(Solution Manual) Basic Clinical Laboratory Techniques

Estridge,Reynolds, 6

Medicine

Solution Manual

6th Edition

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Solution Manual for Basic Clinical Laboratory Techniques, The downloadable file consists of 438 pages, and the total size of the file is 3.64 MB. Purchase now only for highly discounted price.

Author(s): Estridge, Reynolds

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© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. UNIT 1 The Clinical Laboratory UNIT OBJECTIVES After studying this unit, the student will: • Discuss the regulation, orga nization, and function of th e clinical la boratory. • Discuss the qualifications, job functions, and et hical responsibilities of clinical laboratory personnel. • Identify and define selected abbreviations and acronyms commonly us ed in the clinical laboratory. • Identify, define, and use prefixes, suffixes, and stems in selected medical terms. • Discuss and implement laboratory safety rule s that must be followed to guard against biological, chemical, and physical hazards. • Identify common types of labware a nd demonstrate their correct uses. • Discuss and demonstrate safe use of general laboratory equipment. • Use the metric system to perfor m measurements and calculations. • Use laboratory math to prepar e simple laboratory reagents. • Discuss the importance and use of quality asse ssment programs in the clinical laboratory. • Use the compound bright-field microscope. • Perform a capillary puncture. • Perform a venipuncture. UNIT OVERVIEW The clinical laboratory is a place where blood, body fluids, and other biological specimens are tested, analyzed, or evaluated. The observations can be qualitative or quantit ative. The tests can be performed manually or using automated analyzers. Precise measurements are made and the results © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. are calculated and interpreted. Beca use of this, laboratory workers must have the skills necessary to perform a variety of tasks. Unit 1 is an introduction to the laboratory envi ronment as a workplace and to the profession of clinical laboratory science, also called medical laboratory science. Key concepts and procedures laboratory professionals need to know to work in the laboratory are described in the introductory unit. The regulation, organi zation, and function of th e clinical laboratory ar e addressed in Lesson 1-1. Qualifications and job functions of laborato ry personnel are revi ewed in Lesson 1-2. As an introduction to the structure of medical terms, Lesson 1-3 gives basic information about medical terminology and abbreviations and acronyms used in the laboratory. As other units are studied, additional vocabulary te rms will be introduced and defined. Two lessons on laboratory safety (Lessons 1- 4 and 1-5) are included in Unit 1 because workers must understand and follow all safety pr ocedures and practices before any laboratory exercises can be performed. Every worker in the clinical laborator y must be thoroughly aware of potential hazards in the workplace and must perform tasks in a manner that keeps them, coworkers, and patients safe. The correct and safe use of general laborator y equipment such as cen trifuges, pH meters, autoclaves, and laboratory balances is described in Lesson 1-6. Also explained is the care, use, and cleaning of frequently used labware such as beakers, cylinders, test tubes, and flasks. Because laboratory analyses use metric units, a brief introduction to the metric system is given in Lesson 1-7. Knowledge of the metric sy stem is required for exercises in other units. Basic laboratory calculations, met hods of reagent prepar ation, and the correct use of pipets are explained in Lesson 1-8. Principles, methods, and procedures for ensuri ng the reliability and accuracy of laboratory analyses are presented in Lesson 1-9, Quality Assessment. These quality assessment principles are included in Unit 1 because they must be inte grated into all aspects of laboratory operations, from employee training and evaluation to specimen collection and processing, specimen analysis, and interpretation and reporting of results. The proper care and use of the microscope is included in Unit 1 (L esson 1-10) because knowledge of its use is require d for lessons in the microbiology, hematology, urinalysis, and parasitology units. Lessons 1- 11 and 1-12 introduce techniques for collecting capillary and venous blood. Unit 1 is an introduction to the techniques, rule s, and skills needed to perform the exercises in Units 2 through 8. Unit 1 can also be used alone as an introduction to the profession of clinical laboratory science. After Unit 1 has been complete d, the remaining units can be studied in order of the instructor’s preference depending on available time, labor atory space, and equipment. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. LESSON 1-1 Introduction to the Clinical Laboratory LESSON OBJECTIVES After studying this lesson, the student will: • Explain the function of a medi cal or clinical laboratory. • Discuss the organization of a typica l hospital clinical laboratory. • Describe the functions of the differen t levels of laboratory personnel. • List the major departments of a typical c linical laboratory and name a test that would be performed in each department. • List three examples of nonhospit al clinical laboratories and describe the function of each. • Explain how clinical laboratories are regulated. • Explain the relationships between Cent ers for Medicare and Medicaid Services (CMS), Clinical Laboratory Improveme nt Amendments of 1988 (CLIA ’88), and clinical laboratories. • Discuss benefits of point-of-care (POC) testing. • Explain how the Health Insurance Portab ility and Accountability Act (HIPAA) affects the laboratory and laboratory workers. • Discuss the use and value of el ectronic health records (EHRs). • Describe the purpose and scope of quality assessment programs in the clinical laboratory. • Explain the reason for proficiency testing. • Explain the purpose of laboratory accreditation. • Define the glossary terms. 