NHA module 11- Testing and Laboratory Procedures
skin testing for allergies
- apply antigen to non-hairy skin - scratch skin - may produce anaphylactic reaction so have epinephrine handy to cause rapid bronchodilation and vasoconstriction so provider needs to conduct testing
Specific gravity of urine
1.005-1.030
Distance vision(myopia) should be tested at how many feet?
20 feet- Pt can test with corrective lenses. eyes are tested separately and then together, pt can miss one item and still pass that line. vision is recorded in a fraction, with 20/20 representing normal vision
Urine pH range
4.5
fasting blood glucose(FBS)
60 to 110 mg/dL
Triglycerides
<150 mg/dL
Point-of-care-testing (POCT)
A mode of testing in which the analysis is performed at the site where healthcare is provided
Hemoglobin A1c
A test that measures the level of hemoglobin A1c in the blood as a means of determining the average blood sugar concentrations for over approximately three month period
collecting culture specimens
Always collected in a sterile container and precautions should be taken not to touch inside of container or lids and swabs which could contaminate the specimen.
CPOE (Computerized Physician Order Entry)
An order entry and decision support system that allows direct entry of orders into Epic. Only Certified(Credentialed) CCMA's are authorized to enter orders including Pharmacy orders
low-density lipoprotein (LDL)
Bad cholesterol less than 130 mg/dL
International Normalized Ratio (INR)
Blood coagulation test; commonly performed on patients taking anticoagulants (i.e. coumadin/warfarin) range 0.8-1.2
abnormal or critical lab values(outside of the established reference range)
CLIA requires rapid communication of critical lab values If CMA takes a call from the reporting lab on a critical Lab value the CMA should ensure accuracy by repeating the lab values back to the laboratory personnel
CMS
Centers for Medicare and Medicaid Services
Reminders for specimen collections
Collect specimen at the right time, Use the right site of suspected infection, minimize transport time to a reference lab, collect the appropriate quantity, use the appropriate containers and label accordingly.
Myopia (nearsightedness)
Condition in which a person can see things close up but has trouble seeing at a distance.
Hyperopia (farsightedness)
Condition in which a person can see things in the distance but has trouble seeing at close range.
Testing information
Each test is individually checked unless a panel of tests are required;example Lipid panel testing for liver issues. Validate that the tests on the requisition match the provider's orders in the medical record. If pregnancy test is ordered then add date of last menstrual period.
CLIA regulations
Established in 1988 to ensure quality of diagnostic testing through lab regulations. There are three designations for lab testing based on complexity.
visual field testing (perimetry)
Extent of range of vision in each direction. Sensitivity of vision to a given light stimulus is important in diagnosis of glaucoma. May be affected by eye disease, stroke, space-occupying lesions, trauma, etc.
Spun hematocrit
Fingerstick collection of blood in microcapillary tubes is centrifuged and evaluated for the percentage of red blood cells
Hemoglobin machine
Is measured using machine to screen for oxygen-carrying protein in whole blood, performed using capillary blood from a finger stick (capillary puncture).
The ICD-10 coding Information
Lab Requisition slips are already populated with the appropriate ICD-10 codes. Lab testing is strictly coded from the provider's reason for ordering the test. To appropriately assign codes ensure that complete diagnosis info is included on form.
Total cholesterol levels
Less than <200 mg/dL
cholesterol testing
Lipids are evaluated using capillary blood
EMR (electronic medical record) Pt lab results
Make sure Dr has signed off on lab results before you release any lab results to pt portal or to pt. Verify correct address before mailing results and verify identification before releasing Lab results by phone to pt.(HIPAA regulations)
Hemoglobin(Hgb) Range
Male: 13 - 18 g/dL Female: 12 - 16 g/dL Infant: 14 - 22 g/dL
Hematocrit (Hct) Range
Male:42% to 52% Females: 36% to 48%
MACRA
Medicare Access and CHIP Reauthorization Act of 2015(deals with payment for health care under the direction of the CMS
Urobilinogen in urine
Norm- 0.1-1.0; Abn.- absent-biliary obstruction; increasd- early sign of liver or hemolytic disease; reduced- reaction to antibiotic medication
Pap smear test
Papanicolaou (smear or test) is sent to cytology for processing
patient demographic information
Patient name, Address, Date of birth, gender, age, Telephone number, Insurance information,Provider information, Diagnostic or indications for testing, last menstrual period if performing a Pregnancy confirmation test and Order date.
quality assurance
Policies and procedures to maximize pt safety and ensure reliability related to lab testing.(the policy of checking Lab refrigerator temp and documenting it in a log and making sure the temp is maintained between 39 and 41 degree F)
The chain of custody is used for what purposes?
