Biology 2404 A&P Basics Lab Exercise 1 Introduction
to the Lab and
| Objectives |
Background
|
Medical Terms |
Activities |
Applications |
Review Questions |
In this exercise, students will
* review the necessary equipment and methods for lab safety
* understand the basic concepts of the metric system
* be able to discuss the SOAP method of medical records keeping
* review the fundamentals of medical terminology and word parts
Although you wont be physically be working in the laboratory for your on line laboratory exercises, it is still important to know what constitutes a safe lab or working environment no matter where or what it might be.
In the health field, great care must be taken when collecting human or animal body fluids. Proper procedures are in place for collecting, handling, and disposing of these materials. Wearing gloves and protective clothing helps prevent these fluids from contacting your skin, eyes, mouth nose, and other body areas.
Proper disposal of used laboratory items such as syringes, slides, needles and other “sharps” must be done in a puncture proof and sealed container.
Disposal of the fluids in the proper receptacle is also important. Contaminated clothing must also be cleaned with care and may in fact, be disposable as well.
Other safety procedures involve locating equipment to help in case of an accident or emergency, these include:
1) Fire exits : marked above doors that can be used as an exit route
2) Safety Shower with eye wash station : rinse off any substance that has come in contact with the face, skin, or clothing.
3) Fire Extinguisher and Fire blanket : control and help smother flames
4) First Aid Kit : contents of kit allow for treatment of minor injuries
5) Safety Glasses, Goggles, Masks : protect the face from chemical or fluid spills and splashing.
6) Containers : for disposal of hazardous waste materials
7) Disinfectants: Hands and work area should be clean before use.
8) Labels : all warning labels and other labels should be read before using the product.
9) Heating apparatus : never leave any heat source unattended. Handle hot items with proper tools such as safety gloves or tongs.
10) Conditions that puts you at risk in the lab or work environment. Such conditions may include pregnancy, taking immunosuppressive drugs or having diseases, like immunosuppression (HIV) , diabetes, epilepsy, etc.
Identify the following safety equipment and give it’s function
Fire extinguisher Safety Shower
First Aid Kit Safety glasses/goggles
Biohazard container Disinfectants
Fire exits Fire Blanket
Heating apparatus Broken Glass container
a) Go into your kitchen or the kitchen of a friend or relative.
Note any safe or unsafe practices during food preparation and cleanup.
b) The next time you are in a public building (library, office, school, restaurant, hotel) make a note the fire exits regarding location, number, and signage (ease of identifying door). See if you can also locate the fire extinguisher, the first aid kit, and the nearest emergency phone. If not, ask. You should always be aware of how to exit a building in case of an emergency or get help in the case of an injury. Remember, the nearest emergency phone may be your own or a friends cell phone. Know the address / location of where you are in case you need to call and give directions to medical personnel.
c) Go to a hospital or clinic OR watch a medical show, such as E.R, CSI, or a
medical documentary such as those found on PBS or the Discovery channel.
Make a list of how the nurses, physicians, and other medical personnel are protected from a patients bodily fluids.
Note also how contaminated items are disposed.
d) Do you know CPR ? Do you know someone who knows CPR ?
If you do know CPR, do you keep your certification current ?
There are three levels of CPR certification, A, B, and C. Health care workers
need “C” level certification.
Medical Services and Careers:
OSHA (occupational safety and health administration) is the overseeing body for lab safety techniques and measures.
HazMat (Hazardous Materials) is the group that deals with hazardous chemical or material disposal in the case of exposure to the public in general.
In order to analyze and gather data about biological processes, accurate measurements are necessary. Length, mass, temperature, and volume are the most widely used measurements for the world’s scientific community.
The basic unit of length in the metric system is the meter (m), the basic unit of mass is the gram (g), and the liter (l) is the metric unit that is used to measure volume. The basic unit used to measure temperature is degree Kelvin, but degree Celsius is more commonly chosen.
Since the metric system is based on the number 10, it is a decimal system. The numbers do not change, just the position of the decimal.
Prefixes, which are modifiers that precede the root or main word, are used to denote changes to the base unit as a multiplier. Prefixes that are used apply to all the base units in the metric system.
Examples of metric prefixes are Giga, Mega, Kilo, deci, centi, milli, micro.
You may have heard these prefixes in relationship to computer terms, such as seen with memory or speed: Kilobytes, Megabytes, Gigabytes, Megahertz. You may also have seen these prefixes related to length: Kilometers, centimeters, millimeters.
In the medical field, the most common prefixes used are Kilo, deci, centi, milli, and micro.
Kilo K Kilo is 1000 x base unit
deci d deci is 1/10 x base unit
centi c centi is 1/100 x base unit
milli m milli is 1/1000 x base unit
micro µ micro is 1/1,000,000 x base unit
Using the basic unit and prefixes we can come up with the most common medical related units you will see in the medical records.
