rate) (ESR)
Measures rate RBC settle in calibrated tube in given time (1-2hrs)
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Erythrocyte Sedimentation Rate (Sed-Rate) Tests For
- 1. Acute Inflammatory Infection
- 2. Autoimmune Dissorders
- 3. Arthritis / Polymialgia
- 4. Acute / Chronic Infection
- 5. Lupis
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Normal Erythrocyte Sedimentation Rate (Sed-Rate) Range
- Males: 0-10mm/hr
- Females: 0-20mm/hr
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Erythrocyte Sedimentation Rate (Sed-Rate) Can't Detect
- Sickle Cell
- Polycythemia Vera
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Erythrocyte Sedimentation Rate (Sed-Rate) Test Comprimise
- Reading before time can yield false negative
- Reading after time can yield false positive
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Blood Glucose Test
Uses capillary blood to screen glucos levels for Diabetes
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Normal Fasting Gluclose Level
- 70-120mg/dl
- Fasting Blood Sugar (FBS)
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Glucose Tolerance Testing (GTT)
Used to diagnose diabetes, gestational diabetes, and hypoglycemia
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Glucose Tolerance Testing (GTT) Procedure
- 1. Patient drinks a glucose concentrated drink
- 2. Urine and blood collected at 30min, 30min, 1hr, 2hr incriments
- If FBS is over 150mg/dl, DO NOT TEST!
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Symptoms to cause Glucose Tolerance Testing (GTT)
- 1. extreme thirst, dehydration
- 2. fatigue
- 3. weight loss
- 4. visual difficulties
- 5. high glucose reading
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Glucose Tolerance Testing (GTT) Adverse Reactions
- 1. Weakness
- 2. Fainting (Syncopy)
- 3.Excessive sweating
- 4. Vomitting
- 5. Pancrease failure to metabilize sugar
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Hemoglobin A1C (HbA1c)
Glycohemoglobin
- Modified form of hemoglobin elevated when glucose remains too high
- Used to determine how much control patient has with glucose diet
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Cholesterol
Too much can cause atherosclerosis / arteriosclerosis, hardening of the arteries
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Normal Cholesterol Range
130-200mg/dl
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Phenylketonuria (PKU)
- tested on newborns for congenital disease caused by inability to metabolize certain amino acids (Phenylalanine)
- Prevents brain from developing (MR)
- Required in all 50 states and Canada
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Urinalysis - 3 Major Catagories
- 1. Physical, Chemical, Microscopic
- 2. Must test within 1hr or refrigerate for later testing
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Urinalysis - Physical
- Cloudy - cloudy, hazy, turbid
- Volume - how much
- Odor - acrid
- Specific Gravity - waste particles 1.005-1.030 most fall 1.010-1.025
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Urinalysis - Chemical
- Measures variety of chemicals on reagent strip
- 1. Blood
- 2. pH
- 3. Ketones
- 4. Glucose
- 5. Leukocytes
- 6. Bilirubin
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Urinalysis - Microscopic
We only prep for specimen
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Urinalysis - Midstream (Sterile)
- 1. Clean meatus (front to back)
- 2. Urinate small amount into toilet, stop
- 3. Catch in jar without touching inside, stop
- 4. Continue urination into toilet
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Urinalysis - First Morning Pee
- 1. Best to catch
- 2. Been in bladder over night
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Urinalysis - 24hr
- 1. Collect for 24hr from first urination
- 2. Keep in same jar in refridgerator
- 3. Annotate time of first pee on jar
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Substance Abuse Analysis
Used to detect presence of illigal / illicit drugs or chemical substances
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Substance Abuse Analysis Requirements
- 1. Patient must sign Chain-of-Custody form to concent for collection
- 2. Tape lid closed after collection, patient signs
- 3. Patient signs Lab request form to verify test complete and agrees
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Fecal (stool) Sample
Used to provide diagnostic insight
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Fecal (stool) Sample Can Detect
- 1. Occult (hidden) blood
- 2. Ova / parasites (O&P)
- 3. Bacterial / Viral infections
- 4. Fat content (lipids)
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Fecal (stool) Sample
Guaiac Test
- Tests for blood in stool
- Early detection for Colon Cancer Px 50+
- Turns BLUE if positive
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Fecal (stool) Sample
Patient Education before sample
- 1. Increase fluids
- 2. Avoid laxatives
- 3. Avoid straining during collection
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Sputum
Detect serious infections of lower respiratory tract
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Sputum Facts
- 1. First morning is best
- 2. Lower respiratory tract is sterile
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Sputem Diagnosis
- 1. Cancer
- 2. Bacterial / Viral Infection
- 3. Fungal Infection
- 4. Tuberculosis
- 5. Meningitis
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Bacteria Collection (24-48hr Growth)
- 1. Wound / Skin collection
- 2. Blood cultures
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Bacteria Culture Sensitivity
