Module 7 - Point Of Care Testing And Laboratory Procedures
HCG test process
1. test strip in sample for 5 min 2. test strep on dry surface 5 min 3. 1 line pregnant 2 lines pregnant
female hemoglobin
12 to 16 g/dL
male hemoglobin
13.5 to 17.5 g/dL
Cholesterol
130 to 200 mg/dL
Platelet count
150,000 to 400,000/mm3
female hematocrit
36% to 46%
RBC count females
4 to 5.5 million/mm3
WBC
4,500 to 1,1000/mm3
RBC Count males
4.5 to 5.9 million/mm3
Triglycerides
40 to 150 mg/dL
male hematocrit
41% to 53%
granulocyte
50% to 70%
glucose
70 to 100 mg/dL (fasting)
FRC
75% to 120%
RV
75% to 120%
FEV 1
80% to 120%
FVC
80% to 120%
TLC
80% to 120%
hemoglobin
A machine is used to screen for the oxygen-carrying protein in whole blood, performed using capillary blood from a fingerstick (capillary puncture).
analytes
A substance or chemical that is being identified and measured.
MCV
A value score of 80 to 95
H Pylori
A whole blood sample can screen for the presence of H. pylori antibodies.
Quality Control
Action is performed to ensure the reliability of test results by detecting and eliminating error. It is included in quality assurance but is more specific; it is related to test reliability and accuracy while attempting to uncover errors and eliminate them. Example : reviewing the expiration date of urine reagent strips, checking the temperature of the laboratory refrigerator and documenting it on a log is a quality control measure
Snellen test
Adult patients stand 20 feet and identify letters on the chart, with each row of letters getting progressively smaller in size, tests for myopia
Hemoglobin A1C
Below 5.7%
hematology
Blood cell counts that determine RBCs, WBCs, and platelets of a blood specimen
chemistry
Chemicals found in blood, cerebrospinal fluid, urine, joint fluid, lipid profiles (such as triglycerides, total cholesterol, HDL, and LDL), and fasting glucose
Eye test for children
Children stand 10 feet away from a chart at eye level and identify letters, shapes, or the direction an "E" is pointing
CLIA
Clinical Laboratory Improvement Amendments
Specimen Collection Technique
Collect the specimen at the appropriate time. Collect the specimen from the site of suspected infection. Minimize transport time to a reference lab. Collect the appropriate quantity. Use the appropriate containers and label them accordingly.
qualitative
Data in the form of recorded descriptions rather than numerical measurements.. example influenza testing
Steps to releasing lab results
Do not release any lab results to patients without the provider reviewing and signing off on them first. Document notification to pt
Order of vision test
Each eye is tested individually, and then both are tested together
HIPAA Compliance lab results
Ensure the correct address for the patient and verify identity when communicating information over the phone
errors that affect results
Equipment malfunctions (Personnel are required to perform calibration on laboratory equipment. Preventive maintenance schedules must be followed and documented.) Sample mix-up Unindicated failure of quality controls Procedures not properly followed
errors that affect results
Failure to report Improper data entry (Accurate recording is a key responsibility of the medical assistant.) Excessive turnaround time
Spun hematocrit
Fingerstick (capillary puncture) collection of blood is obtained in microcapillary tubes, which are centrifuged and evaluated for the percentage of red blood cells.
HDL
Greater than 60 mg/dL
hCG (human chorionic gonadotropin)
Hormone secreted by the placenta during pregnancy
errors that affect lab results
Inappropriate test request Order entry error Misidentification of the patient Inappropriate container Improperly labeling of specimen Inadequate sample collection Inadequate sample/anticoagulation ratio
urinalysis
Includes the physical, chemical, and microscopic examination of urine
analytic phase
Instruments are maintained and calibrated. Controls are run and analyzed for each testing method. The specimen is tested, and the results are compared with reference ranges. The test results are logged and documented in the patient's health record.
hemoglobin
Iron-containing oxygen-transport in red blood cells that is responsible for carrying oxygen from the respiratory organs to the rest of the body.
critical value
Laboratory results at such variance to the normal value range that a potentially life-threatening, pathophysiologic state is occurring. Action must be taken as soon as possible.