4 Lesson 1-1 ● Introduction to the Clinical Laboratory © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. GLOSSARY accessioning / the process by which specimens are l ogged in, labeled, and assigned a specimen identification code accreditation / a voluntary process in which an inde pendent agency grants recognition to institutions or programs that meet or exceed established standards of quality American Association of Blood Banks (AABB) / international associa tion that sets blood bank standards, accredits blood banks , and promotes high standards of performance in the practice of transfusion medicine anticoagulant / a chemical or substance that prevents blood coagulation bacteriology / the study of bacteria blood bank / clinical laboratory department where blood components are tested and stored until needed for transfusion; immunohematology depa rtment; transfusion services; also the refrigerated unit used for storing blood components Centers for Disease Control and Prevention (CDC) / central laboratory for the national public health system Centers for Medicare and Medicaid Services (CMS) / the agency within the Department of Health and Human Services (DHHS) responsible for implementing CLIA ‘88 Clinical and Laboratory St andards Institute (CLSI) / an international, nonprofit organization that establishes guidelines and standards of best current prac tice for clinical laboratories; formerly National Committee for Clinic al Laboratory Standards (NCCLS) clinical chemistry / the laboratory section that uses ch emical principles to analyze blood and other body fluids Clinical Laboratory Improvement Amendments of 1988 (CLIA ’88) / a federal act that specifies minimum performance standards for clinical laboratories coagulation / the process of forming a fibrin clot College of American Pathologists (CAP) / organization that offers accreditation to clinical laboratories and certification to clinical labora tory personnel COLA / agency that offers accreditation to physicia n office laboratories, hospitals, clinics and other healthcare facilities; formerly the Co mmission on Office Laboratory Accreditation Department of Health and Human Services (DHHS) / the governmental agency that oversees public healthcare matters; also called HHS electronic health record (EHR) / comprehensive, portable electronic patient health record electronic medical record (EMR) / a digital form of a patient chart created in a physician’s office or a hospital where a patient received treatment epidemiology / the study of the factors that cause disease and determine disease frequency and distribution Food and Drug Administration (FDA) / the division of the Department of Health and Human Services (DHHS) responsible for protecting th e public health by ensuring the safety and efficacy of foods, drugs, biological produc ts, medical devices, and cosmetics Health Care Financing Administration (HCFA) / see Centers for Medicare and Medicaid Services (CMS) Lesson 1-1 ● Introduction to the Clinical Laboratory 5 © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. hematology / the study of blood and the blood-forming tissues HIPAA / Health Insurance Portability and Accountability Act of 1996 immunohematology / the study of the human blood groups; in the clinical la boratory, often called blood banking or tr ansfusion services immunology / the branch of medicine encompassi ng the study of immune processes and immunity Joint Commission (JC) / an independent agency that accred its hospitals and large healthcare facilities; formerly known as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Laboratory Response Network (LRN) / a nationwide network of public and private laboratories coordinated by Ce nters for Disease Control and Prevention (CDC) with the ability for rapid response to threats to public health microbiology / the branch of biology dealing with microbes mycology / the study of fungi National Committee for Clinical Laboratory Standards (NCCLS) / see Clinical and Laboratory Standards Institute (CLSI) pathologist / a physician specially trained in th e nature and cause of disease phlebotomist / a healthcare worker trai ned in blood collection physician office laboratory (POL) / small medical laboratory locat ed within a physician office, group practice, or clinic plasma / the liquid portion of blood in which the blood cells are suspended; the straw-colored liquid remaining after blood cells are removed from anticoagulated blood point-of-care testing (POCT) / testing outside the traditional laboratory setting; also called bedside testing, off-site testing, near-patie nt testing, or altern ative-site testing proficiency testing (PT) / a program in which a laboratory’s accuracy in performing analyses is evaluated at regular intervals and compared to the performance of similar laboratories Provider-Performed Microscopy Procedures (PPMP) / a certificate category under CLIA ’88 that permits a laboratory to perform waived tests and also permits specified practitioners to perform on-site microscopy procedures quality assessment (QA) / in the laboratory, a program that monitors the total testing process with the aim of providing the highest-quality patient care reference laboratory / an independent regional laboratory th at offers routine and specialized testing services to hospitals and physicians serology / the study of antigens a nd antibodies in serum using immunological methods; laboratory testing based on the im munological properties of serum serum / the liquid obtained from blood th at has been allowed to clot standard operating procedure (SOP) / established procedure to be followed for a given operation or in a given situation with the pur pose of ensuring that a procedure is always carried out correctly and in the same manner virology / the study of viruses waived test / a category of test defined under CLIA ’88 as being simple to perform and having an insignificant risk for error 6 Lesson 1-1 ● Introduction to the Clinical Laboratory © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. TEACHING AIDS AND RESOURCES • Examples of hospital and laboratory organizational charts • Examples of various laboratory requisition forms • Transparencies or overheads of Figures 1-1 through 1-9 • Transparencies or overheads of Tables 1-1 through 1-5 • Instructor’s Resources CD accompanying Basic Clinical Laboratory Techniques, 6th edition, including computerized test bank and PowerPoint LESSON CONTENT I. Introduction II. Regulation of Clinical Laboratories A. CLIA ’88 B. Centers for Medicare an d Medicaid Services (CMS) III. Types of Clinical Laboratories A. Hospital Laboratories B. Nonhospital Clinical Laboratories 1. Physician office laboratories 2. Reference laboratories 