illustrated study guide for the nclex rn exam by joann zerwekh
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illustrated study guide for the nclex rn exam by joann zerwekhSign in Forgot Password. My Bench Close Sign In Not A Member. Sign Up Join MedWrench OK name type Receive Summary Emails.This will also help other community members who face similar challenges. You are about to submit an abuse report for this post. By continuing to browse the site you are agreeing to our use of cookies. Please review our Privacy Policy for more details. All Rights Reserved. Sign Up Join MedWrench OK name type Receive Summary Emails. Report Post Ali Khayri Tue Jan 09 2018 Reply from Ali Khayri Dear Tegner, You are about to submit an abuse report for this post. Sign Up Join MedWrench OK name type Receive Summary Emails.This will also help other community members who face similar challenges. You are about to submit an abuse report for this post. Abbott - CELL-DYN Emerald by Abbott Download PDF Product Details Forums Documents Videos News Request a quote Request Parts Add to My Bench This site uses cookies. Any product information in this document should be used in conjunction with the latest version of the Operations and Service Manuals. All Abbott Laboratories product names and trademarks are owned by or licensed to Abbott Laboratories, its subsidiaries or affiliates. No use of any Abbott trademark, trade name, trade dress, or product name may be made without the prior written authorization of Abbott Laboratories, except to identify the product or services of Abbott Laboratories. All other trademarks brands, product names, and trade names are the property of their respective companies. All rights reserved. Except as permitted above, no license or right, expressed or implied, is granted to any person under any patent, trademark, or other proprietary right of Abbott Laboratories. Each person assumes full responsibility and all risks arising from use of the information. The information is presented AS IS and may include technical inaccuracies or typographical errors.http://fiberglasssupplydepot.com/userfiles/hornady-366-user-manual.xml
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Abbott Laboratories reserves the right to make additions, deletions, or modifications to the information at any time without any prior notification. Revision Status Date January 2009 NEW Content Revised Trademark CELL-DYN and CELL-DYN Emerald Trademark Statement CELL-DYN and CELL-DYN Emerald are trademarks of Abbott Laboratories. This guide was developed and produced by ADD Global Commercial Training in Irving, TX. Prerequisites Intro to Achieving Service Excellence Effective Troubleshooting Reagent Troubleshooting FORT CELL-DYN Training Plan Goal Training Modules covering each phase of technical training provide a systematic approach to CELL-DYN training. Each module builds on the previous module. You are expected to obtain an 80 or higher score on each module skill assessment and may not move on to the next module until satisfactory mastery is obtained. Objectives and activities are included in each module. Activities optimize the time and resource requirements, while guiding you to mastery of performance objectives. Objectives At the completion of this training plan you will be able to use tools and resources to provide instrument and assay technical support to CELL-DYN customers. Instructions for the trainer and trainee along with objectives are listed in each module CELL-DYN Emerald Technical Support Training Guide Page 7 of 132 8 CELL-DYN System Technical Training Each module builds on the previous one. Before starting a module, you must complete all prerequisites for that module. Pre- work will be listed in Prerequisite section of the Introduction to each module or assigned by your Facilitator. CELL-DYN System Technical Training You are encouraged to take ownership of your training and empower yourself by communicating your needs to your manager, mentor, and National Service and Support Trainer. CSO has established the following expectations for their employees: Take ownership of your training this training program belongs to you and is what you make of it.http://holidaypackagesegypt.com/hormann-supramatic-manual.xml Make sure to stay on schedule when completing modules. Ask for clarification or assistance, if necessary. Be flexible flexibility is a necessary component of your work in CSO. Be productive use your time wisely and productively to meet all deadlines. If schedule changes occur, take advantage of available time to complete other tasks. Attend all scheduled training sessions review your schedule regularly for scheduled training sessions. If you are unable to attend a