Culture bacteria while using different types antibiotics (which ones work)
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Bacteria Culture Media
- 1. Primary Agar (most common) encourages growth of all microorganisms
- 2. Selective Agar lets some grow but not others
- 3. Enrichment Agar has nutrients added
- 4. Place Ager plates (dishes) in incubator upside down (lid down)
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Parenteral
- Meds given outside digestive system
- Injections, Topical, Transdermal (slowest)
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Parenteral Characteristics
- Fast acting
- Used for vomiting of unconscious patients
- Can cause immediate allergic reactions
- Pain / infection from poor techniques
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7 Rights
- 1. Patient - watch same sounding names
- 2. Drug - watch same sounding name
- 3. Dose - too much can kill
- 4. Time - too close = overdose
- 5. Route - how in
- 6. Technique - cause pain
- 7. Documentation - didn't chart, didn't happen
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7 Rights Checked 3x
- 1. When locate meds on shelf
- 2. When remove meds from container
- 3. When replace meds back on shelf
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Methods of Administration
- 1. Oral - by mouth
- 2. Sublingual - under tongue
- 3. Buccul - between cheek and gum
- 4. Inhaler
- 5. Topical - skin
- 6. Sprays - throat
- 7. Transdermal - through skin
- 8. Suppository
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Pharmacology
Study of use, preperation, handling, storage, and actions of drugs
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Medication Ordered
- 1. Administered - given in office, take now
- 2. Prescribed - written order, to be filled later
- 3. Dispensed - given in office, take later (samples)
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Assissting with Medication
- To be able to dispense/administer meds, must have understanding of what meds will do to patients
- Everyone reacts differently
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Physician's Desk Reference (PDR)
Acurate, reliable, and current info about medications
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PDR Sections
- 1. Manufacturer's Index (White)
- 2. Brand / Generic Name (Pink) most used
- 3. Product Category (Blue)
- 4. Product ID (Grey)
- 5. Product Info (White)
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Immunizations / Vaccines
Drugs that prevent disease
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Analgesics
Drugs that have a particular action
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Cardiac Drugs
Drugs that have a target effect
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Drug Actions
- Directly affects one or more body tissues
- Effect on microorganisms
- Replacement body chemicals
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Drug Action Classifications
- 1. Local - area where meds administered
- 2. Remote - away from admin site
- 3. Systemic - throughout
- 4. Synergistic - works with / against another drug
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Drug Forms (special)
- Ocular - drug between to thin membrane layers placed under lower eye lid
- Implantable - beneath the skin
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Prescription
- A written order for medication / treatment
- Legal document
- Narcotics are always hand written
- Record all meds in Px chart
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Precription Requirements
- 1. Full Name Px
- 2. Name Medication
- 3. Dosage & Route
- 4. How often to take
- 5. Date / Time ordered
- 6. Directions & Signature of Prescriber
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Who can Prescribe
- 1. MD - Doctor
- 2. DO - Doctor of Osteopathy
- 3. DDS - Dentist
- 4. PA - Physician Assisstant
- 5. NP - Nurse Practisioner
- 6. CNM - Midwife
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Narcotics - Prescribers Must
Register with DOJ and DEA under the Controlled Substances Act 1970
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Medication Schedule
- 1. No use, prescription prohibited (heroin, LSD, Marijuana)
- 2. May not be refilled, High abuse (cocain, percocet, demerol)
- 3. May refill 5x, Moderate abuse (vicodin, T3)
- 4. May refill 5x, Mild abuse (valium, xanax)
- 5. Subject to state / local laws, Limited abuse (cough syrup with codine)
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Medication Charting
Must Have:
- 1. Who ordered
- 2. What ordered (strength/dose)
- 3. What date given
- 4. How taken
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Quality Control (QC)
Assesses testing procedures, reagents, machines, and techniques
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Quality Assurance (QA)
Program evaluates quality and effectiveness according to acceptable standards
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Drug Action Considerations
- 1. Patient age (old/young need less)
- 2. Patient weight
- 3. Body surface area
- 4. Drug interactions (when mixed with others)
- 5. Allergies
- 6. Tolerance to the meds
- 7. Time
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Theraputic
- Pertaning to results obtained from treatment
- Application of remedies and treatment of disease
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Diagnostic
- Pertaining to a diagnosis
- Finding what is wrong
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O2 Ordered
- In liters per minute
- Via nasal cannula / mask / etc...
