WPC4W cZRSdP2Dè77f+1RSdb`б )njn07ByD&{xMjP j2?SogP8z}ncpF-FƏIiƸtNF)uSP n=X thK[˶־N(de)% C?;C#fSӶB4z}1! .>`L{jxDkT \;Fh_b ߻iw5LFG;ԚD|"c{kPїR)'$Ar,cDitEM^q|@R$07#3%ͺ0Z6Y:EWBfIý!arkegZkl֬, <$<~%Xn#9+\1O 'ج5F'TO6 dvR?[ 0~ 0xP 0k 0k3 0 0~8 0 0 0k 0 0  0 010 0Ca 0V 0 0 0m 0 0 0 0K 0$ 0U6j % 0z 0   0= 0FR 0P 1 0{ 1T 0Y!" 0O%E&~& C( 1( 72&) BV*X) BB)f)a)f)a)f)a) 1)*n* 04U+N+U:+U 4+U@+ 19,, , m,w,4,f,a, - 0+e-#8.UN1fO1aQ1"e11M2334^ e5 1uq5 0c5 1I6 16 1W7 17 1e8-8 729K9 0P>: 0U:^:-A;-n; D3;^;e,< 0P<< 0= 0> 0p? 0)@ 0@ 0A 00B 0B 0lC 0+D 0D 0E 0JF 0F 0G 0H 0H 01I 0I 0J 0_K 0L 0L 09M 0M 0WN 1N CfO 72O 02wO 0)P 0P iSQ 0rQ 0&R 0R 0S 0DT 1U 72~V6V 0NVV& 8Document[8]Document Style0..8` ..` V8Document[4]Document Style.. . V 8Document[6]Document Style8..V 8Document[5]Document Style0..V/8Document[2]Document Style 2A.3  Ԁ   V& 8Document[7]Document Style0..0` ..` zU :Right Par[1]Right-Aligned Paragraph Numbers..2I.3  Ԁ..0..zh :Right Par[2]Right-Aligned Paragraph Numbers..` ..2A.3  Ԁ..0` ..` V?8Document[3]Document Style.. 21.3  Ԁ   z{ :Right Par[3]Right-Aligned Paragraph Numbers..` ..`  ..P 21.3  Ԁ` ..` 0 .. z :Right Par[4]Right-Aligned Paragraph Numbers..` ..`  .. .. 2a.3  Ԁ .. 0..z :Right Par[5]Right-Aligned Paragraph Numbers..` ..`  .. ..h..2(1)3  Ԁ..0h..hz :Right Par[6]Right-Aligned Paragraph Numbers..` ..`  .. ..h..h..2(a)3  Ԁh..h0..z :Right Par[7]Right-Aligned Paragraph Numbers..` ..`  .. ..h..h....2i)3  Ԁ..0..z :Right Par[8]Right-Aligned Paragraph Numbers..` ..`  .. ..h..h....p..2a)3  Ԁ..0p..pVX8Document[1]Document Style  @..^  2I.3  Ԁ     Ԉ l2:Technical[5]Technical Document Style.. 2(1)3  Ԁ. l2:Technical[6]Technical Document Style.. 2(a)3  Ԁ. l/%:Technical[2]Technical Document Style 2A.3  Ԁ   .. l,!:Technical[3]Technical Document Style 21.3  Ԁ   .. l(!:Technical[4]Technical Document Style 2a.3  Ԁ   .. l:0:Technical[1]Technical Document Style  2I.3  Ԁ     .. l1:Technical[7]Technical Document Style.. 2i)3  Ԁ. l1:Technical[8]Technical Document Style.. 2a)3  Ԁ. <\  `(Roman 10cpiXR& 8BibliogrphyBibliography0....fp2Doc InitInitialize Document StyleS !    I. 1. A. a.(1)(a) i) a)S ($0 ($0 0 (($0 0 0   A_ekqwDocumentDocument StyleI.1.A.a.(1)(a)i)a)jo4Tech InitInitialize Technical StyleS #  1 .1 .1 .1 .1 .1 .1 .1 S CuyTechnicalTechnical Document Style11.11.1.11.1.1.11.1.1.1.11.1.1.1.1.11.1.1.1.1.1.11.1.1.1.1.1.1.1x?t2PleadingHeader for numbered pleading paper %  &R(   >XXXXX?-''*dE*??-''*dE*?cc1cc2cc3cc4cc5cc6cc7cc8cc910111213141516171819202122232425262728  .+('2R$ 7U!   ' 'Lab #9: Blood Donor Interview and Physicallab9sq  0 .    d8 CSY_ekqw}Numbers 2Numbers1.1.1.1.1.1.1.1.*1.&0 d d dTable_BTable_CTable_D  CRight ParRight-Aligned Paragraph NumbersI.A.1.a.(1)(a)i)a)#|x<\  `(Roman 10cpiXx\  @ X@( U$  ,@AZ"Arial RegularArial Bold(C Z(Times New Roman (5hCEKQW]cioAutoList11.1.1.1.1.1.1.1.HU٩L;$TABLE A1, 2, 3,Level 1Level 2Level 3Level 4Level 54#92Quick 1.D  .0 DHPE438C7 (HP Officejet J6400 series)0(9 Z6Times New Roman Regular TABLE B     сLevel 1Level 2Level 3Level 4Level 5Level 1Level 2Level 3Level 4Level 5Level 1Level 2Level 3Level 4Level 5Level 1Level 2Level 3Level 4Level 5Level 1Level 2Level 3Level 4Level 52<  3#37=CIQYag1.a.i.(1)(a)(i)1)a)(;3$2#  0  .3  0  (EhCEKQW]cioAutoList21.1.1.1.1.1.1.1.(UhCEKQW]cioAutoList31.1.1.1.1.1.1.1.