3. Government laboratories—federal a. Centers for Disease Control and Prevention b. Consultation c. Education d. Epidemiology e. Laboratory Response Network 4. Government Laboratories—State a. Specialty tests b. Confirmation of reportabl e infectious diseases c. Environmental testing IV. CLIA Certificate Categories A. Certificate of Waiver B. Certificate of Registration C. Certificate of Compliance D. Certificate of Accreditation—Mode rate or High-Complexity Tests E. Certificate for Provider-Performe d Microscopy Procedures (PPMP) Lesson 1-1 ● Introduction to the Clinical Laboratory 7 © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. V. Organization of the Hospital Laboratory A. Clinical Laboratory Personnel 1. Laboratory director 2. Technical supervisor/laboratory manager 3. General supervisor/department head 4. Testing personnel B. Departments of the Clinical Laboratory 1. Hematology a. Coagulation b. Urinalysis 2. Clinical Chemistry 3. Immunology 4. Blood Bank/Transfusion Services 5. Microbiology a. Bacteriology b. Virology c. Mycology d. Parasitology 6. Laboratory Support Services a. Specimen collection b. Accessioning c. Specimen sorting and processing 7. Laboratory information systems 8. Point-of-care testing (POCT) VI. Electronic Health Records A. Electronic Health Records vs . Electronic Medical Records B. Benefits C. Concerns VII. Quality Assessment in the Laboratory A. Proficiency Testing B. Accreditation VIII. Privacy Issues A. HIPAA B. Computers C. Confidentiality IX. Critical Thinking Problem X. Summary 8 Lesson 1-1 ● Introduction to the Clinical Laboratory © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Critical Thinking Problem and Answer Timothy is a medical assistant working in a small POL. His laboratory operates under a certificate of waiver. The physician requests a micr oscopic examination of urine for patient Mary Smith. During Timothy’s medical assistant tr aining, he learned to perform microscopic examination of urine, classified by CL IA as a moderate complexity test. 1. What is the appropriate ac tion for Timothy to take? a. Tell the physician that it is not poss ible to have the test performed. b. Send the specimen to a laboratory approve d for performing moderate- to high- complexity testing. c. Perform the test and report the results to the physician. 2. Explain your answer. Even though Timothy has been trained to perform the re quested test, which is of moderate complexity, the labo ratory where he is employed only has permission to perform waived tests. Laborato ries with certificates of waiv er use reference laboratories to perform tests that are beyond their permitted level. STUDENT ACTIVITIES 1. Complete the written examination for this lesson. 2. Interview an employee of a c linical laboratory and report on your interview. Inquire about the laboratory’s organization, th e types of tests performed, ho w specimens are received, and how results are recorded and de livered to physicians. Obtain va rious laboratory test report forms and note the types of tests performed in each department. 3. Tour a hospital laboratory or re ference laboratory in your area. 4. Visit a POL and find out the type s of tests performed there. Web Activities 1. Select five analytes from Ta ble 1-2. Find information about the analytes from the CMS or FDA web site. List two brands of test kits that qualify as waived for each of the five analytes. 2. Find web sites of three clinical laboratories. No te the types of information provided on each web site. Look for organizational charts for th e laboratories and compar e them with what you have learned in this lesson about how laboratories are organized. REVIEW QUESTIONS AND ANSWERS 1. What is the function of a clinical laboratory? Clinical laboratories perform chemical a nd microscopic tests on body fluids and tissues to aid in diagnosis of diseases. 2. Draw an organizational chart of a typical hospital laboratory. See Figure 1-2 in the textbook. Lesson 1-1 ● Introduction to the Clinical Laboratory 9 © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 3. Name five major departments f ound in a hospital laboratory. Any 5 of the following are acceptable: a. Chemistry b. Microbiology c. Hematology d. Blood bank e. Immunology f. Laboratory support services (Specimen collection and processing) g. Laboratory information systems 4. Name two procedures performed in the hematology department. Any two of the following are acceptable: a. Blood cell counts b. Hemoglobin determinations c. Hematocrit d. Examinations of blood smears e. Coagulation tests 5. Name two tests performed in the chemistry department. Any two of the following are acceptable: a. Glucose b. Electrolytes c. Cholesterol d. Enzymes e. Drug levels f. Hormone levels 6. How does the HIPAA affect wo rkers in the laboratory? Much communication in laboratories is fa cilitated by computers. Patient information stored in computers must be password-prot ected so that only authorized personnel can access information. Computer monitors must be positioned so that visitors, other patients, and other nonauthorized perso nnel cannot view the screen. All patient information must remain private and confid ential and must be shared only with authorized persons to facilitate and improve patient care. 7. Name three benefits of el ectronic health records. Any three of the following are acceptable: a. Better coordination of patient care b. Improved follow-up after hospitalization c. Maintain comprehensive information about patient’s health in one file d. Provide a secure way to share patient information e. Motivate patient to comp ly with recommendations 10 Lesson 1-1 ● Introduction to the Clinical Laboratory © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 8. List three locations of clinical laborato ry facilities other than in hospitals. Any three of the following are acceptable: a. Physician offices b. State and federal government facilities (public health) c. Universities d. Research institutions or facilities e. Reference laboratories 9. Explain the job functions of th e laboratory director, technical supervisor, and department head or general supervisor. The laboratory director has ultimate respons ibility for all laboratory operations; the director may be a pathologist, a qualified M.D ., or a doctoral scientist. The technical supervisor handles the day-to-day operati on of the laboratory, sets personnel standards, and supervises employee performa nce. The department head is responsible for work within a specific department a nd for training and evaluating employee performance. 