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Placebo
- Non-medication treatment for comfort
- Usually used in clinical study
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Antitoxin
An antibody produced in response to and capable of neutralizing specific biologic toxin
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Emultion
- Mixture of two liquids not mutually soluable
- The lipid is broken into small globules
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Digoxin
Antiarrhythmic and cardiotonic up force and contractility of heart muscle (treats CHF)
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Analgesic
Relieves pain, no loss consciousness (motrin, tylenol)
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Anasthetic
Produces lack of feeling (lidocaine, novocaine)
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Antianxiety
Relieves anxiety and muscle tension (diazepam, benzodiazepines)
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Antibiotic
Destructive / inhibits growth of microorganisms (penicillins)
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Anticonvulsant
Prevents / relieves convulsions (tegretol, dilantin)
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Antidepressant
Prevents / relieves symptoms depression (isocarboxazid, nardil, tofranil)
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Antidote
Counteracts poisons / effects (narcan)
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Antiemetic
Prevents / relieves nausea and vomiting (dramamine, tigan)
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Antihistamine
Counteracts histamine (benadryl, seldane)
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Anti-inflammatory
Counteracts inflammation (naproxin, aspirin, advil)
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Antipyretic
Reduce fever (aspirin, acetaminophen)
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Bronchodilator
Dilates bronchi (isuprel, albuteral)
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Contraceptive
Prevents conception (ortho-novum, triphasil)
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Decongestant
Reduces nasal congestion / swelling (afrin, sudafed)
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Diuretic
Increases excreation of urine (diuril, lasix)
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Expectorant
Facilitates removal of secretions from bronchopulmonary mucous membrane (robitussin)
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Hypnotic
Produces sleep / hypnosis (seconal, placidyl)
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Hypoglycemic
Lowers blood glucose level (diabinese, micronase)
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Laxative
Loosens / promotes normal bowel eliminations (metamucil, dulcolax)
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Muscle Relaxant
Aids relaxing skeletal muscle (norflex, paraflex, valium)
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Sedative
Produces calming effect without causing sleep (amytal, buticaps)
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Tranquilizer
Reduces mental tension / anxiety (thorazine, haldol)
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3 Types Injections
- 1. Intramuscular
- 2. Subcutanious
- 3. Intradermal
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Intramuscular Injection
- 1. Three muscles (Deltoid, Gluteus, Vastus Lateralis)
- 2. Vastus Lateralis (used on peds, EpiPens)
- 3. Gluteus - 1 to 3cc (21gx1)
- 4. Deltoid - up to 1cc (23gx1)
- 5. Use at least 3cc syringe
- 6. 90deg angle always
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Subcutaneous Injection
- 1. Fatty layer beneath skin (adipose)
- 2. Back of arm
- 3. Lower abdomen
- 4. Lateral upper leg
- 5. 3cc syringe (25g x 5/8)
- 6. 45deg angle always
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Intradermal Injection
- 1. Anterior forearm 4" above wrist, 4" below elbow
- 2. .1cc (27g x 1/2)
- 3. 1cc syringe
- 4. Create wheel in skin
- 5. Upper back used for allergies
- 6. 10-15deg angle always
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Syringe Parts
- 1. Plunger
- 2. Rubber Stopper
- 3. Flange
- 4. Barrel
- 5. Lock / Plain Tip
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Needle Parts
- 1. Hub
- 2. Hilt
- 3. Shaft
- 4. Lumen (guage)
- 5. Point
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Ampule
- One dose, sealed glass container
- No need to inject air
- Flick point end to drop med in main body
- Hold gauze at middle and snap top off
- Draw up meds with filter needle
- Remove/discard filter needle
- Replace with propper needle and inject
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Vial
- Swab vial top with alcohol every time
- Inject air equal to med required in vial
- Draw med at eye level
- Remove air bubbles
- Administer meds
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PPD
- TB Test
- 4" above wrist and 4" below anticubical space
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