Moderate- and high-complexity tests are considered nonwaived
Labs performing these tests must have a CLIA certificate and undergo inspections to ensure standards are being met. These tests are typically performed in a reference or hospital laboratory.
LDL
Less than 100 mg/dL
Cholesterol testing
Lipids are evaluated from a capillary blood sample. The sample is placed on a reagent strip and analyzed in a cholesterol testing machine.
Quality Assurance
Maintenance of a desired level of quality related to a service or piece of equipment. It is comprehensive and relates to policies and procedures that must be implemented for the reliability of test results. Example: rotating stock to put the newest containers in the back, policy of checking the temperature and maintaining it between 2° C and 8° C (35° F and 46° F)
Normal hemoglobin
Male: 14-18 Female: 12-16
peak flow meter
Measures the forced expiratory volume, which indicates the effectiveness of airflow out of the lungs. 80% or better is considered well-controlled and does not require treatment.
cytology
Microscope examination of cells for diagnostic purposes
patient identifiers
Name Assigned identification number (e.g., medical record number) Date of birth Phone number Address
Jaeger Eye chart
Near vision testing screens for a refractive disorder that occurs with the aging eye (presbyopia) or or hyperopia (farsightedness) by using the
spirometry pre-procedure instructions
No large meals 2 hours before the test No smoking 1 hour before the test Discontinuation of the use of bronchodilators or other breathing therapies (inhalers, nebulizers) for at least 6 hours before the test
demographic information found on a requisition
Patient name Address Date of birth Sex Telephone number Insurance information Provider information Diagnosis code or indications for testing Order date
blood bank
Processes and stores blood and blood products for transfusion and blood disorder treatments
quantitative
Related to measuring the amount of something.
decibels (dB)
Sound amplitude is measured in
specimens for cultures
Specimens for cultures are always collected in sterile containers. Take precautions to avoid touching the insides of lids, swabs, or containers, which could contaminate the specimen. If the specimen is not properly collected, the identification of the causative agent might not occur, and proper treatment cannot be started.
microbiology
Studying bacteria, fungi, parasites, yeasts, and viruses; specimens can include urine, blood, sputum, cerebrospinal fluid, stool, and wound material
Drug testing
Substances such as recreational drugs and medications can be detected in urine and blood samples.
pulmonary function test
Test to assess lung functioning, which will help assist in the detection and evaluation of pulmonary disease.
point of care testing
Tests performed at the patient's bedside or work of area, using a portable instrument pregnancy tests,
20/20 vision
The ability to see at 20 feet what the average person sees at 20 feet.
Eye exam results
The last line at which the patient can clearly read the letters or pictures with accuracy is their screening result. Most facilities state that a patient can miss one item and still pass that line. Once the patient misses two items in a single line, the test is complete, using the previous line read without error as the final result.
first morning specimen
The patient collects their first urine specimen of the morning in a clean container. This specimen is more concentrated and is often used for pregnancy testing or when other analytes (protein, nitrites) need to be evaluated.
preanalytical phase
The provider orders a test to screen, monitor, or diagnose a patient's condition. A written or electronic requestion is filled out, showing the requested tests to be ordered, the specimen required, and where the specimen will be tested. The specimen is collected, labeled, and processed. The specimen is transported to the laboratory or properly prepared for offsite laboratory pickup.
Hemoglobin A1C
This capillary blood test determines the approximate control of blood glucose levels over a 3-month period.
catheterized collection
This method is used when a sterile urine sample is needed or if patients are unable to provide a specimen on their own. It involves insertion of a sterile tube (catheter) through the urethra into the bladder. The provider or nurse performs this procedure, with the medical assistant prepping the patient and assisting, if needed.