(ehCEKQW]cioAutoList41.1.1.1.1.1.1.1.(uhCEKQW]cioAutoList51.1.1.1.1.1.1.1.(hCEKQW]cioAutoList61.1.1.1.1.1.1.1. ##:77:Xd#Qi) [)   _HH\A-') xddEHWH!A X Exercise11:BloodDonorInterviewandPhysical((3$ 7U!   *+ (_2623  .. T [)   HH] ##::Xd# ##::Xd#----'dxd T [)   HHa [ c*   _    1  ((3$ 7U!    [)   _HHdA-') xddEHWH!A X Exercise10:BloodDonorInterviewandPhysical*D+D (_25   ," <DL,23  ..," <DL,   *5+5 (_24  ) <DL)23  ..) <DL)  *2+2 (_23 ` &<<DL&23  ..&<<DL& ` */+/ (_22  #DL#23  ..#DL#  *,+, (_21   DL 23  .. DL  *)+) (_20 h DDL23  ..DDL h *&+& (_19  L23  ..L  *#+# (_18   L23  .. L  *>> (_17  2( 4 <DL223  Ԁ2( 4 <DL2  *DD (_16   ," <DL,23  Ԁ," <DL,   *55 (_15  ) <DL)23  Ԁ) <DL)  *22 (_14 ` &<<DL&23  Ԁ&<<DL& ` *// (_13  #DL#23  Ԁ#DL#  *,, (_12   DL 23  Ԁ DL  *)) (_11 h DDL23  ԀDDL h *&& (_10  L23  ԀL  (## &_9   L23  Ԁ L  (>> &_8  2( 4 <DL223  2( 4 <DL2  (DD &_7   ," <DL,23  ," <DL,   (55 &_6  ) <DL)23  ) <DL)  (22 &_5 ` &<<DL&23  &<<DL& ` (// &_4  #DL#23  #DL#  (,, &_3   DL 23   DL  ()) &_2 h DDL23  DDL h (&& &_1  L23  L  &## $_   L23   L  RxeyIcgkosw{Large BulletLarge Bulletd(O;$0  2#  a  .3  0` (#(#(b$0  0` (#(#2#   .3  0 ` (#` (#(xir$0  0` (#(#0 ` (#` (#2#(  0  )3  0 (# (#`-) ($0  0` (#(#0 ` (#` (#0 (# (#2#(  a  )3  0h(#(#(F$0  0` (#(#0 ` (#` (#0 (# (#0h(#(#2#(   )3  0h(#h(#($0  0` (#(#0 ` (#` (#0 (# (#0h(#(#0h(#h(#2#  0  )3  0(#(#({$0  0` (#(#0 ` (#` (#0 (# (#0h(#(#0h(#h(#0(#(#2#  a  )3  0p(#(#(F$0  0` (#(#0 ` (#` (#0 (# (#0h(#(#0h(#h(#0(#(#0p(#(#2#     )3  0p(#p(# RxR?[_cgkoswSquaresSquare Bullethttp://tinyurl.com/yzoyel5(O$ 7U!   _XXHH 9XXXX9v X9XJ*X Z899XXdd8EXERCISE11:0 P BLOODDONORINTERVIEWANDPHYSICAL#9XX9v # XP $P $ GX{eXX9XTextbook:0  Chapter13Arterial,IVandSpecialCollectionProceduresX$$ Skills:0  0$$20points0$$ Objectives:0  $$  Q(#33Q"R3"  R342#  1  .3  0    Determineifanindividualiseligibletodonatebloodbyproperperformanceofthedonorinterview.R34a݌ $$ Ќ  "R3"  R3a2#  2  .3  0    Identifytheconditionswhichwouldcausedeferralofapotentialblooddonorandthelengthoftime  t  ofdeferralwhetheritispermanent,12monthsortemporary.R3a݌ ` $$ Ќ  "R3"  R32#  3  .3  0    Listthedeferralrequirementsforimmunizationsandmedicationslistedintheprocedure.R3 ݌ L $$ Ќ  "R3"  R32#  4  .3  0    Statetheacceptablevaluesforweight,pulse,temperature,bloodpressure,hemoglobinandhematocrit  8  forroutineblooddonors.R3.݌|$ $$ Ќ  "R3"  R3]2#  5  .3  0    Performthephysicalexamination,andbasedontheresults,determineifthedonoriseligibleforblood h  donation.R3]݌T $$ Ќ  "R3"  R3 2#  6  .3  0    Statetworeasonsforcarefulscreeningofblooddonorspriortothedonationprocess.R3 ݌@$$ Ќ  b GXGX{eIntroduction #GX{eXG #  Carefuldonorselectionplaysamajorroleindeterminingwhetherornotaunitofdonorbloodwillbe  therapeuticallyeffectiveandfreeoftransmissibledisease.Therearetwopartsintheselectionofeligible  blooddonors.Thefirstpartinvolvesobtainingabrieforalmedicalhistory.Theinterviewmustbeconducted  byqualifiedpersonnelinamannerthatassuresauditory(visualprivacyisalsorecommended),thatallays n apprehension,andallowstimeforanynecessarydiscussionorexplanation. Z  MedicalHistory  2 Prospectivedonorsareaskedaseriesofquestionsrelatedtotheirmedicalhistory.Answerstothequestions b  mustberecordedas"yes"or"no"withdetailsaddedasindicated.Someveryspecificquestionswillbe N necessarybutagreatdealofpertinentinformationcanbeobtainedbyaskingsomegeneralorleading : questionsinsimplelanguagethatthedonorcanunderstand.Usually,blooddonationcentershavethe & questionslistedonacard,formoroncomputer.    