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Chapter 48. Collecting, Processing, and Testing Blood Specimens. PowerPoint® presentation to accompany: Medical Assisting Third Edition Booth, Whicker, Wyman, Pugh, Thompson. Learning Outcomes. 48.1 Discuss the composition and function of blood.

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slide1

Chapter 48

Collecting, Processing, and Testing Blood Specimens

PowerPoint® presentation to accompany:

Medical Assisting

Third Edition

Booth, Whicker, Wyman, Pugh, Thompson

learning outcomes
Learning Outcomes

48.1 Discuss the composition and function of blood.

48.2 Describe the process for collecting a blood specimen.

48.3 Explain the importance of confirming patients’ identities and correctly identifying blood samples.

48.4 Describe how to perform venipuncture and capillary puncture procedures.

learning outcomes cont
Learning Outcomes (cont.)

48.5 Identify the equipment and supplies required for blood-drawing procedures.

48.6 Discuss the correct procedures for disposing of waste generated during blood-drawing procedures.

48.7 Discuss common fears and concerns of patients and how to ease these fears.

learning outcomes cont4
Learning Outcomes (cont.)

48.8 Develop techniques for helping patients with special needs, including children, the elderly, patients at risk for uncontrolled bleeding, and difficult patients.

48.9 Identify common blood tests and explain their purposes.

48.10 Perform certain blood tests.

introduction
Introduction
  • Medical assistant
    • Collects blood specimens
    • Performs waived testing
    • Knowledge needed
      • Understand circulatory system and function of blood
      • Appropriate supplies and equipment
      • How to perform and screen common blood tests
role of the medical assistant
Role of the Medical Assistant
  • Phlebotomy – insertion of a needle or cannula into a vein to withdraw blood
  • Put the patient at ease during procedure
  • Process specimens and conduct testing
  • Complete necessary paperwork and make sure specimens are handled properly
functions and composition of blood
Circulatory system transports blood

Heart pumps 8–12 pints of blood through 70,000 miles of vessels / day

Hematology – the study of blood

Functions and Composition of Blood
functions and composition of blood cont
Functions and Composition of Blood (cont.)
  • Functions of blood
    • Distributes oxygen, nutrients, and hormones
    • Eliminates waste products
    • Attacks infecting pathogens
    • Maintains acid-base balance
    • Regulates body temperature
functions and composition of blood cont9
Functions and Composition of Blood (cont.)
  • Red blood cells – erythrocytes
    • Internal respiration
    • Transport oxygen to cells
      • Hemoglobin – 98%
      • Dissolved in plasma – 2 to 3 %
    • Hemoglobin
      • Main component of RBCs
      • Protein containing iron
functions and composition of blood cont10
Functions and Composition of Blood (cont.)
  • White blood cells – leukocytes
    • Protect against infection
    • Granular
      • Basophils
      • Eosinophils
      • Neutrophils
    • Agranular
      • T and B lymphocytes
      • monocytes
functions and composition of blood cont11
Platelets – thrombocytes

Fragments of cytoplasm

Essential for clot formation

Plasma

Clear, yellow liquid

Contains formed elements of blood

90% water

Serum

Clear, yellow liquid remaining after clot formation

Functions and Composition of Blood (cont.)
functions and composition of blood cont12
Functions and Composition of Blood (cont.)
  • Blood types or groups
    • Presence of antigens A and B determines type
    • Blood also carries antibodies
  • Transfusions require careful matching to prevent hemolysis
apply your knowledge
Apply Your Knowledge
  • What is the role of the medical assistant related to collecting blood samples?

ANSWER: The medical assistant will put the patient at ease during the procedure, process specimens, conduct testing, complete necessary paperwork, and make sure specimens are handled properly.

Very Good!

apply your knowledge14
Apply Your Knowledge

What are three functions of blood?

ANSWER: Functions of the blood are: (list any 3)

Distributes oxygen, nutrients, and hormones

Eliminates waste products

Attacks infecting pathogens

Maintains acid-base balance

Regulates body temperature

Very Good!

collecting blood specimens
Reading and interpreting the test order

Review order

Assemble equipment and supplies

Preparing the patient

Greet and identify the patient

Confirm pretest preparation

Explain the procedure and safety precautions

Establish chain of custody

Collecting Blood Specimens
collecting blood specimens cont
Collecting Blood Specimens (cont.)
  • Use Standard Precautions and PPE as needed
  • Handling exposure incident
    • Needlestick or other exposure to blood / blood products
    • Report to appropriate person immediately
    • Wash area and apply bandage
    • Document date, time, people involved, type of exposure
collecting blood specimens drawing blood
Collecting Blood Specimens: Drawing Blood

Not all states permit medical assistants to draw blood

Venipuncture

Puncture of a vein

Most common sites are in the anticubital fossa and forearm

Common Sites for Venipuncture

collecting blood specimens cont18
Venipuncture complications

Hematoma

Hold needle still

Hold pressure on siteafter removal of needle

Latex allergy

Ask patient

Use non-latex gloves,tourniquet, and bandages

Nerve injury

Know anatomy

Infections

Rare

Clean site prior to venipuncture

May not be evident for several days

Collecting Blood Specimens (cont.)
collecting blood specimens cont19
Collecting Blood Specimens (cont.)
  • Equipment
    • Evacuation systems – use special double-pointed needle, needle holder
    • Needle and syringe systems
    • Butterfly system – winged infusion set and syringe
    • Collection tubes
      • Sealed to create a vacuum
      • Color-coded to identify appropriate additive
collecting blood specimens cont20
Collecting Blood Specimens (cont.)
  • Engineered safety devices
    • Reduce the possibility of needlestick injuries
    • Types
      • Retracting needles
      • Hinged or sliding shields
      • Self-blunting needles
      • Retractable lancets
collecting blood specimens cont21
Capillary puncture