24-hour sample
This method uses a large container with preservatives. The patient discards their first morning urine specimen and collects all remaining urination specimens for the next 24 hr, including the first morning void of the second day. This type of collection is important in the quantitative analysis of components such as protein when analyzing kidney function. It is also used to analyze substances that are sporadically released into the urine over a 24-hour period.
random urine
This sample can be collected at any time of the day and is used for screening purposes. The patient urinates in a clean, nonsterile container.
Nasal Swab Specimen for Influenza Types A and B
This screening is a qualitative test for multiple influenza antigens using a swab that is inserted into the nostril to obtain the sample specimen.
Mononucleosis screening
This screening tool tests for the presence of the Epstein-Barr virus in a capillary blood sample.
Fecal Occult Testing
This test is performed to screen for hidden blood in the stool. This test is performed with a fecal occult blood testing kit using the patient's stool specimen.
Rapid Streptococcus testing
Throat swabs are obtained to screen for group A streptococcus. Both sides of the posterior throat/tonsil area are swabbed and tested for the presence of the group A antigen.
HCG testing
Urine or blood is screened for the presence of human chorionic gonadotropin (hCG) antibodies.
Ishiahara test
Vision test to assess for color deficiency.
Hematocrit
Volume percentage of red blood cells in blood.
Peak Flow meter instructions
Wear nonrestrictive clothing. Begin with the marker at the bottom of the scale on the meter. In an upright sitting or standing position, take a deep breath and forcefully blow out of the mouth, which is secure around the mouthpiece of the machine. Record the number where the marker is located at the end of the test. Repeat the test two to three times and record the results.
Blood Glucose
Whole blood is analyzed in a glucometer for a quantitative glucose level and is a screening test for diabetes, performed using capillary blood from a fingerstick.
Absolute FEV1/FVC ratio
Within 5% of the predicted ratio
antihistamine
a drug that blocks the effects of histamine in the body
Ishihara test
a test for color-blindness in which the subject is asked to distinguish numbers or pathways printed in colored spots on a background of spots of a different color or colors. If the patient misses four or more plates, there might be a color deficiency, and further testing is warranted.
appropriate packaging
clear plastic bag with a zip closure and dual pockets, which allows for the separation of the specimen and lab requisition
Scratch Test and Intradermal Allergy Test
diluted allergen is applied to a scratch or prick that has been made on the surface of the patient's skin. The testing is usually conducted on the forearm or upper back. If a wheal occurs in the first 15 minutes, the allergist can identify the substance as a possible allergen and consider further allergy testing to be conducted intradermally.
intradermal testing
diluted allergen is injected intradermally, and the patient is observed. An initial wheal is expected. If the wheal becomes inflamed with induration (raised, hard area), the substance can be identified and confirmed as an allergen.
Instructions prior to allergy testing
discontinue the use of antihistamines three days prior to allergy skin testing
denominator in eye chart
distance at which patients with typical vision can read the line
numerator in eye chart
distance at which the test is performed (20 feet away from the chart)
Improper instructions for clean-catch urine samples.
excessive bacteria presence and may result in the need for the patient to provide a new sample.
Drug Testing process
explained thoroughly to the donor, and they need to sign a consent form. The consent form can be part of the chain of custody form. The consent will state the purpose of the test and gives you permission to collect the specimen, prepare it for transport to the laboratory for analysis, and release the results to the agency requesting the test. Copies of the chain of custody form will be distributed to the medical review officer, laboratory, patient, collector, and employer or requesting party.The donor needs to be aware and informed that medications (both prescription and nonprescription), drugs, and alcohol could show in the test results. Encourage the donor to list any substances that may have been consumed within the last 30 days, indicating the name and amount of what was taken.The chain of custody form will indicate the source of the specimen. The patient's signature on the consent form states, officially, that they are the same person that provided the sealed specimen to send fo
clean-catch midstream
he patient cleanses the genitalia area using three moist antiseptic wipes. Females will cleanse each side and the middle of the urinary meatus from front to back using a separate wipe for each passage. Males will cleanse each side of the glans penis and across the middle using a separate wipe for each passage. The patient will begin by urinating in the toilet, then pause and collect the rest of the urine specimen in a sterile container or until it is adequately filled. This specimen is used for cultures or when a noncontaminated specimen is required.
wheal reaction
larger the wheal, the more significant the allergy. If a wheal is evaluated less than 15 minutes from time of application, it may not have had enough time to develop a reaction.