scheduled session, please inform your manager or National Service and Support Trainer. Be aware of the technical resources you are using verify that you are using the latest approved technical resources. If you are uncertain whether or your material is current, check with your Technical Information Analyst (TIA), Lead Customer Technical Advocate (LCTA) or National Service and Support Trainer (NSST) before using it. Page 8 of 132 CELL-DYN Emerald Technical Support Training Guide 9 Safety Considerations Safety Considerations Operation and maintenance of hematology systems may expose individuals to potential safety and health hazards. All work must be performed in accordance with procedures described in the Operator s Manual or as directed by your Facilitator. Warning Label WARNING is defined as a physical, mechanical, or procedural condition that could result in moderate to serious personal injury. For information about hazards, refer to the CELL-DYN Emerald Operator s Manual. The following activities may involve the presence of biological materials: Handling samples, reagents, calibrators, and controls Cleaning spills Handling and disposing of waste Performing maintenance procedures Performing decontamination procedures WARNING: Biohazard Identifies an activity or area where potentially infectious material may present a safety-related hazard and advises you to consult the associated caution or warning instructions provided.http://www.bouwdata.net/evenement/earthquake-garden-tiller-manual Follow procedures as outlined in the CELL-DYN Emerald Operator s Manual, Biological Hazards section. WARNING: Pinch Hazard Indicates an area of the instrument where operators can be exposed to moving parts. Be careful around these parts when performing diagnostics and maintenance operations with safety shield and covers removed. CAUTION: Radio Frequency Hazard Do not use mobile telephones, wireless telephones, mobile radios, or any other radio frequency (RF) transmitting devices in the same room as the instrument. WARNING: Sharps Hazard Indicates an area containing cutting parts. Follow instructions written in the CELL-DYN Emerald Operator s Manual when performing maintenance CELL-DYN Emerald Technical Support Training Guide Page 9 of 132 10 Safety Considerations Precautions for Potential Biohazards Warning Potential Biohazard: Consider all clinical specimens, reagents, controls, surfaces or components that contain or have contacted blood, serum or other bodily fluid as potentially infectious. Wear gloves, lab coats and protective eye wear, and follow other bio-safety practices as specified in the OSHA Bloodborne Pathogen Rule (29 CFR part ) or other equivalent bio-safety procedures. No known test method can offer complete assurance that products derived from human-sourced material will not transmit infection. Therefore, all products derived from human-sourced materials and system components exposed to human-sourced materials should be considered potentially infectious. It is recommended that you handle all potentially infectious materials in accordance with the OSHA Standard on Bloodborne Pathogens 1. You should use Biosafety Level 2 2 or appropriate biosafety practices 3,4 for materials that contain or are suspected of containing infectious agents. Precautions include, but are not limited to the following: Wear gloves, lab coats, and protective eyewear when handling humansourced material or contaminated system components. Do not pipette by mouth. Do not eat, drink, smoke, apply cosmetics, or handle contact lenses when handling human-sourced material or contaminated system components. Clean spills of potentially infectious materials and contaminated system components with a detergent followed by an appropriate disinfectant, such as 0.1 sodium hypochlorite or other suitable disinfectant. Decontaminate and dispose of all samples, reagents, and other potentially contaminated materials in accordance with local, state, and federal regulations. If you are exposed to biohazard or potentially infectious materials, you should seek medical attention immediately and take steps to cleanse the affected area: Eyes - rinse with water for - 15 minutes. Mouth - rinse with water. Skin - wash the affected area with soap and water. Puncture wound - allow to bleed freely. Wash the affected area with soap and water. 