Superficial puncture of skin with sharp point

Lancets / automatic puncturing devices

Micropipettes – small calibrated glass tubes that hold a small, precise volume of fluid

Reagent products

Chemically treated paper or dipstick

Smear slides

Collecting Blood Specimens (cont.)
apply your knowledge22
Apply Your Knowledge

What precautions should you take when collecting a blood specimen?

ANSWER: You should use Standard Precautions and appropriate personal protective equipment.

excellent!

responding to patient needs
Responding to Patient Needs
  • Respond with sensitivity and competence
  • Fears and concerns
    • Pain
    • Bruises or scars
    • Serious diagnosis
    • Contracting a disease from the procedure
responding to patient needs special considerations
Responding to Patient Needs: Special Considerations
  • Children
    • Talk with parent or caregiver first
    • Address child directly
    • Speak in a calm, soothing voice
    • Explain the procedure briefly in terms they can understand
    • Keep child informed of status during the procedure
responding to patient needs special considerations cont
Responding to Patient Needs: Special Considerations (cont.)
  • Elderly
    • Prone to bruising
    • Difficult to obtain an adequate sample
    • Speak clearly in a low-pitched voice
    • Allow adequate time for patient to respond to questions
responding to patient needs special considerations cont26
Responding to Patient Needs: Special Considerations (cont.)
  • Risk of bleeding
    • Hemophilia or taking blood-thinning medication
    • Hold site for at least 5 minutes
    • Contact physician if bleeding does not stop
responding to patient needs special considerations cont27
Difficult patients

Difficult venipuncture – do not stick more than twice

Fainting patients –

Reaction to blood draw

Position to avoid injury

Angry or violent patients

Explain need for testing

Avoid arguing

Do not force patient

Document behavior and if patient refuses

Responding to Patient Needs: Special Considerations (cont.)
apply your knowledge28
Apply Your Knowledge

What is one precaution you can take when drawing blood from a patient who is taking anticoagulants?

ANSWER: After drawing blood on a patient taking anticoagulants, you should hold a cotton ball over the puncture site for at least 5 minutes, monitor the site carefully, and notify the physician if bleeding does not stop.

Correct!

performing common blood tests
Performing Common Blood Tests

Results aid in diagnosis

POLs often only perform waived tests

Know office policy

performing common blood tests cont
Performing Common Blood Tests(cont.)
  • Chemicals in lab
    • Anticoagulants – keep blood in uncoagulated state
    • Serum separators – form a gel-like barrier between serum and clot in coagulated sample
    • Stains – color particular cells
performing common blood tests hematologic tests

Centrifuged Capillary Sample

Performing Common Blood Tests:Hematologic Tests
  • Blood counts
    • RBC count
    • White blood cells
    • Differential white blood cell
    • Platelet
    • Hematocrit
    • Hemoglobin
performing common blood tests hematologic tests cont
Performing Common Blood Tests: Hematologic Tests (cont.)
  • Morphologic studies
    • Morphology – study of shape and form of objects
    • Requires special training
  • Coagulation tests
    • Identification of potential bleeding problems
    • Monitor therapeutic drug levels for anticoagulants
    • PT and PTT
performing common blood tests hematologic tests cont33
Performing Common Blood Tests: Hematologic Tests (cont.)
  • Erythrocyte sedimentation rate
    • Measures rate of RBCs falling to the bottom of the blood sample
    • Must be performed on a fresh sample
    • Tube must contain an anticoagulant
    • Read after one hour
    • Recorded as mm/hr
performing common blood tests chemical tests
Performing Common Blood Tests:Chemical Tests
  • Rarely performed in the POL
  • Waived tests
    • Blood glucose monitoring
    • Hemaglobin A1c
    • Cholesterol tests
performing common blood tests serologic tests
Introduction of an antigen or antibody into a specimen and detection of a reaction to it

Immunoassays

Western blot

Radioimmunoassay (RIA)

Enzyme-linked immunosorbent assay (ELISA)

Immunofloruescent antibody (IFA) test

Rapid screening tests

Infectious mononucleosis

HIV

Helicobactor pylori

Performing Common Blood Tests: Serologic Tests
apply your knowledge36
Apply Your Knowledge

Matching:

___ Hemoglobin A1c A. ESR

___ Lysing RBCs / evaluating the color B. Serology test

___ Shape or form of objects C. Coagulation tests

___ Identify bleeding problems D. Chemical test

___ Rate at which RBCs fall E. Differential

___ Percentage of each type of WBC F. Morphology

___ ELISA G. Hemoglobin

ANSWER:

D

G

F

C

A

E

Super!

B

in summary
In Summary
  • Phlebotomy procedures require
    • Technical skills
    • Interpersonal communication skills
  • Medical assistant
    • Patient instructions
    • Completion of testing procedures
end of chapter
End of Chapter

End of Chapter 48

  • Blood will tell, but often it tells too much.
    • ~ Don Marquis