Retaining evidence integrity by identifying people coming into contact with evidence especially for a court subpoena to prevent specimen tampering
Tuning forks to diagnose hearing loss
Sensorineural hearing loss: hears better through the air than through the bone via vibration Conductive hearing loss: hears better through the bone (vibration) than through the air vibrating tuning fork is placed on top of the head or on the mastoid process to tst hearing
Stool samples for O & P, ova & parasite collection
Stool samples can be collected for parasites and or to evaluate for bacterial infections. Give patient special container and directions for collection at home
Quality control procedures
Testing specimens, quality control samples are tested to ensure pt. samples are accurate. example. (exp. if using a fecal occult slide a control strip turns blue if the developer is effective. if the control strip does not turn blue than the developer is not working or the slide is not valid and the test will not be accurate.)
What should be added to a urine container?
The following should be noted on the container: patient's name, date of collection, time of collection, and tests to be performed on the specimen.
Catheterized Urine collection
The nurse or provider inserts a sterile tube through the urethra into the bladder and the CCMA preps the patient and assists provider during procedure.
Nasal smear for influenza types A and B
This screening is a qualitative test for influenza antigens using a swab that is inserted into the nostril
Mononucleosis screening
This screening tool tests for the presence of the Epstein-Barr virus in capillary blood
Rapid Streptococcus testing
Throat swabs are obtained to screen for Group A streptococcus
tape test for pinworms
Typically collectd on small children. provide Parents with a slide with a piece of tape on it. The tape is placed over child's anus before getting up in the morning and then back on the side and brought back to provider for analysis.
storing nonblood specimens
Urine should be refrigerated if testing is not immediately performed. Urine left at room temp will have ph changes and be considered unfit for testing,. Swabs for std testing can be destroyed if they are cooled and should remain at room temperature
Peak flow testing
Used to measure a patients ability to exhale, (forced expiratory volume) which indicates the effectiveness of airflow out of lungs diagnosis of asthma
blood glucose levels
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 finger stick(capillary puncture)
Helicobacter pylori (H. pylori)
a blood test to determine the presence of H. pylori antibodies, which indicate infection with the bacteria; H. pylori is also found in the lining of the stomach and causes duodenal ulcers
Intradermal testing
a diluted allergen is injected ID and the pt is observed. if the wheal becomes inflamed with induration (raised, hard area ) the substance can be identified as an allergen
sputum culture
a microbial test used to identify disease-causing organisms of the lower respiratory tract, especially those that cause pneumonia patient should produce a deep,productive cough. Pts should avoid mouthwashes prior to sputum collection
first morning urine specimen
a urine specimen that is collected after a night's sleep; contains greater concentrations of substances that collect over time than specimens taken during the day and is used for pregnancy testing or when other analytes (protein, nitrites) need to be evaluated.
Bilirubin
a urine test that requires testing for bilirubin needs special handling to protect the specimen from light which would affect the accuracy of the testing is required. A dark container is required for the specimen
How long should you wait to perform any lab testing in urine?
any testing should be performed within one hour of collection to prevent decomposition of the specimen due to bacterial overgrowth and cellular breakdown.
Spirometry testing
automated test that produces a graphic result, pt should wear loose clothing, sit in upright or standing position, and breath through mouth, pursing lips around the mouthpiece, CMA applies clip to pt's nose to avoid nose-breathing during procedures. pt should lift the chin slightly and extend the neck a little during test to reduce breathing resistance
pregnancy test
blood or urine test to detect the presence of hCG
erythrocyte sedimentation rate (ESR, sed rate)
blood test that measures rate at which red blood cells settle out of blood to form sediment in bottom of test tube; indicates presence of inflammatory disease 0 to 20 mm/hr males 0 to 30 mm/hr females
moderate to high complexity and not under the scope of MA
considered non-waived. Labs performing these tests have CLIA waived Certificate and undergo inspections to ensure standards are met. typically performed in reference or hospital labs
Specimen collection containers
containers should be labeled with pt information at the time of collection. The labels should then be verified against the pt chart and lab order before sending the specimen to the lab for processing
quantitative Urinalysis results
glucose-neg, spec gravity-1.020., pH- 6.1, protein-neg, ketones-neg, WBC's-neg, bilirubin-neg, blood-neg, nitrate-neg, urobilinogen- neg,
fasting blood sugar (FBS)
goes to Chemistry Lab for processing
white blood cell count (WBC)
goes to Hematology for processing
culture and sensitivity (C&S)
goes to Microbiology for processing
type and crossmatch for blood typing
goes to the Blood Bank for processing
High-density lipoprotein (HDL)
good cholesterol greater than 40mg/dL
Clinical Laboratories Improvement Amendments (CLIA-waived tests)
have little chance of harm due to error; can be performed in a physician office and by a medical assistant
dipstick urinalysis
involves dipping a type of chemical analysis strip into a sample or urine and reading the colors of the squares that measure the specific gravity, acidity (pH), glucose, ketones, blood, leukocytes, nitrites, bilirubin, and urobilinogen levels in the sample
Commission on office Laboratory Accreditations (COLA)
is a independent accreditor for labs and focuses on meeting CLIA regulations with a goal of providing the best care to the patient.