Basedontheanswerstospecificquestionstheinterviewermustdeterminewhetherornotthepotentialdonor !" iseligibletodonateblood.Thequestionsaskedserve twopurposes .Thefirstistoensurethatthedonation "~ # ofbloodorbloodcomponentswillnotcompromisethehealthofthepotentialdonor.Thesecondistomake #j!$ surethatapotentialdonor'sbloodwillnottransmitadiseasestatetothepotentialrecipient.Thedonor'spast $V"% andpresenthealthstatuswillaidinmakingthisdetermination.Basedontheanswerstothequestionsinthe %B#& medicalhistoryadonorwillbeaccepted,temporarilydeferredorpermanentlydeferred. &.$' Ifapotentialdonorpassestheoralmedicalhistoryinterviewtheymustthenundergoaverylimitedphysical ^(&) examtoensurethatthedonationofbloodwillnotharmthem. J)&* Whilethedonorisinthewaitingareatheyaregiveneducationalmaterialswhichtheymustreadinforming "+(, themofactivitiesthatmayplacethemathighriskforHIVinfection.PersonsatriskforHIVinfectionmust ,)- refrainfromdonatingblood.Donorscreeningmustincludequestionsrelatingtothesignsandsymptomsof ,*. AIDS,includingevidenceofHIVinfection,AIDSrelatedcomplex(ARC),and_Kaposi_'ssarcoma. -+/ Ї_Many_Ԁfacilitiesprovideinformationsheetsforblooddonors,whichemphasizethatbloodshouldnotbe X donatedbypersonswantingtoensurethattheydonothaveAIDS(i.e.,apersonshouldnotdonatebloodto D receivea"free"AIDStest).DonorswhomaybeatriskforAIDSmayconfidentiallyselfexcludetheirblood 0 fromthegeneralbloodsupply.  Thedonor'sresponsestothequestionsaskedarerecorded,andthecardissignedbythedonortoverifythe  informationprovided.Donorsmaybedeferredtemporarilyorpermanently,basedontheirmedicalhistory.  Thefollowingchartlistsconditionsthatmaycauseadonortobedeferred. t ;X{eXXGX{e_AABB_Ԁ(AmericanAssociationofBloodBanks)hassimplifiedandstandardizedthisprocessbyproviding  L  a" UniformMedicalHistoryQuestionnaireforWholeBloodDonors .4 O  5  http://tinyurl.com/yzoyel56?OS7  7 "Ԁ  8   Permanentdeferral : l    *( 93Q"R3"    R32   1  .3  0    Menandwomenwhohaveengagedinsexfordrugsormoneysince1977.R3݌X $$ Ќ  "R3"    R32   2  .3  0    Menwhohavehadsexwithanothermale,evenonetime,since1977.R3݌D $$ Ќ  "R3"    R32   3  .3  0    PeoplewhohaveusedIVdrugs(evenonce).R33݌0 $$ Ќ  "R3"    R32   4  .3  0    Takingclottingfactorsforableedingdisordersuchashemophilia.R32݌$$ Ќ  "R3"    R3 2   5  .3  0    PeoplewithclinicalorlaboratoryevidenceofHIVinfection.R3 J ݌$$ Ќ  "R3"    R3#!2   6  .3  0    Hepatitisatage11orolder.R3#!\!݌$$ Ќ  "R3"    R3"2   7  .3  0    Cancerexceptionsaremadeforsomecancers(basalorsquamouscellcarcinoma).R3"N"݌$$ Ќ  "R3"    R3<#2   8  .3  0    _Cruetzfeldt_ԀJakobdisease(_CJD_):Thefollowingindividualsarepermanentlydeferred:R3<#u#݌t$$ Ќ  0  0$$a)0P $$Receivedpituitarygrowthhormoneofhumanorigin`P $P $ 0  0$$b)0P $$Receivedatransplantofbraincovering(duramater)LP $P $ 0  0$$c)0P $$Familymemberwith_CJD_#GX{eXX;X{e;#;X{eXXGX{e8P $P $ "R3"    R3&2   9  .3  0    Individualswhohaveeverhadthefollowingparasiticblooddiseases:ChagasDiseaseor |$ _Babesiosis_R3&&݌h$$ Ќ  "R3 "    R3'2   10  .3  0    Peoplewhohaveeverhadapositivetestforoneormoreofthefollowing:R3'&(݌T$$ Ќ  0    a)0P $$_HBsAg_@P $P $ 0    b)0P $$HepatitisC,P $P $ 0    c)0P $$_HTLV_ԀI/IIP $P $ 0    d)0P $$HIV#GX{eXX;X{eC&#;X{eXXGX{eP $P $ "R3 "    R3*2   11  .3  0    Donorwhodonatedonlyunitofbloodgiventoapatientwhothendevelopedposttransfusion  hepatitis,orhasbeeninvolvedin2ormorecasesofposttransfusionhepatitis.R3*+݌ $$ Ќ  "R3 "    R3v,2   12  .3  0    Peoplewhohavespenttimethataddsupto3monthsormoreintheUnitedKingdomdueto  p! exposureriskto_CJD_.R3v,,݌!