1 US Department of Labor, Occupational Safety and Health Administration, 29 CFR Part, Occupational Exposure to Bloodborne pathogens; Final Rule, Federal Register 1991;56(235): US Department of Health and Human Services. Biosafety in Microbiological and Biomedical Laboratories, Fourth Edition. Washington, DC: US Government Printing Office, May World Health Organization. Laboratory Biosafety Manual. Geneva: World Health Organization, National Committee for Clinical Laboratory Standards. Protection of Laboratory Workers from Occupationally Acquired Infections: Approved Guideline - Second Edition. NCCLS Document M29-A2. Wayne, PA: NCCLS, Page 10 of 132 CELL-DYN Emerald Technical Support Training Guide 11 Safety Considerations Pinch Hazards and Sharps If you come in contact with moving parts, they can pinch you. Avoid contact with moving parts. Warning Potential Biohazard: The aspiration probe and vent needle are sharp and potentially contaminated with infectious materials. Avoid contact with the tips of the probes and needles. For detailed safety information, refer to the CELL-DYN Emerald Operator s Manual. Spill Clean-up Clean spills in accordance with established biosafety practices and follow instruction in the MSDS(Material Safety Data Sheets). In general, safe work practices for cleaning spills include: Wear appropriate personal protective equipment, such as gloves, eyewear, and lab coat. Absorb the spill with absorbent material. Wipe the spill area with detergent solution. Clean with an appropriate disinfectant such as 0.1 sodium hypochlorite. Waste Handling and Disposal Each facility is responsible for labeling all waste containers and characterizing its waste stream to ensure waste is disposed of in accordance with the appropriate local, state, and federal regulations CELL-DYN Emerald Technical Support Training Guide Page 11 of 132 12 Safety Considerations Electrical Hazards The CELL-DYN Emerald does not pose uncommon electrical hazards if it is installed properly and connected to a power source that meets required specifications. Basic electrical hazard awareness is essential to the safe operation of any system. It is recommended that a ground fault circuit interrupter be used when working on a wet environment. Only qualified personnel should perform electrical servicing. Elements of electrical safety include, but are not limited to the following: Inspect electrical cabling periodically for signs of wear and damage Turn the instrument OFF before disconnecting the power cord and before servicing any electrical or internal components. Determine the cause of blown fuse or thrown circuit breakers and correct the problem before attempting to resume operation of the equipment. Only use replacement fuses of the specified type and electrical rating. Be aware that a high voltage charge may remain on the Power Supply with the power OFF. Use an electrically insulated tool to disconnect the Power Supply and short both male pins to the instrument chassis. Keep liquids away from all connectors of electrical or communication components. Unplug the instrument before clean up of major liquid spills. Make sure hands are dry prior to touching any switches or outlets. Keep the floor dry and clean under and around the instrument. Page 12 of 132 CELL-DYN Emerald Technical Support Training Guide 13 Module 1: Instrument Training CELL-DYN Emerald Technical Support Training Guide Page 13 of 132 14 Instrument Specifics Instrument Specifics Introduction The CELL-DYN Emerald Is an automated hematology analyzer designed for in-vitro diagnostic use in clinical laboratories. The CELL-DYN Emerald analyzer has built-in parts that work together, called subsystems. Parts that are not built-in that the operator can clean and reuse, are called components, and supplies that are used and discarded, are called consumables. You will need a thorough understanding of the CELL-DYN Emerald subsystems, components, and consumables in order to answer calls and assist customers. Automatically aspirate the specimen and present it for automated processing. Use microprocessors for systems control, data acquisition, and data analysis. Accept input and send data output to: LCD screen, hard drive, and printer Provide RS232 interface to an on-line LIS. Provide data alerts to assist in data review. Use electrical impedance for counting and sizing cells. Use LED hemoglobin analysis. The CELL-DYN Emerald System and the CELL-DYN 1800 System differ in these ways: CELL-DYN 1800 CELL-DYN Emerald Agent Cyanide-Free Differential Lyse Reagent CELL-DYN Emerald Cyanide-Free Lyse Reagent Bar Code Scanning Printer Compatibility Size Capable of specimen information input Capable of specimen information input from a from a bar code through a hand held bar bar code through a hand held bar code code scanner scanner. The Bar Code Reader reads Code 128, Code 39 or Interleaved 2 of 5 barcodes. Capable of data output to both a dot matrix printer and an inkjet printer Larger system than the CELL-DYN Emerald The CELL-DYN Emerald System has been configured for and tested with the specific printer that