Quality Assurance (QA)
is comprehensive and relates to policies and procedures that must be implemented for reliability of the test results(exp putting newest urine test strips in back of older urine strip containers)
Quality Control (QC)
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(reviewing expiration dates on urine mult-sticks)
fecal occult blood test
lab test performed to detect blood in the feces which can indicate a disease process or G.I.Bleed. To prevent a false positive instructions on medications and foods to avoid for 3 days prior to testing and the pt is to collect three separate specimens on the filter paper.
Spirometry measures
lung capacity
Tympanometry measures
middle ear function. tests record movement of the tympanic membrane which can be affected by increased pressure in the middle ear.
CLIA-waived tests
most common designation for ambulatory care and its lowest level of complexity and can be done at home or office
pre-test pt instruction prior to spirometry rest
no large meals 2 hours prior to test, no smoking 1 hour prior to test, and discontinuing the use of bronchodilators or other breathing therapies (Inhalers,Nebulizers) for at least 6 hours before the test.
transporting nonblood specimens
padding and protection is needed if specimen has the potential to break, and specimens should be put into a biohazard bag with a biohazard label on the outside of shipping packages to warn handlers of potential hazards
near vision test(presbyopia or hyperopia)
patient holds card 14 to 16 inches from the eye and reads the chart - without glasses on. Test each eye separately and then both together. This test is for patients with poor eye sight. Test results should read "14/14" (Jaeger card is used)
SPECIMEN LABELS SHOULD INCLUDE
patients full name and date of birth the date and time of collection and initials of person collecting the specimen the type of specimen Providers name
clean-catch midstream urine specimen
performs perineal cleaning using moist wipes, begins to urinate, and then collects the specimen midstream in a sterile urine container. This is used for cultures or when a non-contaminated specimen is desired.
tympanogram
record of middle ear function (presented in graph form)
proper disposal of nonblood specimens
red biohazard waste bags are sufficient for specimen containers that are not breakable, Use sharps containers for anything that could splinter or break . A designated sink is often adequate for disposal of urine samples. ALWAYS follow the policies and procedures outlined by the facility and adhere to OSHA standards
FDA (Food and Drug Administration)
requires all testing to meet federal guidelines and determines the complexity of the tests performed in the Lab. Ambulatory care centers perform CLIA waived tests.
Nitrate
sent to Urinalysis for processing
Controls
specific tools used in lab with a known result, used to compare with results of a pt sample to confirm validity of the test and specimen using a quantitative result range or qualitative descriptor
processing non-blood specimens
swabbed specimens needs to be kept moist by breaking the fluid chamber within the specimen container urine specimens for microscopic analysis can require centrifuging prior to transport with the supernatant fluid removed
RAST testing
test blood for specific antibodies that could indicate an allergy. safer regarding avoiding a potential allergic reaction but requires a blood draw.
Prothrombin Time (PT)
test of the ability of blood to clot range 10.4 to 15.7 seconds
fecal occult blood test
test to detect hidden occult blood in feces
Presbyopia is:
the gradual loss of power to focus on near objects due to the aging process
CMS-1500 form
the standard form used by health-care providers to bill for services, including disease state management services.
audiometry
the use of an audiometer to measure hearing acuity. CMA's can perform audiometry testing if pts can respond to directions of pushing or raising a hand to acknowledge when various tones are heard through headphones(adults should hear at 25 decibels, child at 15 decibles
24-hour Urine
this method uses a container with preservatives. The pt. discards the first morning specimen and collects all specimens for the next 24 hours, including the first void of the second day. This type of collection is important in quantitative analysis of the components such as proteins when analyzing kidney function
scratch test
type of allergy testing in which body is exposed to allergens through a light scratch in skin, If a wheal occurs within 15 minutes the allergist can identify the substance as a possible allergen
Random urine specimen
urinates in a clean, non-sterile container. This specimen is used for screening purposes and does not require fasting and can be performed at anytime
Qualitative Urinalysis
urine dip-Clarity-clear, color- amber
Drug Testing
urine, blood screening, or hair analysis used to identify those who may be using drugs
color vision tests
use of multicolored charts to determine ability of patient to recognize color. screening tests is an 11 plates within the Ishihara book. if pt misses four or more there might be a color deficiency and further testing is warranted
food challenge testing
used to detect specific food allergies. Not first choice but could be prescribed if scratch test or Intradermal test is positive. Pt is given increased amounts of food suspected of causing an allergy (peanut butter) Environment must be controlled where medication and treatments are available
peak flow testing instructions
wear non restrictive clothing -begin with marker at the bottom of the scale on the meter-in a upright sitting or standing position, take deep breath and forcefully blow out of the mouth- record number where the marker is located at the end of the testometry -repeat the test two to three times and record the results
abnormal tympanogram
will produce a flat line