\"$$ Ќ   Deferfor12months  #4!$ ! ! *( 99 *"R3"    R3.2   1  .3  0    #GX{eXX;X{e*#;X{eXXGX{eRecipientofblood,bloodcomponentsorhadtissueororgantransplant.R3..݌`%#&$$ Ќ  "R3"    R3$02   2  .3  0    Highriskbehaviors:R3$0]0݌L&#'$$ Ќ  0  0$$a)0P $$Womenwhohavehadsexwithmenwhohavehadsexwithanotherman,evenone 8'$( time,since1977.$(%)P $P $ 0    b)0P $$Hashadsexwithsomeonewhowasgivendrugsormoneyforsex.)&*P $P $ 0  0$$c)0P $$HashadsexwithanypersonwhoisapastorpresentIVdruguser.)'+P $P $ 0  0$$d)0P $$Historyofsyphilisorgonorrhea.*(,P $P $ 0  0$$e)0P $$Hadsexwithsomeonewhohastakenclottingfactorsonregularbasis.+|)-P $P $   0  f)0P $$SexualpartnerofsomeonewhoisHIVpositive.#GX{eXX;X{e{/#;X{eXXGX{e,h*.P $P $ "R3"    R342   3  .3  0    Receivedaninjectionofhepatitisimmuneglobulin(_HBIG_).R344݌-T+/$$ Ќ  "R3"    R352   4  .3  0    Acupuncture,tattooing,orearpiercingdoneunderquestionablecircumstances.R35,6݌X$$ Ќ  "R3"    R372   5  .3  0    Accidentalneedleexposureornonsterileskinpenetrationwithinstrumentscontaminatedwith D bloodorbodyfluids.R37O7݌0$$ Ќ  "R3"    R3r82   6  .3  0    Rabiesvaccinegivenfollowingthebiteofarabidanimal.R3r88݌$$ Ќ  "R3"    R392   7  .3  0    Recentinmateofaprisonormentalinstitution.R399݌$$ Ќ  "R3"    R3:2   8  .3  0    ClosecontactwithAIDSorhepatitispatientwhichisdefinedasdonorswhoshareliving  quartersorareasexualpartnerofapersonwithviralhepatitisorAIDS.R3::݌$$ Ќ  "R3"    R3<2   9  .3  0    Traveledtoamalarialendemicarea,componentsfreeof_RBCs_Ԁareexempt.R3<K<݌t$$ Ќ  "R3 "    R3O=2   10  .3  0    IntranasaluseofcocaineR3O==݌ `$$ Ќ   Temporarydeferral   8  ! ! Q(#39 *"R3"    R3?2#  1  .3  0    ImmunizationsR3?O?݌d $$ Ќ  ";"    ;?0  2#  a  .3  0P $$  Redmeasles(rubeola),mumps,yellowfever,oralpolio,oraltyphoid2weeks;?1@݌P P $P $ Ќ  ";"    ;/A0  2#  b  .3  0P $$  Germanmeasles(rubella),Varicellazoster(chickenpox)4weeks;/AhA݌< P $P $ Ќ  ";"    ;[B0  2#  c  .3  0P $$  Rabies,HepatitisBImmuneGlobulin(_HBIG_)1year;[BB݌( P $P $ Ќ  ";"    ;C0  2#  d  .3  0P $$  Smallpox56days;CC݌P $P $ Ќ  ";"    ;D0  2#  e  .3  0P $$  Fluvaccinenodeferral;DD݌P $P $ Ќ  ";"    ;E0  2#  f  .3  0P $$  HepatitisB#GX{eXX;X{e4#;X{eXXGX{eԄ2weekwaitaftereachdose ` ;EE݌P $P $ Ќ  ";"    ;F0  2#  g  .3  0P $$  NOTE:Thereisnodeferralfor_toxoids_ԀorkilledvaccinessuchasTetanusand  Meningitis.#GX{eXX;X{eiF#;F-G݌lP $P $ Ќ  "R3"    R3H2#  2  .3  0    MedicationsR3HH݌X$$ Ќ  ";"    ;nI0  2#  a  .3  0P $$  Aspirin,_piroxicam_Ԁ(_Feldene_)deferplateletdonorsfor48hours.;nII݌DP $P $ Ќ  ";"    ;J0  2#  b  .3  0P $$  _Isotretinoin_Ԁ(_Accutane_,_Amnesteem_,_Claravis_,_Sotret_);X{eXXGX{eԀ1month;JK݌0P $P $ Ќ  ";"    ;L0  2#  c  .3  0P $$  _Finasteride_Ԁ(_Proscar_)(_Propecia_)1month;LL݌tP $P $ Ќ  ";"    ;2N0  2#  d  .3  0P $$  _Acitretin_Ԁ(_Soriatane_)3years;2NkN݌`P $P $ Ќ  ";"    ;zO0  2#  e  .3  0P $$  _Etretinate_Ԁ(_Tegison_)permanent#GX{eXX;X{eSL#;X{eXXGX{e;zOO݌LP $P $ Ќ  ";"    ;Q0  2#  f  .3  0P $$  _Dutasteride_Ԁ(_Avodart_)6months;Q>Q݌8P $P $ Ќ  ";"    ;NR0  2#  g  .3  0P $$  _Chopidogrel_Ԁ(_Plavix_)and_Ticlopidine_Ԁ(_Ticlid_)14_days_;NRR݌$P $P $ Ќ  ";"    ;T0  2#  h  .3  0P $$  BovineInsulinmanufacturedinUKindefinite;TGT݌P $P $ Ќ  "R3"    R3%U2#  3  .3  0    Existingpregnancyorpregnancyinlast6weeksiscausefordeferralexceptunderextremely  unusualcircumstances.R3%U^U݌$$ Ќ  "R3"    R3V2#  4  .3  0    Malaria3yearsaftertreatmentorimmigrantfrommalarialendemicarea1yearifvisitor |  ofmalarialendemicarea.R3VV݌ h!$$ Ќ  "R3"    R3W2#  5  .3  0    WestNilevirus120days.R3WX݌!T"$$ Ќ  Otherillnessesormedicationsareevaluatedonanindividualbasis.#GX{eXX;X{eP# #,!$ XH  p$"% J* J  J    *./ ddd Xdd Xdd XX$X$,G" +  /,,,,DD /@PP{ CONDITIONSTHATMAYTEMPORARILYDEFERADONOR 3)' 0  ,,,, 3 *e01ddG" G"./X$X$e,d ,[ +  6,,' p6Condition0  0? 0 ? ? 0  0G0GG0@++0@70@70@7 I,,,6+X,, ILengthofDeferral S-,D,X p ,,, PS Activeallergies 6-,,#$-, 6 Untilfreeofsymptoms J-,;#$ P -,, PJ Acutecough,sorethroat,cold 6-,,#@-, 6 Untilfreeofsymptoms J-,;#@ P -,, J Age0  @-,,-"  -, @ Personsmustbe17yearsofageorolder    todonateblood J-,;#    -,, J Antibiotics(oral) 6-,,#l  -, 6 Noneiffordermatology,otherwise l   dependsoncondition J-,;#X   -,, J Asthma0  @-,,-"t -, @ 6monthsafterlastattack 򀀀 J-,;#t   -,, PJ BloodTransfusion 6-,,#D -, 6 12monthsaftertransfusion J-,;#D  P -,, PJ Closecontactwithahepatitispatient 6-,,#`-, 6 12months J-,;#` P -,, J Drugtherapy,includingantibiotics,anticoagulants, , digitalis,insulin,_anticonvulsant_,_vasodilators_,  _antiarrythmics_ 6-,,#-, 6 Clinicalconditionforsuchtreatmentmay , deferadonor J-,;#  -,, PJ Earpiercing/tattooing/acupuncture 6-,,#x -, 6 12months J-,;#x  P -,, PJ Formerinmatesofpenalinstitution 6-,,#-, 6 12months J-,;# P -,, PJ Germanmeasles(rubella)vaccine 6-,,#`-, 6 4weeks J-,;#` P -,, J Historyofmalarialinfection 6-,,#| -, 6 3yearsafterbecomingasymptomatic A-,2#|!  -,, A Visitedacountryendemicformalaria --,,H"-, - 12months J-,;#H#  -,, J Inoculationwithattenuatedvirus,includingpolio(oral), |$ measles(rubeola),mumps,yellowfever 6-,,#h%-, 6 2weeks J-,;#|&  -,, J Majorsurgery/illness 6-,,#4 '-, 6 Iffullyrecoveredandnobloodwas 4 ( given,nodeferral J-,;# !)  -,, PJ Malarialarea(nodiseaseacquired) 6-,,#"< *-, 6 12months J-,;#"< + P -,, J Mononucleosis 6-,,#$!,-, 6 6monthsafterbecomingasymptomatic H-,,7#$!-  -,, H Pregnancy 6-,,,#|%$#.-,, 6 Durationofpregnancyand6weeks |%$#/ followingconclusionofthepregnancy 3)'h&$0 0   -,,, 3     `     h    \)'2     *xH-Iddd [ [01X$X$x,8"dd +  &DD &  OTHERDEFERRALS1'%P   1*e23dd8"dd 8"H-IX$X$e,7d , t +  6,,'ll p6Condition 6,-,#l,, 6LengthofDeferral J-,;#l p ,-, pJRabies vaccine ? 6--,#-, 6Nodeferral,unlesstheepisodefollowed  thebiteofarabidanimal,inwhichcase t theprospectivedonorisdeferredfor12 ` months. J-,;# L  p --, JRecentblooddonation      6--,# -, 6 8weeksforwholeblooddonation(there    mustbean8weekintervalbetween   blooddonations ) J-,;#   --, PJ Skincancer 6--,#h -, 6 1month J-,;#h  P --, PJ Toothextraction 6--,# -, 6 72hoursifnotonantibiotics J-,;#  P --, J Unexplainedweightlossof10lbsormore 6--,#P-, 6 Untilphysicianhasevaluatedthe P potentialdonorandapproved < participationasablooddonor C,,,2#(  --, C Vaccinations:inoculationwith_toxoids_Ԁandkilledvirus, D bacterialandrickettsialvaccines,includingdiphtheria, 0 pertussis,typhoid,paratyphoid,cholera,typhus,Rocky t Mountainspottedfever,polio(injection),plague  `  -,-,,L,,, - Nodeferralifprospectivedonoris D symptomfreeand_afebrile_ 3)'0   ,-,, 3HXPhysicalExamination  $ Toensurethatthedonationofbloodwillnotharmthepotentialdonorabriefphysicalisdone.Thepotential ! donormustweigh123lbs.Thepulse,temperatureandbloodpressurearetaken.Thepulsemustbebetween " 50100beatsperminuteandregular.Theoraltemperaturemustnotexceed99.5F.Thediastolicblood |# pressuremustnotexceed100mmofmercuryandthesystolicmustnotexceed180mmofmercury.A h$ capillarypunctureisperformedonthedonorforhemoglobinorhematocritdetermination.Manydonor T% centersuseacoppersulfatesolutiontoscreenforhemoglobin.Adropofbloodisaddedtothecoppersulfate  @& solution,ifthehemoglobinis12.5g/_dL_Ԁormorethedropofbloodwillsinkwithin15seconds.Ifthe !,' hemoglobinlevelislessthan12.5g/_dL_Ԁthedropwillremainsuspendedorfloattothetop.Ifahematocritis p" ( doneitmustbeatleast38%ormore. Warning: doNOTperformcapillarypunctureonthedonor'sfinger \#!) whiletheglassthermometerisintheirmouth! L$!* G XGX{e  *h(1   ^k_kProcedure:0  DonorInterview#GX{eX G7|# X$$  Materials :0  X$$ 1.0  DonorInterviewSheet4$$ 2.0  Pen $$ 0  0$$ $$  Instructions :   ! ! Q(#33Q"R3"  R3~2#  1  .3  0    Onthedonorformonthenextpagefillinthedonor'spersonalhistory,includingname,addressand  h  DOB.R3~~݌ T $$ Ќ  "R3"  R32#  2  .3  0    Determinethedonor'smedicalhistorybyposingthequestionslistedonthedonorrecordcardtothe ,  donor.R3+݌p $$ Ќ  "R3"  R3G2#  3  .3  0    EachdonorMUSTansweratleast3itemsonthequestionnaireinappropriately.Forexample,ifthe H questionrequiresa yesanswer no.R3Gt݌4$$ Ќ  "R3"  R32#  4  .3  0    Foreachinappropriateanswergivenbythedonortheinterviewermustinvestigatefurthertodetermine   thedonor'seligibility.Thedonor'seligibilityisbasedonthecriteriapresentedinthediscussion  sectionofthislab.Iftheinterviewerisunsureaboutadonor'seligibility,theinterviewershould  consultthebloodbanksupervisorand/ormedicaldirector.Resultsoftheadditionalinvestigation x mustappearasanoteonthedonorinterviewsheet.Forexample,ifthedonorisasked,"Haveyou d evergottenatattoo?"andthedonorrespondspositively,thedatethetattoowasobtainedmustbe P determinedtoevaluatethedonor'seligibility.R3݌<$$ Ќ  "R3"  R32#  5  .3  0    Theinterviewermustlisteachinappropriateresponse(maximumofthree)andstatethe l deferraltimeofeach. R3݌\$$ Ќ  "R3"  R3ۇ2#  6  .3  0    Thedateofthedonor'slastdonationmustberecorded.R3ۇ݌4$$ Ќ  "R3"  R3܈2#  7  .3  0    Thedateoftheinterview,theinterviewer'sinitials,andthedonor'ssignaturemustalsobecompleted    onthedonorinterviewsheet.R3܈ ݌ !$$ Ќ  "R3"  R3?2#  8  .3  0    Aftertheinterviewperformthebriefphysical.R3?l݌"x #$$ Ќ   -+/ ЇInterviewerName____________________________________________________ X DonorName_______________________________________________________ 0 Address____________________________________________________________  DateofBirth_____________________SocialSecurityNumber________________  Whendidyoueatlast?