Kg = Kilogram mass (weight) of individual, used in drug calculations
cm = centimeter measure lesions such as tumors in or on organs
mm = millimeters measure smaller lesions such as on the skin
l = liter basic volume of fluids given
dl = deciliter volume measured, usually seen with blood values
ml = milliliters smaller volume of fluids given, usually as injections
µl = microliters very, very small amount of fluid volume given
seen as a measurement for IV fluid drip apparatus
Health science professionals should have a thorough understanding of the metric system since most scientific measurements are made in metric units.
In the medical field you may encounter use of both the metric and English units for measurements, so conversions may be necessary.
1 cc = 1 ml
1 Kg = 2.21 pounds
1) Go to your pantry or grocery store and record the unit of measurements for
at least four items for these basic units. Note English and Metric values.
1. Volume
2. Mass
2) Look on your (or a friend’s) car and compare the speedometer reading for the English (mph) verses metric (Km) at 20 mph, 55 mph, 65 mph, 80 mph, & 100 mph.
3) See if you can compare the English and metric units for this syringe.
d) What is the difference with these syringes in terms of the metric system ?
e) Look over the medical abbreviations used in the attached handout and be able to give examples of four abbreviations.
4). Truth in Packaging: Obtain several household items to determine if the label is accurate. Suggestions would be liquid detergent, soda, bag of peanuts, candy bar, cereal (you get the idea) or use those measured in question #1.
a) record their brand and product type
b) stated weight of package and contents (record both english and metric units)
c) Weight of package less contents (remove contents and reweigh package)
* Net weight of contents vs stated weight of contents on label. Was there a difference?
* Convert the measured weight of contents to metric
(Hint: there are 28.3grams/ounce)
Application of the metric system
Medical calculations are an important part of the medical record. Dosage, amount, route, and time should be a part of any drug received by the patient.
For example, a penicillin based drug is given at the dosage rate of 1mg/kg. If your patient’s weight (mass) is 165 pounds you will have to convert pounds to Kg or else the patient will be overdosed as the calculation would have been 165 mg of the drug. To get the correct dosage, change pounds to Kg by using the conversion given earlier and then calculate the correct dosage.
1 mg/kg x 1Kg / 2.21 pounds x 165 pounds = 165/2.21 = 74.66 mg of the drug.
In addition to this dosage amount, the route and how often (when) the drug was administered should be recorded.
These items need to be considered for the medical record and may include:
Drug A given at 1 mg/kg
Weight of patient is 165 pounds or 74.66 Kg
Dosage of Drug A is 74.6 or ~ 75 mg
Drug A comes in a tablet form at 50 mg each
Given
Amount of drug administered
Drug ordered (Rx)
Therefore, in the medical record, you may come across the drugs given and the script (Rx) written much like the following, understanding that all considerations have been met and assuming that the drug choice and calculations are correct.
Rx 50mg Amoxicillin 1 ˝ tablets PO BID # 30
Medical problem solving is a conceptual, systematic approach to the practice of medicine. In its simplest form, the problem oriented medical record consists of a data base, problem list, plan, and progress notes. The importance of the problem-solving approach is that it provides a set of rules for creating an initial problem list based on problems identified from the history and physical examination. Thereafter, the problem-solving approach encourages a logical approach to diagnosis and management of each problem cited. Using this approach, significant but unrelated problems are not overlooked in the patient evaluation.
The Data Base
A data base represents information collected at the time of patient presentation. A complete data base always includes:
1. Primary complaint
2. Patient profile = signalment (age, race, sex), identifier (name, SSN)
3. History of the present illness and current health status
4. Previous medical history
allergies or drug reactions
medications
previous test results or ancillary study results
consultation reports
hospital discharge summaries
5. Complete physical examination
Problems identified from this database are used to construct the initial problem list. Laboratory data are not ordinarily included in the initial problem list.
Rather, every test must be justified under the diagnostic plan for a given problem.
The problem list is subsequently updated as new problems are identified from laboratory tests and other studies (i.e. imaging studies such as radiographs,ultrasound, MRI, CAT scans, etc).
6. Master Problem list
The Problem List
A problem is broadly defined as anything that interferes with patient well-being and requires management or further evaluation. Each problem identified in the data base is then entered into a problem list and will have one of three possible outcomes:
a. Resolution or inactivation from the list
b. Better definition as additional data are collected
c. Grouped with other problems
The diagnostic and therapeutic components of the plan then focus on the problems that currently have some effect on the patient.
The Plan
The initial plan has three components :
a. diagnostic
b. therapeutic
c. education
Diagnostic Component -->
A list of diagnostic differentials is compiled for each problem on the problem list and specific tests or procedures are then proposed to rule in or rule out a diagnostic differential.
Therapeutic Component -->
Each active problem or major problem set must be evaluated as to the necessity or desirability for therapy. All treatments including drugs and procedures are included in the therapeutic part of the plan.
Education Component -->
The patient must be given information about each problem on the problem list, the treatment, and the prognosis.