is shipped with the instrument. Electrical impedance is used to count and size blood cells. A modified Methemoglobin method is used for the colorimetric determination of hemoglobin (HGB). Electrical Impedance counting is use to count and size WBCs, RBCs and Platelets. Hemoglobin is measured using a methemoglobin chromagen formed using the cyanide-free lytic reagent CELL-DYN Emerald Technical Support Training Guide Page 15 of 132 16 Instrument Specifics CELL-DYN 1800 CELL-DYN Emerald Hinged door Yes - Easier access for maintenance. No Left side door lifts off for easy access to the reagent compartment. Right side door is unlocked using a key from the accessory kit and allow access to the sampling, syringe and counting modules. Fan filter No - Quieter and less maintenance. No no visible fans The following chart is a comparison of all CELL-DYN 1000 series instruments. Focused flow impedance, lysate modified. This module serves as the backbone for follow-on modules that will add to your knowledge of the instrument. To effectively answer your customers questions, it is helpful to have an in-depth knowledge of CELL-DYN Emerald operations, components, and features. Knowing how the CELL-DYN Emerald and its components operate correctly will allow you to distinguish what is or isn t and what should be. Prerequisites Before beginning this module you should have completed: Effective Troubleshooting FORT Reagent Troubleshooting Time to Complete Allow about 1 hour for the completion of this module. Resources These resources are helpful: CELL-DYN Emerald Operator's Manual CELL-DYN Emerald Flow Panel Mixing and Handling Instructions Flag tabs for Activity 1 Content is taken from CELL-DYN Emerald Operator's Manual C February 2009 unless otherwise indicated. Page numbers provided may differ in a different Operator s Manual version. Please refer to the most current revision of the Operator's Manual. Expectations Upon completion of this module you will be able to use the Operator's Manual to identify CELL-DYN Emerald component function. You will be able to run backgrounds, process samples, perform quality control and perform auto calibration CELL-DYN Emerald Technical Support Training Guide Page 19 of 132 20 Technologies, Components and Features, and Basic Operation Achieving Service Excellence (ASE) Connection The skills you learn in this module will reinforce the Understanding and Helping skills learned in ASE. Electrical Impedance Electrical Impedance is based on one principal: Electrical Resistance. It measures the changes in resistance between two electrodes as a blood cell is passed between them. The cell acts as a resistor and impedes the flow of the current. This is possible because blood cells are poor conductors of electric current. To measure the resistance requires: An electrical current A particle free isotonic solution to conduct the current An opening between the electrodes A known quantity of blood Electrical Impedance Counting Electrical Impedance counting is use to count and size WBCs, RBCs and Platelets. This method is based on the measurement changes in an electrical current produced by particles (cells), suspended in a conductive liquid, as they pass through an aperture of known dimensions. An electrode is submerged in the liquid on either side of the aperture to create an electrical pathway through it. As each cell passes through the aperture, a transitory change in the resistance between the electrodes is produced. This change produces a measurable electrical pulse CELL-DYN Emerald Technical Support Training Guide Page 21 of 132 22 Technology The number of pulses indicates the number of cells that traversed the aperture. The amplitude of each pulse is essentially proportional to the volume of the cell that produced it. Electrical Impedance provides key information on three components of cell populations: 1. Cell Type 2. Cell Count 3. WBC Differential Cell Type Identifies cells based on their size. As a cell moves through the aperture, one at a time, it impedes the flow of current producing a voltage pulse. The magnitude of the pulse is proportion to the size of the cell. Thresholds set within the analyzer: Discriminate between the voltage pulses Categorize the pulses into on of three blood cell types Use thresholds based on the volume of the cell measured in femtoliters. Page 22 of 132 CELL-DYN Emerald Technical Support Training Guide 23 Technology The diluted blood sample is split into two parts, one for counting Red Blood Cells (RBC) and platelets (PLT) and the other for counting white blood cells (WBC). The number of cell pulses for each cell type are counted and reported as the total number of cells presented in the volume of blood being tested. After