Question

Description:

Sylvia Gonzales, a 51-year-old female, is at the office for a 3-month return check for her newly diagnosed Type 2 diabetes. She states that she has taken the medication she received for her “sugar” and she knows the doctor wants to a do a special “sugar test” this time. Her medication list includes Januvia^®100 mg daily. The physician has ordered a fasting blood sugar (FBS), electrolytes, and a CBC. You will need to collect a venipuncture blood specimen to send the lab. During the esam Sylvia states, she is feeling lightheaded, so the licensed practitioner asks you to perform a waived blood sugar and hemoglobin A1C immediately.

Discussion Questions:

1. What blood tube(s) would you fill to collect a specimen for the CBC and lytes?
2. Compare a fasting blood sugar test to a hemoglobin A1C test.
3. What steps will you take to perform a dermal puncture?
4. If Sylvia tells you that she ate breakfast before coming in for the test, what should you do?

Answer 1

Lavender-Top Tube - EDTA: EDTA is the anticoagulant used for most hematology procedures. Its primary use is for the CBC and individual components of the CBC. The larger (6ml) tube is used for blood bank procedures.

For lytes,Green top (Li Heparin) tube, preferred Alternate tube: Red, marble or gold top tube

A1C tests measure average blood glucose over the past two to three months. So even if you have a high fasting blood sugar, your overall blood sugar may be normal, or vice versa.A normal fasting blood sugar may not eliminate the possibility of type 2 diabetes. This is why A1C tests are now being used for diagnosis and screening of prediabetes and diabetes. Because it doesn’t require fasting, the test can be given at any time as part of an overall blood screening.The measurement of A1C equals the assessment of hundreds (virtually thousands) of fasting glucose levels and also captures postprandial glucose peaks.

Steps of dermal puncture

1. obtain and examine requisition
2. greet patient and explain procedure
3. identify patient by two identifiers ( name, dob)
4. compare patient information with requisition ( if patient, compare with armband)
5. sanitize hands and put on gloves
6. position patient
7. select appropriate puncture site
8. warm site if applicable
9. cleanse site with alcohol and allow to air dry
10. assemble rest of equipment needed
11. smoothly perform puncture
12. dispose of sharp in sharps container
13. fill tubes in correct order of draw
14. apply pressure to puncture with gauze
15. seal tube and invert tube to mix (8-10 time)and label the tube
16. examine puncture site for stoppage of bleeding and apply bandage

The tests doesn't require fasting, the test can be given at any time as part of an overall blood screening. So no worries if the patient had bre