Instructions on FOBT
medications and foods to avoid for three days prior to obtaining the specimen. Patients should avoid red meats or dyes, aspirin or aspirin products, vitamin C, and iron supplements because these could create false-positive fecal occult blood tests (FOBT).
red-green deficiency
most common color deficiency
CLIA Waived
most common designation for ambulatory care and is the lowest level of complexity. These tests could be performed in the home environment or easily conducted in the medical office with minimal risk of incorrect results. They pose no reasonable risk of harm to the patient if the tests are performed incorrectly.
chain of custody
must be established to document the handling of the specimen. Everyone who handles the specimen, including the patient being tested, must sign
myopia
nearsightedness
first part of a requisition
patient demographic information
information required on requisition
patient demographic information, provider's signature , specific tests ordered ,source of the specimen, date and time of specimen collection , diagnosis code
Jaeger Eye chart
patient is asked to read words from various-sized prints on cards that are held 14 to 16 inches away from the eyes (without corrective lenses). Similar to distance vision, each eye is tested individually and then together. The level at which the patient can read the smallest printing clearly and accurately is the final result
spirometry procedure
patient should wear loose clothing, be in an upright sitting or standing position, and breathe through the mouth, pursing the lips around the mouthpiece. The medical assistant will likely apply a clip to the patient's nose to avoid nose-breathing during the procedure. The patient should lift the chin slightly and extend the neck a little during the test to reduce breathing resistance. Instruct the patient to "Take the deepest breath possible. Seal your lips around the mouthpiece. Blow as hard and as fast as you can, blowing until you empty the air from your lungs." Proper coaching is essential for yielding the best results from the patient. The procedure is repeated until there are three acceptable maneuvers or attempts.
lack of patient adherence
patient who has not completed proper testing preparation may need to delay their testing, such as when a patient has not fasted for bloodwork requiring fasting.
Label specimen container
patient's name and date of birth, date and time of collection, and medical assistant's initials
postanalytic phase
pecimens are properly discarded. Analyses of control results are compared over time. Patient reports from outside laboratories are logged or documented. The provider interprets and signs all lab reports. The patient is notified of the results in the office or is contacted by laboratory personnel. The final report and all communication with the patient are documented in the patient's health record.
spirometry
pulmonary function test, is a noninvasive test that detects the lung's ability to function. It is an automated test that produces a graphic result by measuring how "fast" a patient can move air into and out of the lungs and how "much" air is moved into and out of the lungs.
tympanometry
records movement of the tympanic membrane, which can be affected by increased pressure in the middle ear. Using a small earbud, eardrum movement can be measured by changing the amount of air pressure applied. This test is valuable for determining the presence of fluid and potential infections in the middle ear. A normal tympanogram produces a peak on the graph, whereas an abnormal tympanogram will produce a flat line.
Critical Value steps from lab
repeat value back to confirm, notify provider and document
urinalysis
screening tool for analytes that are excreted in the urine. The urine sample is performed and tested with a reagent strip.
hertz (Hz).
sound frequency is measured in
testing for bilirubin
special handling to protect the specimen from ligh
collection of stool specimens
stool specimen collection to screen for the presence of hidden blood, which can indicate the presence of disease or gastrointestinal bleeding.
urine samples
tested within one hour of collection, and if not tested, the specimen must be refrigerated.
audiometry
the patient will wear a set of headphones, and various tones will be played. The patient will be directed to push a button or raise their hand to indicate they hear the tone. The level of hearing is documented in decibels and the frequency in hertz. An adult who has normal hearing should be able to hear tones below 25 decibels, and a child should be able to hear below 15 decibels.
audiometer
to measure hearing acuity at different frequencies. Sound amplitude is measured in decibels (dB), and sound frequency is measured in hertz (Hz).