counting the WBCs, the dilution remains in the WBC bath and is measured for hemoglobin concentration. This is accomplished by using reagents to lyse, or destroy, the RBCs releasing the Hemoglobin into the solution and perforating the WBC cytoplasmic membrane allowing the cytoplasm to escape. The resulting WBC population is counted directly by impedance and the differential measurands are obtained from the graph. The WBC differential is classified into three key cell populations. The smallest cells are identified as lymphocytes. Neutrophils make up the Gran population. The other white blood cells including the Monocytes, Basophils and Eosinopils are generally included in the mid-size population CELL-DYN Emerald Technical Support Training Guide Page 23 of 132 24 Technology Lysate Modified Differential The lyse alters the WBC membrane to allow the cytoplasm to slowly diffuse and shrink the membrane around the nucleus and any granules that may be present. The cells are counted and sized as they travel through the aperture plate of the Counting Module. The analyzer produces a three part differential: Lymphocytes Mids (monocytes, basophils, eosinophils) Granulocytes. Page 24 of 132 CELL-DYN Emerald Technical Support Training Guide 25 Technology Absorption Spectrophotometry and Hemoglobin Measurement A modified hemoglobin complex is used for the colorimetric determination of Hemoglobin (HGB). A portion of the lysed, diluted sample from the WBC Mixing Chamber is used for HGB measurement. A low-energy Light-Emitting Diode (LED) is used as the light source and the complex is measurable at 555 nm. (The quaternary ammonium lysate participates to form a chromagen for hemoglobin measurement.) Instrument Hemoglobin Method Measurement CELL-DYN Emerald Cyanide Free methemoglobin Chromagen Hemoglobin is measured using a methemoglobin chromagen formed using the cyanide-free lytic reagent. The methemoglobin is measured by means of absorption spectrophotometry using a 555 nm LED as the light source. The LED shines through the WBC counting chamber after the WBC count is completed. The Hemoglobin concentration is directly proportional to the absorbency of the sample. A blank reading is made during the rinse cycle and an automatic offset circuit for the LED maintains the blank range. The blank and sample readings are compared to determine the hemoglobin concentration of the sample. Three measurands are obtained: HGB MCH MCHC CELL-DYN 1800 Cyanide Free Modified Methemoglobin The hemoglobin concentration is measured optically using the solution from the WBC bath. It is derived from the volume of the RBCs that are counted during the measurement cycle. Task Content Page Number Sample Specifications Basic Run Sample collection and handling Specimen stability Interfering substances Sample identification Daily Start Up Auto-Background Background (not auto ) Run Quality Control When to run QC QC Guidelines Running Controls Operator s Manual, section 5: Operating Instructions Appendix B Operator s Manual, section 5: Daily Startup, Quick Reference Card Operator s Manual, section 11: When to Run QC, QC Guidelines, Quick Reference Card Daily Shut Down Run Sample Specimen ID Running Specimens Manual Shut Down Auto Shut Down Operator s Manual, section 5: Operating Instructions, Running Specimens, Quick Reference Card Operator s Manual, section 5: Running specimens Section 2: Installation Procedures and Special Requirements, Quick Reference Card CELL-DYN Emerald Technical Support Training Guide Page 27 of 132 28 Activity 1 Component Identification Activity 1 Component Identification Component Identification Instructions To help customers, you should be able to locate the system components. List the function of each reagent Component Number 5 Reagent Tray; Operator s Manual page 1-10 Component Function Name 1 Cleaner Reagent An enzymatic cleaner used to clean the measurement system and the fluidics. 2 Cleaner Reagent Inlet line for Cleaner reagent line green collar 3 Lyse Reagent Rapidly lyse RBCs and minimize resultant cell stroma Alter WBC membrane to allow cytoplasm to diffuse and shrink the membrane around the nucleus and any granules t Convert hemoglobin to a modified hemoglobin complex that is measurable at 555 nm. (The quaternary ammonium lysate participates to form a chromagen for hemoglobin measurement.) 