10. Who is responsible for creati ng the laboratory’s SOP manual? The technical supervisor (or laboratory ma nager) is responsible for the information and keeping the manual up-to-date. 11. What is contained in the SOP manual? It contains the up-to-date instructions for all procedures performed in the laboratory. 12. What is the purpose of CLIA ’88? CLIA ’88 specifies minimum standards for al l clinical laboratories. The objective of CLIA ’88 is to ensure quality laboratory testing. 13. What federal agency is responsible for implementing CLIA ’88? CMS (formerly known as HCFA) is respons ible for implementing CLIA ’88. 14. What are waived tests? Waived tests are those that are determined by CDC or FDA to be so simple that there is insignificant risk for error. 15. List the five certificates i ssued under CLIA ’88, and state the activities ea ch certificate permits. a. Certificate of Waiver—permits a laborato ry to perform CLIA-waived tests only b. Registration Certificate—permits th e laboratory to (temporarily) conduct moderate- or high-complexity laboratory testing (or both) until the laboratory is determined by survey to be in compliance with CLIA regulations c. Certificate of Complian ce—issued to a laboratory holding a Certificate of Registration after an inspection finds the laboratory to be in compliance with all applicable CLIA regulations Lesson 1-1 ● Introduction to the Clinical Laboratory 11 © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. d. Certificate of Accreditatio n—issued to a laboratory that has been accredited by a CMS-approved accrediting organization e. Certificate for PPMP—permit s the laboratory to perform waived tests and allows a physician, midlevel practitioner, or de ntist to perform microscopy procedures but no other tests of complexity. 16. What is the advantage of proficiency testing? Proficiency testing programs evaluate a la boratory’s performance for accuracy and compare it to that of other laboratories. This allows the laboratory to have confidence in testing methods and to identify deficient areas. 17. How do laboratories become accredited? A facility desiring accreditation invites the accrediting agency to inspect its facility and evaluate its performance to determine if established standards are being met. 18. Define accessioning, accreditation, American Association of Blood Banks (AABB), anticoagulant, bacteriology, blood bank, Centers for Disease Control and Prevention (CDC), Centers for Medicare and Medicaid Services (CMS), Clinical and Laboratory Standards Institute (CLSI), clinical chemistry, Clinical Laboratory Improvement Amendments of 1988 (CLIA ’88), coagulation, College of American Pathologists (CAP), COLA, Department of Health and Human Services (DHHS), electronic health record (HER), electronic medical record (EMR), epidemiology, Food and Drug Ad ministration (FDA), Health Care Financing Administration (HCFA), hematology, HI PAA, immunohematology, immunology, Joint Commission (JC), Laboratory Response Network (LRN), microbiology, mycology, National Committee for Clinical Laboratory Standards (NCCLS), parasitology, pathologist, phlebotomist, physician office laboratory (POL ), plasma, point-of-care testing (POCT), proficiency testing, Provider-Performed Micr oscopy Procedure (PPMP), quality assessment, reference laboratory, serology, serum, standard operating procedure (SOP), virology, and waived test. See Glossary. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. LESSON 1-2 The Clinical Laboratory Professional LESSON OBJECTIVES After studying this lesson, the student will: • Give a brief history of medical technology. • List five personal qualities that are desirable in a clinic al laboratory professional. • Describe the educational requirements fo r medical laboratory scientists and technicians. • Explain the functions of accrediting agencies and credentialing agencies. • Discuss the relationship between the labo ratory professional and the patient. • Explain the laboratory professional’s respon sibility in relation to patient privacy. • Explain the purpose and benefits of professional societies. • Discuss the importance of ethical co nduct by laboratory professionals. • Name five areas of employment for clinical laboratory professionals other than in hospital laboratories. • Define the glossary terms. GLOSSARY American Association of Med ical Assistants (AAMA) / professional society and credentialing agency for medical assistants American Medical Technologists (AMT) / professional society and credentialing agency for several categories of medi cal laboratory personnel American Society for Clinical Laboratory Science (ASCLS) / professional society for medical/clinical la boratory personnel American Society for Clinical Pathology (ASCP) / professional society for medical/clinical laboratory personnel and al lied health personnel American Society of Phlebotomy Technicians (ASPT) / professional society and credentialing agency for phlebotomists, as well as credential ing agency for specialty areas such as point- of-care technicianLesson 1-2 ● The Clinical Laboratory Professional 13 © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. ASCP Board of Certification (ASCP BOC) / a separate body within the ASCP organizational structure, formed in 2009 by merging NCA with the ASCP BO R and providing certification for medical laboratory personnel clinical laboratory science / the health profession con cerned with performing laboratory analyses used in diagnosing and treating dise ase, as well as in maintaining good health; synonymous with medical laboratory scienc e and medical (labor atory) technology clinical laboratory scientist (CLS) / the NCA term for a profe ssional who has a baccalaureate degree from an accredited college or univers ity, has completed clinical training in an accredited clinical/medical labo ratory science program, and has passed a national certifying examination; also called medical laboratory scientist (MLS) or medical technologist (MT) clinical laboratory technician (CLT) / the NCA term for a professional who has completed a minimum of 2 years of specific training in an accredited clinica l/medical laboratory technician program and has passed a national ce rtifying examination; also called medical laboratory technician (MLT) Commission on