Test 1 Flashcards by Lillian Dewsnap

What is diagnostic testing

Tools used to aid in a formal diagnosis.

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What is key to the PA-patient relationship

Open communication
shared trust
honesty
beneficence

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What is a paternalistic relationship?

Provider determines treatment in best interest of pt, regardless of pt values.

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What is an informative relationship?

Patient determines which treatments to accept/ refuse based on personal values

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What is a deliberative relationship?

Decision regarding treatment determined from shared deliberation between patient and provider.

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Physician focused in nature based on beneficence

Paternilism

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Recognizes patient autonomy, right to self determination

Patient centered

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Informed consent

A formal agreement that a patient signs or verbalizes to give permission for a medical procedure after being told the risks and benefits.

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Assent

an act of agreeing to something especially after thoughtful consideration.

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Implied consent

used when immediate action is needed (ER, cardiac arrest)

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General conesnt

for routine services (hospital admission)

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special consent

specific high risk procedures and treatment (Children, ivf, pregnant women)

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Informed consent

Obtained before all medical interventions, adequate information about proposed treatment is provided.

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3 essential components of informed consent

Pt must have capacity for competence.
Pt must be given enough information about the treatment including alternatives.
Pt must give consent voluntarily.

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A minor is legally what? unless state specific legislation declares competency

imcompetent

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What information must be provided to the pt?

Diagnosis
Nature of procedure
Risks
Consequences
Likelihood procedure will achieve desired outcome.
Any alternatives and their risks including the risk of not doing the treatment.

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PARQ?

P- Procedure
A- Alternatives
R- Risks
Q- Answer pt questions.

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What can limit a patient’s understanding of information

Language and education

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How to ensure understanding

Frequently ask questions, provide interpreters , use models, speak in pt’s terms. Have material in native languages.

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How to make sure consent is voluntary?

Make sure not to exert any influence on patients decision making based on your opinion of the treatment.

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Does informed consent need to be written?

No, legally verbal consent is just as binding as written.

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In Illinois minors can sign informed consent if:

Married, pregnant, or a parent

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Illinois public act 87-460

Physicians and counselors are barred from providing notice to parent or guardian without the child’s consent unless it is for safety.

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Illinois law states minor girls of any age can;

receive birth control or abortions

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Minors 12 or older can

seek primary care for sexual health, consent to treatment for venereal disease and drug abuse.

Mental health: minors of 12 and over can consent to;

counseling or psychotherapy on an outpatient basis.

An abortion does not require what in Illinois?

Parental consent.

The selection of a substitute decision maker is guided by

The health care consent act

Hierarchy

Power of attorney spouse parent or child siblings other relatives

If there is no one to make a decision

then the provider is the power of attorney

Social determinants of health

conditions in places where people live, learn, work, and play that affect a wide range of health and quality of life risks and outcomes.

Why is medical record documentation so important?

Main source of communication between you and the patient , legal and billing.

As of January 1st 2021

All clinical documentation is available to patient's.

Written documentation Do's

sign and date each encounter use military time read all transcripts before signing Use a single line through an error and initial it.

Written documentation Dont's

Use white out/ correction tape Write in margins Destroy records Skip lines in rule pages

test results that fall significantly outside normal range and may be life threatening/ require urgent medical intervention

Panic value

Lab values may come back later in afternoon or next day

Routines

Lab values return as soon as possible

Stat

after eating a meal

postprandial

Before eating a meal

Preprandial

NPO

nothing by mouth

How close a measure value is to the true value

Accuracy

How close measure values are to each other.

Precision

A set of values that includes upper and lower limits of a lab test based on a group of healthy people

Reference range

Refers to the proportion of those who received a positive result on a test out of those who actually have the condition

Sensitivity Ex; D-dimer

Refers to the proportion of those who received a negative on a test out of those who do not have the condition.

Specificity

What is the gold standard

Any test that is felt to be the current best for diagnosis of a particular condition.

What are standard precautions

minimum infection prevention practices that apply to all patient care

Universal precautions

standard set of guidelines to prevent the transmission of bloodborne pathogens from exposure to blood and other potentially infectious materials.

PPE examples

gloves, shoe coverings, gowns, head coverings, masks, respirators, other face and eye equipment.

What is an example of something not considered PPE?

Lab coat

Indications for handwashing

Before and after pt contact contact with blood, bodily fluids, contaminated items

Hand washing procedure

Wet, lather, scrub, rinse, dry

Hand sanitizer must be

60% alcohol used for 20 seconds

Indications for injections

To diagnose- allergy testing To treat- deliver medication To prevent- vaccines

Intramuscular

90 degrees

subcutaneous

45 degrees

intravenous

25 degrees

intradermal

10-15 degrees

Patient preparation- verify

Patient (name, DOB) Medication Dosage Route Correct site Document

ID indications

TB PPD testing Intradermal anesthesia Cosmetic Allergy testing Mole biopsies

SQ indication

Mostly medication administration

IM indication

Vaccines Can give in butt upper right quadrant

Surgical puncture of a vein for the withdrawal of blood or to give fluids or drugs

Venous catheterization

Indications for IV

Fluid administration Medication administration Blood product administration Diagnostic (contrast)

Contraindications

Burns, edema, injury infection, cellulitis Phlebitis Fistula Circulation issues

IV Insertion technique

Gloves tourniquet feel vein clean with alcohol retract skin distally

Once you have a flash;

lower catheter almost parallel with arm then advance catheter

Once the plastic catheter is in place then what?

Apply pressure proximal to insertion site and remove tourniquet, secure tubing hug to iv, apply tegaderm, tape tubing to skin

IV complication

Bleeding, infection/cellulitis, thrombophlebitis

Venipuncture most common site

Antecubital fossa, cephalic and basilic veins

Insert needle into vein at;

15-30 degrees

Venipuncture complications

cellulitis, phlebitis, thrombosis, hematoma, vasovagal response, vein laceration

Central line insertion locations

internal jugular femoral subclavian

Central line indications

Fluid resuscitation Pressure monitoring emergency venous access

Central line contraindications

Infection Thrombus Coagulopathy Combative patients

Central line compliactions

Pain Hematoma Infection Misplacement

Finger stick common uses

blood glucose, mono, HGB, genetic testing

Where to puncture finger

on volar aspect off of the midline, avoid tip and sides.

Indications for nutrition assessment

No other causes Dietary restrictions Geographic locations Social history Genetic history Underlying medical issues

Most common nutrients assessed

B2, B12, B9, Mg, Ca, Fe, ACDEK

Why is the liver imortant in nutrition?

Conversion of food into essential chemicals, bile production (fat soluble vitamins).

Many chronic liver disease are associated with

Malnutrition and alcoholic liver disease

Incidence of this increases after the age of 60

Anemia

Causes of anemia in older adults

1/3 nutritional deficiency 1/3 kidney disease 1/3 unexplained

Common nutritional deficiencies associated with anemia

Copper (helps absorb iron from the GI), B12, B9, Iron (body uses to make hemoglobin)

Iron studies panel

Serum iron, serum transferrin, or TIBC

Other common causes of nutritional anemia

Gastric bypass, Zinc supplements (depletes copper), autoimmunes

Common deficiencies secondary to gastric bypass?

B1, B12, D, Iron, Copper

Metabolic disturbance that occurs when nutrition is reintroduced rapidly to people who are starved.

Refeeding syndrome

Most common feature of refeeding syndrome

Hypophosphatemia

What to order for refeeding syndrome

CMP, Phosphate, Mg, B1

Test 1 Flashcards

(92 cards)