4 Lyse Reagent line Inlet line for Lyse reagent blue collar 5 Reagent Tray Holds the Lyse and Cleaner 6 Diluent Reagent Act as diluent for WBC, RBC, PLT, and Hgb measurements Maintain cell volume during counting and sizing portion of the measurement cycle Provide a conductive medium for impedance counting and sizing of cells and platelets Rinse the Aspiration Probe and fluidics Page 34 of 132 CELL-DYN Emerald Technical Support Training Guide 35 Activity 1 Component Identification Rear Panel Identify the rear panel connections. Follow the directions in the Operator s Manual and run each of the following: Normal Background Patient Sample (use normal control if whole blood samples are not available) Task Training Content Operator s Manual Section Reagent Overview Sample Types and Handling System Startup Power On and Power Off Running a Background Running control Sample Cleaner Reagent Lyse Reagent Diluent Reagent Specimen requirements Control mixing and handling handout Patient specimen mixing and handling handout Startup Operator Login Run Startup cycle Power analyzer off and on. Normal Background Auto-background as part of Start-up Manual Normal background Running Controls (Read only. Controls will be run later in training) Operator s Manual, section 1: Overview Operator s Manual, section 5: Operating Instructions Operator s Manual, section 5: Operating Instructions and Routine Operation Operator s Manual, section 5: Operating Instructions and Running Specimens Operator s Manual, section 5: Daily Startup, Quick Reference Card Operator s Manual, section 11: When to Run QC, QC Guidelines, Quick Reference Card Page 36 of 132 CELL-DYN Emerald Technical Support Training Guide 37 Activity 2 Basic Run Running patient sample Running Specimens Probe availability Idle for 1 hour Operator s Manual, section 5: Operating Instructions, Running Specimens, Quick Reference Card CELL-DYN Emerald Technical Support Training Guide Page 37 of 132 38 Technologies, Components and Features, and Basic Operation Skill Check Technologies, Components and Features, and Basic Operation Skill Check 1. If logged in as an operator or supervisor, what is printed on each report if the Start Up background checks fail. If a Start Up Cycle is not successfully completed, either the message Start Up Failed or Start Up Not Done, as appropriate, is printed with every result when the user is logged in as operator or supervisor. (CELL-DYN Emerald Operator s Manual C February 2009, page 5-9) 2. What are the three modules that make up the fluidics components. Sampling Module, Syringe Module, Counting Module (CELL-DYN Emerald Operator s Manual C February 2009, page 1-5) 3. Name the reagents used on the CELL-DYN Emerald. CELL-DYN Emerald Diluent Reagent, CELL-DYN Emerald Cyanide-Free Lyse Reagent, CELL-DYN Emerald Cleaner Reagent (CELL-DYN Emerald Operator s Manual C February 2009, page 1-10 to 1-11) 4. Should the diluent reagent be above, below or at the same level of the instrument. CAUTION: Diluent must be at the same level as the instrument for proper operation. (CELL-DYN Emerald Operator s Manual C February 2009, page 2-11) 5. If the aspiration probe is not visible, what must the operator do to run a sample. If the Aspiration Probe is not visible, press the Start Switch (located directly behind the probe) and wait for it to descend. (CELL-DYN Emerald Operator s C February 2009, page 5-12) Page 38 of 132 CELL-DYN Emerald Technical Support Training Guide 39 Technologies, Components and Features, and Basic Operation Skill Check 6. How often should Shutdown be performed. The CELL-DYN Emerald must be put through a Shut Down cycle once during every 24 hours of operation. (CELL-DYN Emerald Operator s Manual C February 2009, page 5-16) 7. What process occurs before a sample can be run if the instrument has been idle for an hour or more. If more than one hour has elapsed since the last cycle, the instrument will initiate an auto rinse cycle before the probe is presented for aspiration. (CELL-DYN Emerald Operator s Manual C February 2009, page 5-12) The CELL-DYN Emerald performs an automatic rinse of the fluidics pathway when a cycle is initiated following system idle time of one hour or more. (CELL-DYN Emerald Operator s Manual C February 2009, page How is a normal background cycle initiated. Background counts can be run at any time by touching the Start Switch located behind the Aspiration Probe. (CELL-DYN Emerald Operator s Manual C February 2009, page 2-32; QRG-2) 9. What ways can a patient specimen be identified. Which of these IDs is required to run the specimen. Name 20 characters can be entered in the name field Patient ID (PID) used to enter a unique patient ID number, such as a medical record number. 16 characters can be entered in the PID field. Specimen ID (SID) This field is used to enter a specimen ID. The instrument will automatically increment the SID if Auto SID is selected on the Set Up Screen. When Auto SID is selected, the SID can be set to start at one (or whatever number is desired) at the start of each day s run. 16 characters can be entered in the SID field.