Accreditation of Allied Health Education Programs (CAAHEP) / agency that accredits edu cational programs for allied hea lth personnel; formerly CAHEA ethics / a system of conduct or behavi or; rules of professional conduct Health Insurance Portability and Accountability Act (HIPAA) / 1996 Act of Congress, a part of which guarantees protection of privacy of an individual’s health information medical laboratory science / the health profession concer ned with performing laboratory analyses used in diagnosing and treating dise ase, as well as in maintaining good health; synonymous with clinical laboratory scie nce and medical (lab oratory) technology medical laboratory scientist (MLS) / a professional who has a baccalaureate degree from an accredited college or university, has completed clinical training in an accredited medical laboratory science program, and has passed a national certifying exam ination; synonymous with medical technologist (M T) or NCA certified clinical laboratory scientist (CLS) medical laboratory technician (MLT) / a professional who has completed a minimum of 2 years of specific training in an accredited medical laboratory technician program and has passed a national certifying examination; synonymous with NCA certified clinical laboratory technician (CLT) medical technologist (MT) / a term gradually being replaced but referring to the professions of medical laboratory scientist (MLS) or clinical laboratory scientist (CLS) medical technology / synonymous for clinical laboratory science and medical laboratory science National Accrediting Agency for Clinical Laboratory Sciences (NAACLS) / agency that accredits educational programs for clinical laboratory personnel National Credentialing Agency for Laboratory Personnel (NCA) / a credentialing agency for clinical laboratory personnel that merged w ith the ASCP Board of Registry (BOR) in 2009 to form the ASCP Board of Certification (BOC) National Phlebotomy Association (NPA) / professional society a nd credentialing agency for phlebotomists 14 Lesson 1-2 ● The Clinical Laboratory Professional © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. TEACHING AIDS AND RESOURCES • Career Information Fact Sheet and Interview Fact Sheet • Clinical/Medical Laboratory Science journals • Information about medical laboratory pr ofessions from professional societies • Information about educational programs in clinical/medical laboratory science • Guest speaker: laboratory prof essional from a local hospital or other laboratory • Transparencies or overheads of Figures 1-10 and 1-11 • Transparencies or overheads of Tables 1-6 through 1-9 • Instructor’s Resources CD accompanying Basic Clinical Laboratory Techniques, 6th edition, including computerized test bank and PowerPoint LESSON CONTENT I. Introduction A. Medical Technology B. Medical Laboratory Science C. Clinical Laboratory Science II. History of Medical Technology A. Early Medical Laboratories 1. Late nineteenth century 2. Primitive B. Modern Medical Laboratories 1. Growth in laboratories after World War I 2. Need for formal education and identification of trained personnel 3. Rapid changes in technology after World War II C. The Clinical Laboratory in the Twenty-First Century 1. Emphases on wellness, geriatrics, home health care, and hospice 2. State-of-art technology 3. Rapid, portable testing 4. ASCP Board of Certification (BOC )—change in certification categories III. Role of the Laboratory Professional IV. Certification Requirements for Laboratory Personnel A. Educational Programs a nd Accrediting Agencies B. Educational Requirements 1. Medical Laboratory Scientist 2. Medical Laboratory Technician C. Areas of specialization Lesson 1-2 ● The Clinical Laboratory Professional 15 © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. D. Credentialing and certification E. Licensing of Laboratory Professionals V. Other Allied Health Personnel in the Clinical Laboratory A. Phlebotomist / Phlebotomy Technician B. Certified Medical Assistant / Registered Medical Assistant C. Physician Office Laboratory Technician D. Clinical Laboratory Assistant E. Diagnostic Molecular Scientist F. Point-of-Care Technician G. Other Personnel Performing Testing 1. Paramedics 2. Nursing staff VI. Ethics and Professionalism A. Ethics and the Clinical Laboratory Professional 1. Maintain high standards of practice 2. Duty to patients, profession, colleagues, and society 3. Maintain honesty, inte grity, and reliability 4. Maintain respect for patients, the prof ession, and other healthcare professions B. Qualities Desirable in Laboratory Professionals C. Patient Privacy/Confidentiality D. Interactions Between Labor atory Personnel and Patients E. Professional Organizations F. Employment Opportunities VII. Case Study VIII. Summary Case Study and Answer Rob works in the laboratory at Bay Regional Hospita l. Each work day before he begins his duties in the laboratory, he helps collect blood from hospital patients. On one occasion, the patient on his collection list was his friend Louis, who had been admitted to the hospital through the emergency department the night before. Rob coll ected blood from Louis for several laboratory tests and chatted with him briefly be fore returning to the laboratory. After Rob got home that evenin g, he received a call from Susa n asking for information about their mutual acquaintance Louis, who she heard was in the hospital. Susan sa id she had called the hospital but they would not release information ab out Louis and would not even confirm that he was a patient in the hospital. Susan asked Rob if he knew if Louis was hospitalized and if so, why. 1. How should Rob respond to Susan? Even though Rob, Louis, and Susan are mu tual friends, Rob shou ld not reveal medical information about Louis, because the ho spital was not releasing information. 16 Lesson 1-2 ● The Clinical Laboratory Professional © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 2. What are his obligations? Rob’s first obligation is to protect patient information, unless the patient gives specific permission for it to be revealed. 3. What are his options? Rob could contact Louis and ask permission to tell Susan that Louis is hospitalized. 4. Role-play the conversation between Rob and Susan or Rob and Louis Have students discuss options for handling this situation. STUDENT ACTIVITIES 1. Complete the written examination for this lesson. 