The Problem Oriented Medical Record (POMR) is standard in medical record keeping.
It is based on four elements and is used to organize notes for the problem oriented medical record.
SOAP FORMAT or HEAP FORMAT of the POMR
S = Subjective
History, observations, presenting complaint
O = Objective
Physical exam findings, laboratory data & other test data
A = Assessment
Diagnosis based on subjective and objective data
P = Plan
Diagnosis, treatment procedures, patient education
HEAP stands for History, Exam, Assessment, Plan
Information technology has allowed hospitals and practioners to create, store, and retrieve patient charts on the computer. Known as the electronic medical record (EMR), this integrated program allows for efficiently processing information for patient treatment, progress, and billing/accounting practices.
The DAMN-IT-V acronym of pathophysiologic causes (etiologies) of disease,
when used in conjunction the the SOAP/POMR method, can help in formulation
of probable
role-ins vs.
rule-outs to help with patient assessment.
It is based on the most probable
cause(s) of clinical problems that can then
be evaluated with further diagnostic testing.
The following table is an overview
of how this acronym triggers assessment and planning for each patient.
| D | degenerative developmental [congenital] |
| A | anomalous autoimmune |
| M | metabolic mechanical [pressure, radiation, etc] mental [psychological, behavoral, etc.] |
| N | nutritional [excesses, deficiencies] neoplastic [benign, malignant] |
| I | inflammatory infectious [bacterial, viral, fungal, protozoal, mycoplasmal, rickettsial, parasitic] noninfectious [perivascular injection of drugs, vasculitis, etc.] ischemic [vascular related, thromboembolic disorders] immune inherited iatrogenic [drug induced, surgical, etc.] idiopathic [unknown cause] |
| T | traumatic [external, internal] toxic toxins
|
| V | vascular |
Laboratory and Diagnostic Test Values
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References
Washabau, Robert : The Compendium, August 1992, Vol 14 No 8 pg1030
Weed, L : Medical Records, Medical Education, and Patient Care.
Chicago, Yearbook Medical Publishers, 1971.
Pittenger, Stephen: The Electronic Medical Record, TVMA convention, February 2002
By now you should be taking or have taken at least one medical terminology class. The following is a review of the basics of understanding medical terms.
The medical profession has a language all it’s own and was based on the language of the educated, who at the time, knew Latin and Greek. Other terms can be based on personal names (Eponyms), modern language terms, and abbreviations creating acronyms.
Medical terms are based on four word parts :
A) Root word (RW)
B) Suffixes (S)
C) Prefixes (P)
D) Combining vowels (CV)
The root word is the main or fundamental meaning of the word.
All medical terms must have a root word. It can stand alone or be modified.
The suffix is a modifier that comes at the end of the root word to change its meaning.
The prefix is a modifier that comes at the beginning of the root word and is used to change the root word’s meaning.
Combining vowels are used to join a prefix, suffix, or another root word to the original root word. Combining vowels are a, e, i, o, u. The most commonly used combing vowel is o. Not all medical terms have combining vowel, as a prefix or suffix may have a vowel associated with it. Combining vowels aid in pronunciation of the word, but it does not modify any word part.
To analyze a medical term, divide it into it’s word parts, define each part based on it’s English meaning and define the term starting with any suffixes first, any prefixes next, and then the root word(s).
An example of a medical term to analyze is panosteoarthritis.
Pan / oste/ o / arthr/ itis
(P) (RW) (CV) (RW) (S)
Entire / bone / -- / joint / inflammation
Therefore the meaning would be : Inflammation of all the bones and joints.
Be sure to review the medical terms and word parts you (will) have had in previous class(es). You will be responsible for related medical terms in each lab exercise.
Look up these words or word parts in your dictionary or other medical terminology book(s).
-gram, -graph, - graphy mal-
-plasia meta-
-oma -onco
carin- -centesis
Symptoms syndrome
Iatrogenic pathology
Etiology auscultation
Palpation idiopathic
Homeostasis cystocentesis
Exercise and Application for Medical Terminology, Medical Records, and Metric
Read the following excerpt from a medical record case study (click on link below) to
1) Identify and define 10 medical terms
2) Identify the components of the SOAP method
a) What was the Subjective part of the record?
b) What was the Objective part of the record?
c) What was the Assessment part of the record?
d) What was the Plan part of the record?
3) Identify any metric terms used.
4) Identify any symbols or abbreviations
http://www.medicalmailbox.com/
http://library.thinkquest.org/3007/links.html
http://www.msu.edu/user/greenejo/index2.html
http://labtestsonline.org (explanations of different lab tests you might encounter)
Medical Transcriptionist
1. Name two safety equipment items and give their function.
2. Define the following medical terminology word parts
a) prefix
b) suffix
c) root word
d) combining vowels
3. Give the components of a medical record written in the SOAP format.
4. Name four prefixes used in the metric system and their meaning.
5. Name the base metric units for
a) temperature
b) volume
c) mass
d) length