2. Use the Interview Fact Sheet and interview a clinical laboratory prof essional. Be sure to consider the following areas: job functions, relationship with coworkers and patients, advantages and disadvantages of job, satisfactions, dissatisfactions, salary, and opportunities for advancement. Describe the benefits of ta lking to the laboratory professional in person rather than reading the information in a book. Web Activities 1. Visit the web sites of three ag encies or professional societie s listed in Tables 1-6 and 1-9. List the programs they certify and the e ducational requirements of each program. 2. Search the Internet to find a school in your st ate (or nearby state) th at offers training for clinical laboratory scientists. Find out what re quired courses are listed in the curriculum. 3. Complete a Career Information Fact Sheet for the careers of medical laboratory technician and medical laboratory scientist. Use this text, ot her available texts, and the Internet to gather your information. For each career include educ ational training, estimated cost of the program, nature of the job, advantages and disadvantages, employment opportunities, and salary range. 4. Use the Internet to find sources of current topics related to th e clinical laboratory, such as online journals or newsletters. Request an em ail subscription to some of the free ones. REVIEW QUESTIONS AND ANSWERS 1. What is clinical laboratory science? Wh at other term is used for this field? Clinical laboratory science is the health profession concerned with performing laboratory analyses used in the diagno sis and treatment of disease and in the maintenance of health. It is al so called medical laboratory sc ience or medical technology. Lesson 1-2 ● The Clinical Laboratory Professional 17 © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 2. Describe the beginnings of medical technology. Until the improvement of the microscope in the seventeenth century, physicians relied mostly on crude observations, such as ob servations of urine. The first medical laboratories for clinical testing were establis hed in the late nineteenth century, and the number of laboratories began to grow rapi dly after World War I. During this time, schools to train workers were established. Since World War II, laboratory techniques have become increasingly complex. The growth of emerging technologies has allowed rapid changes in clinical laboratory science. 3. Name five personal qualities desirabl e in clinical laboratory personnel. Any five of the following are acceptable: a. Manual dexterity b. Good intellect c. Aptitude for biological sciences d. Good eyesight e. Physical stamina f. Ability to perform accurate, precise manipulations and calculations g. Ability to work well and communicate well with others h. Honesty and integrity 4. What are the educational requirements for medical laboratory scientists? For medical laboratory technicians? A bachelor’s degree and 1 year of clinical training are required for medical laboratory scientists; 2 years of postsecondary trai ning, including clinical experience, are required for medical laboratory technicians. 5. What is the purpose of accrediting agencies? Accrediting agencies such as CAAHEP and N AACLS establish standards for certain health professions and ensure that educationa l institutions provide courses that meet national standards for students enro lled in allied health programs. 6. What are the functions of credentialing agencies? Credentialing agencies are independent organiz ations that administ er examinations to graduates of health profession programs to ensure they have gained sufficient knowledge to work in their chosen field. 7. List five places of employment for laborat ory professionals other than in hospitals. Any five of the following are acceptable: a. Public health b. Reference laboratories c. Military d. Research 18 Lesson 1-2 ● The Clinical Laboratory Professional © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. e. Education f. Physician offices g. Pharmaceutics h. Veterinary medicine i. Sales, technical service, or product development for medical suppliers 8. Explain the importance of ethical standards in the practice of medical laboratory science. Ethical behavior is required of all health care professionals, including laboratory employees. They must be committed to main taining standards of excellence in their work and safeguarding the dignity and privacy of patients. 9. Explain the laboratory professiona l’s obligation to the patient. The laboratory professional must perform an alyses carefully and accurately. He or she must be courteous and considerate of all patients and maintain confidentiality concerning patient information. 10. How do laboratory professionals become certified? They become certified by passing an exam ination administered by a certifying agency. 11. What is the value of professional soci eties to the laboratory professional? Professional societies provide opportunities for professional growth through continuing education, publishing journals, and supporting professionalism. 12. Define American Association of Medical Assistants (AAMA), American Medical Technologists (AMT), American Society for Clinical Laboratory Science (ASCLS), American Society for Clinical Pathology (ASCP), American Society of Phlebotomy Technicians (ASPT), ASCP Board of Certif ication (ASCP BOC), clinical laboratory science, clinical laboratory scientist (CLS), clinical laboratory technician (CLT), Commission on Accreditation of Allied Hea lth Education Programs (CAAHEP), ethics, Health Insurance Portability and Accountabil ity Act (HIPAA), medical laboratory science, medical laboratory scientist (MLS), medical laboratory technician (MLT), medical technologist (MT), medical technology, Nati onal Accrediting Agency for Clinical Laboratory Sciences (NAACLS), National Cr edentialing Agency fo r Laboratory Personnel (NCA), and National Phlebotomy Association (NPA). See Glossary. FACT SHEET ANSWERS Answers to Career Information Fact Sheet an d Interview Fact Sheet will differ among students depending on ava ilable student resources. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. LESSON 1-3 Medical Terminology LESSON OBJECTIVES After studying this lesson, the student will: • Discuss the importance of healthcare workers understanding and correctly using medical terms. • Define stem words from a selected list. • Define prefixes from a selected list. • Define suffixes from a selected list. • Identify common clinical laboratory abb reviations and acronyms from a selected list. • Pronounce commonly used medical terms from a selected list. • Recognize prefixes, stems, or suffixes in medical terms. • Analyze medical terms based on knowledg e of prefixes, suffixes, and stems. • Define the glossary terms. GLOSSARY abbreviation / the shortening of a word, often by removing letters from the end of the word acronym / combination of the first letters or syll ables of a group of words to form a new group of letters that can be pronounced as a word prefix / modifying word or syllable(s) pl aced at the beginning of a word stem / main part of a word; root word; the part of a word remaining after removing the prefix or suffix suffix / modifying word or syllable(s) placed at the end of a word terminology / terms used in any specialized field 20 Lesson 1-3 ● Medical Terminology © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. TEACHING AIDS AND RESOURCES • Medical dictionary, clinical ch arts, diagrams, or atlases • Medical terminology text(s), CD of medical terms with pronunciations • Transparencies or overheads of Tables 1-10 through 1-13 • Instructor’s Resources CD accompanying Basic Clinical Laboratory Techniques, 6th edition, including computeri zed test bank and PowerPoint LESSON CONTENT I. Introduction II. Structure of Medical Terms A. Prefixes B. Stems C. Suffixes D. Derived from Latin and Greek III. Pronunciation of Medical Terms IV. Abbreviations and Acronyms V. Case Studies VI. Summary Case Studies and Answers Case Study 1 On a very busy day, Dr. Martin handed his medical assistant a handwritten preliminary diagnosis and an order for laboratory tests for his patient Mr. Jones. The medical assistant had difficulty reading Dr. Martin’s handwriting and could not decide if the preliminary diagnosis was “temporary arthritis” or “temporal arteritis.” Mr. Jones’ major symptom was recurring headache and pain in the temple area of the head. 1. Which preliminary diagnosis is most lik ely the diagnosis written by Dr. Martin? Based on the patient’s symptoms, Dr. Martin probably wrote “temporal arteritis.” 2. Discuss the importance of correctly sp elling and understanding medical terms. The accurate use of medical terms is requi red for effective communication and correct patient care. All members of the healthca re team need to understand the patient’s condition and use care when interpreting written orders. Lesson 1-3 ● Medical Terminology 21 © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Case Study 2 Mr. Benton went to the gastroenterologist because of abdominal pain and rectal bleeding. After examining Mr. Benton, the physician recommende d an additional procedure be performed. After Mr. Benton arrived home, he became confused and could not remember if the test ordered was “colonoscopy” or “cholectomy.” Using only the stem and suffix tables, explain the differences between the two procedures. Colonoscopy = colon + observation (visual examination of the colon) Cholectomy = gall bladder + excision (s urgical removal of the gall bladder) Case Study 3 Ms. Jackson consulted a urologist and descri bed several symptoms. The urologist wrote a preliminary diagnosis of “paroxysmal nocturnal hemoglobinuria” and orde red several laboratory tests to help confirm the diagnosis. 1. Examine the name of the suspected cond ition. What symptom would the patient have reported to cause the physician to diagnose “hemoglobinuria”? Hemoglobin or blood + urine (blood in the urine, red urine) 2. What other symptom(s) could have been re ported based on the qualifiers “paroxysmal” and “nocturnal”? Nocturnal = occurring at night Paroxysmal = episodic, occurring suddenly at irregular intervals STUDENT ACTIVITIES 1. Complete the written examination for this lesson. 2. Practice pronouncing the word parts and medi cal terms in Tables 1-10 through 1-12. Look up pronunciations of 10 terms from each tabl e and practice saying the terms out loud. 3. Study the definitions for prefixes, suffixes, and stems listed in the tables. Select 10 prefixes, suffixes, and stems from each of Tables 1-10, 1-11, and 1-12. Use each of the selected word parts in a word not on the list. 4. Prepare 20 flashcards using terms from tables in this lesson, a medical dictionary, or a textbook glossary. Write the term on the fr ont and the definition on the back. 5. Obtain examples of laboratory requisition or report forms. Look for abbreviations or acronyms used on the forms. Web Activities 1. Select five terms from each usage column in Tables 1-10, 1-11, and 1-12. Write your best definition of the term, using the definitions of stems, prefixes, and suffixes in the tables. Search an online medical dictionary for the terms, and compare your definitions with the dictionary definitions. 2. Search the Internet for free medical terminology tutorials or self-tests . Use these to enhance your knowledge of medical terms. 22 Lesson 1-3 ● Medical Terminology © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. REVIEW QUESTIONS AND ANSWERS 1. Why is it important for healthcare wo rkers to understand medical terminology? Effective communication and the ability to carry out instructions require an understanding of medical terminology. 2. Most medical terms are derived from which languages? Greek and Latin 3. How can one learn to correc tly pronounce medical terms? Pronunciation can be learned by consulti ng the dictionary, listening to others pronounce terms, and practi cing pronouncing terms. 4. Name the stems for cell, heart, head, ski n, chest, kidney, muscle, liver, and stomach. cell: cyt(o) heart: card head: ceph(al) skin: derm chest: thorac kidney: ren muscle: myo liver: hepat(o) stomach: gastr(o) 5. Name 10 common suffixes and give a meaning for each. See Table 1-12 in the textbook. 6. Name 10 common prefixes and give a meaning for each. See Table 1-10 in the textbook. 7. List 10 abbreviations or acronyms frequently us ed in the clinical laboratory and give the meaning of each. See Table 1-13 in the textbook. 8. Define abbreviation, acronym, pr efix, stem, suffix, and terminology. See Glossary. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. LESSON 1-4 Biological Safety LESSON OBJECTIVES • After studying this lesson, the student will: • Explain the purpose of the Bloodborne Pathogens Standard. • Explain the reason for issuing Standard Precautions in 1996. • Explain what is meant by exposure control plan. • List the components of an exposure control plan. • Explain the evolution of safety laws and rules since the 1970s. • Explain the roles of the Centers for Dise ase Control and Prevention (CDC) and the Occupational Safety and Health Administ ration (OSHA) in promoting safety in healthcare institutions. • Explain the impact of the Needlestic k Safety and Prevention Act of 2000. • Discuss how work practice controls improve safety. • Discuss how engineering controls improve safety. • List types of personal protective equipm ent (PPE) commonly used in the clinical laboratory. • Discuss infection prevention and heal thcare-associated in fections (HAIs). • Demonstrate correct hand hygiene techniques. • Demonstrate how to remove and discard contaminated gloves. • Demonstrate the correct way to wear PPE su ch as face protection and fluid-resistant gowns or laboratory coats. • Discuss how sterilization, disinfection, a nd antisepsis are used in the clinical laboratory. • Explain the impact of human immunodefici ency virus (HIV) and hepatitis B and C viruses on safety practices in healthcare. • List safety precautions that must be obs erved when handling biological materials. • List additional safety precautions that must be observed wh en working in the microbiology laboratory. • Define the glossary terms. 24 Lesson 1-4 ● Biological Safety © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. GLOSSARY acquired immunodeficiency syndrome (AIDS) / a form of severe immunodeficiency caused by infection with the human i mmunodeficiency virus (HIV) aerosol / liquid in the form of a very fine mist alimentary tract / the digestive tube from the mouth to the anus antiseptic / chemical used on living tissue to cont rol the growth of infectious agents biohazard / risk or hazard to health or th e environment from biological agents biological safety cabinet / a special work cabinet that provides protection to the worker while working with infectious microorganisms bloodborne pathogens (BBP) / pathogens that can be present in human blood (and blood-contaminated body fluids ) and that cause disease Bloodborne Pathogens (BBP) Standard / OSHA guidelines for preventing occupational exposure to pathogens present in human blood and body fluids, including, but not limited to, HIV and hepatitis B virus (HBV); final OSHA standard of December 6, 1991, effective March 6, 1992 community-acquired infection (CAI ) / infection acquired through contact with friends, family, and the public or by contact with contaminated environmental surfaces disinfectant / chemical used on inanimate objects to kill or inactivate microbes engineering control / use of available technology and e quipment to protect the worker from hazards exposure control plan / a plan identifying employees at risk for exposure to bloodborne pathogens and providing training in methods to prevent exposure exposure incident / an accident, such as a needlestick, in which an individual is exposed to possible infection through c ontact with body substances from another individual hand antisepsis / decontamination of hands using antis eptic soap or waterless antiseptic hand hygiene / a set of techniques that includes handwashi ng with soap and water, washing with antiseptic soap, or cleansing with a waterless antiseptic product healthcare-associated infection (HAI) / infection acquired while being treated for another condition in a healthcare setting; synonym for healthcare-acquired infection; formerly called nosocomial infection hepatitis B virus (HBV) / the virus that causes hepatitis B infection and is transmitted by contact with infected bl ood or other body fluids hepatitis C virus (HCV) / the virus that causes hepatitis C infection and is transmitted by contact with infected bl ood or other body fluids human immunodeficiency virus (HIV) / the retrovirus that has been identified as the cause of AIDS isolation / the practice of limiting the movement and so cial contact of a patient who is potentially infectious or who must be protected from exposure to infectious agents; quarantine Lesson 1-4 ● Biological Safety 25 © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. nosocomial / hospital-acquired; acquired as a result of being hospitalized or institutionalized other potentially infectious materials (OPIM) / any and all body fluids , tissues, organs, or other specimens from a human source parenteral / any route other than by the alimen tary canal; intravenous, subcutaneous, intramuscular, or mucosal pathogenic / capable of causing damage or injury to the host personal protective equipment (PPE) / specialized clothing or equipment used by workers to protect from direct exposure to blood or other potentially infe ctious or hazardous materials; includes, but is not limited to, gloves, labor atory apparel, eye pr otection, and breathing apparatus Standard Precautions / a set of comprehensive safety gui delines designed to protect patients and healthcare workers by requiring that all patients and all body fluids, body substances, organs, and unfixed tissues be rega rded as potentially infectious sterilization / killing or inactivation of living organisms and viruses Transmission-Based Precautions / specific safety practices used in addition to Standard Precautions when treating patients known to be or suspected of being infected with pathogens that can be spread by air, droplet, or contact Universal Precautions (UP) / a method of infection contro l in which all human blood and other body fluids containing visibl e blood substances are treat ed as if infectious work practice controls / methods of performing tasks that reduce the worker’s exposure to blood and other potentially hazardous materials TEACHING AIDS AND RESOURCES • Biological Safety Worksheet • Safety Agreement Form for each student to sign • Safety brochures explaining bi ohazards; safety charts • Examples of biohazard labels, sharps containers, PPE, splash guards, etc. • Guest speaker on biological safety or audiovisual safety materials • Transparencies or overheads of Figures 1-12 through 1-22 • Transparencies or overheads of Tables 1-14 through 1-20 • CDC “Guide to Infection Prev ention in Outpatient Setti ngs” available for download at http://www.cdc.gov/HAI/settings/outpati ent/outpatient-care-guidelines.html • Instructor’s Resources CD accompanying Basic Clinical Laboratory Techniques, 6th edition, including computeri zed test bank and PowerPoint