___________________________  ` Doyouweigh123lbsormore?YESNO  8  *B-Cdd7d 7 t 23H$H$,dd ,dd ,dd +  +)h  h   +  MEDICALHISTORYQUESTIONNAIRE A),! t  ) AGA8 XGX{eYes A),! t ) ANo 6,& t   ) 6#GX{eX GA8ώ#Areyou: \    d    L  _0  E9  E9D1  .0\l l   Feelingwellandhealthtoday?E9 Dی  t\l \l    t   t 0  E9  E9D2  .0\l l   Currentlytakinganantibiotic?E97Dی  L\l \l    L   L 0  E9  E94D3  .0\l l   Currentlytakinganyothermedicationforaninfection?E94ODی  t\l \l    t  $) t $PleasereadtheMedicationDeferralList    'L) '0  E9  E9ړD4  .0\l l   HaveyouevertakenanymedicationsontheMedicationDeferralList?E9ړDی  t\l \l    t  $) t $Inthepast 48hours 'L) '0  E9  E9gD5  .0\l l   Haveyoutakenaspirinoranythingthathasaspirininit?E9gDی  x\l \l    x   $) x! $Inthepast 4weeks    d 'P") 'E9  0  E9D6  .0\l l   Haveyouhadanyvaccinationsoranyotherkindofshot?   t E9(Dی  |#\l \l    |$  $) |% $Inthepast 6weeks @* 'T&) 'E9  0  E9D7  .0\l l   Femaledonors:Haveyoubeenpregnantorareyoupregnantnow?E9ӘDی'\l \l  Ќ  0   \ (Males:checkNo)  l(l l    )  $) * $Inthepast 8weeks 'D"+) 'E9  0  E9zD8  .0\l l   Haveyoudonatedblood,plateletsorplasma?E9zDی  #p!,\l \l    #p!-  $) #p!. $Inthepast 16weeks    d   'H%"/) '0  E9  E9+D9  .0\l l   Haveyoudonatedadoubleunitofredcellsusinganapheresisdevice?E9+FD ی  &t$0\l \l    &t$1  $) &t$2 $Inthepast 12months haveyou 'L(%3) 'E9  0  E9D10  .0\l l   Hadabloodtransfusion?    E9ߝD ی  )x'4\l \l    )x'5   )x'6 E9  0  E9D11  .0\l l   Hadatransplantsuchasorgan,tissue,orbonemarrow?E9 D ی  P+(7\l \l    P+(8   P+(9 0  E9  E9D12  .0\l l   Hadagraftsuchasboneorskin?E9:D ی  ,x*:\l \l    ,x*;   ,x*< _E9  0  E9HD13  .0\l l   Comeintocontactwithsomeoneelsesblood?E9HoD ی  <d\l \l    <d   <d E9  0  E9{D14  .0\l l   Hadanaccidentalneedlestickinjury?E9{Dی  \l \l        ! ! <(5h83Q"R3"  0  R3<25h  15  .3  0\l l   HadsexualcontactwithanyonewhohasHIV/AIDSorhashadapositive <d testfortheHIV/AIDSvirus?R3<u݌  (P\l \l    <d    <d  "R3"  0  R325h  16  .3  0\l l   Hadsexualcontactwithaprostituteoranyoneelsewhotakesmoneyor    drugsorotherpaymentforsex?R3݌    \l \l           "R3"  0  R3<25h  17  .3  0\l l   Hadsexualcontactwithanyonewhohaseverusedneedlestotakedrugsor  < steroids,oranythingNOTprescribedbytheirdoctor?R3<u݌   ( \l \l     <    < ! ! S(Eh88<0  18.0\l l Hadsexualcontactwithanyonewhohashemophiliaorhasusedclotting   factorconcentrates? l \l \l          0  190\l l Femaledonors:hadsexualcontactwithamalehohaseverhadsexual   contactwithanothermale?(Males:checkNo) \l \l          0  20.0\l l Comeintocontactwithsaliva(includingkissing)fromapersonwhohas X hepatitis? Dl\l \l    X   X 0  21.0\l l Comeintocontactwithbloodfromapersonwhohashepatitis? \l \l        ! 0  22.0\l l Hadsexualcontactwithapersonwhohashepatitis? Dl"\l \l    Dl#   Dl$ 0  23.0\l l Hadatattooapplied? %\l \l    &   ' 0  24.0\l l Hadearorbodypiercing? Dl(\l \l    Dl)   Dl*  T(Uh88S0  25.0\l l Hadacupuncture? +\l \l    ,   - 0  26.0\l l Hadorbeentreatedforsyphilisorgonorrhea? Dl.\l \l    Dl/   Dl0 0  27.0\l l Beeninjuveniledetention,lockup,jail,orprisonformorethan72hours? 1\l \l    2  $) 3 $ U(eh88TInthepast 3years haveyou 'D l4) '0  28.0\l l BeenoutsidetheUSorCanada? !5\l \l    !6  $) !7 $From 1980through1996 ,  d   'H#p8) '0  29.0\l l Didyouspendtimethataddsuptothree(3)yearsormoreinEurope? $ 9 (ReviewlistofcountriesinEurope) %!:\l \l    $ ;   $ <  V(uh88U0  30.0\l l WereyouamemberoftheUSmilitary,acivilianmilitaryemployee,ora 8'`#= dependentoftheUSmilitary? $(L$>\l \l    8'`#?  $) 8'`#@ $From 1980tothepresent ,didyou ')%A) ' W(h88V0  31.0\l l Spendtimethataddsuptofive(5)yearsormoreinEurope? (+P'B\l \l    (+P'C   (+P'D 0  32.0\l l ReceiveabloodtransfusionintheUnitedKingdom? ,(E\l \l    ,(F _ $) ,(G $From 1977topresent ,haveyou d     '<d) ' 0  33.0\l l Receivedmoney,drugs,orotherpaymentforsex? \l \l        0  34.0\l l Maledonors:hadsexualcontactwithanothermale,evenonce?@h\l \l  0  0\l l (Females:checkNo) ,T\l \l    @h  $) @h $Haveyou EVER '  ) '  35.0 \ HadapositivetestfortheHIV/AIDSvirus? 0 X \l \l    0 X    0 X  0  36.0\l l Usedneedlestotakedrugs,steroids,oranythingNOTprescribedbyyour    doctor?  \l \l          0  37.0\l l Receivedclottingfactorconcentrates? D \l \l    D    D    38.0 \ Hadhepatitis?  \l \l          0  39.0\l l Hadmalaria? D\l \l    D   D 0  40.0\l l HadChagas'disease? \l \l        0  41.0\l l Had_babesiosis_? D\l \l    D   D 0  42.0\l l Receivedaduramater(orbraincovering)graft?     \l \l    !   " 0  43.0\l l hadanytypeofcancer,includingleukemia? D#\l \l    D$   D% 0  44.0\l l Hadanyproblemswithyourheartorlungs? &\l \l    '   ( 0  45.0\l l Hadableedingconditionorablooddisease? D)\l \l    D*   D+ 0  46.0\l l HadsexualcontactwithanyonewhowasborninorlivedinAfrica? ,\l \l    -   . 0  47.0\l l BeeninAfrica? D/\l \l    D0   D1 0  48.0\l l Haveanyofyourrelativeshad_Creutzfeldt_ԄJacobdisease? 2\l \l    3  4 =  Pleaseindicateinthespacebelowthenumbersofquestionsansweredinappropriately AND whattypeof !5 deferral,ifany,thiswouldcause. THISISNOTOPTIONAL! Listthequestionnumberfollowedbythe "6 deferraltime.  #7  ! ! W(h88W"R3"  R32h  1  .3  0    R3݌\%!9$$ Ќ  "R3"  R32h  2  .3  0    R3݌ (H$<$$ Ќ  __"R3"  R3x2h  3  .3  0    R3x݌ * '?$$ Ќ      G XGX{eMEDICATIONDEFERRALLIST#GX{eX GX# X L GXGX{ePleasetellusifyouhaveEVERtakenoneormoreofthesemedications:#GX{eXG#  V ! ! R(Ry8W"R3"  R32R3  0    _PROSCAR_Ԁ (_FINASTERIDE_)forprostateglandenlargementR3O݌@$$ Ќ  "R3"  R3R2R3  0    _PROPECIA_Ԁ (_FINASTERIDE_) forbaldnessR3R݌$$ Ќ  "R3"  R3z2R3  0    _ACCUTANE_Ԁ (_ISOTRETINOIN_) forsevereacneR3z݌ $$ Ќ  "R3"  R32R3  0    _SORIATANE_Ԁ (_ACITRETIN_) ! forseverepsoriasisR3݌ | $$ Ќ  "R3"  R32R3  0    _TEGISON_Ԁ (_ETRETINATE_) ! alsoforseverepsoriasisR3݌ X $$ Ќ  "R3"  R32R3  0    GROWTHHORMONEFROMHUMANPITUITARYGLANDS wasprescribeduntil1985for 4  childrenwithdelayedgrowthR3;݌|$$$ Ќ  "R3"  R3E2R3  0    INSULINFROMCOWS(BOVINE,ORBEEF,INSULIN) usedtotreatdiabetesR3Er݌T$$ Ќ  "R3"  R3G2R3  0    HEPATITISBIMMUNEGLOBULIN! givenAFTERanexposuretohepatitisB.R3Gt݌0$$ Ќ  0  NOTE: ThisisDIFFERENTfromthehepatitisBvaccinewhichisusedtopreventfuture $$ 0  infectionwithhepatitisB.$$  A-') xdEEHH!A  IFYOUWOULDLIKETOKNOWWHYWENEEDTODEFERYOUFORTAKINGTHESE  MEDICINES,PLEASEKEEPREADING: w   R(eyyyR"R3"  0  R32ey3  0$$  Ifyouhavetakenoraretaking _Proscar_,_Propecia_,_Accutane_,_Soriatane_,or_Tegison_, your O donatedbloodcouldcontainsignificantlevelsofthesemedicinesandpossiblycausebirth ? defectsinfetuses.Oncethemedicationhasbeenclearedfromyourblood,youmaydonate + again.Deferralperiodisonemonthfor_Proscar_,_Propecia_Ԁand_Accutane_,andthreeyearsfor o _Soriatane_._Tegison_Ԁisapermanentdeferral.R3݌[ $$ Ќ  "R3"  0  R3y2ey3  0$$  Growthhormonefromhumanpituitaryglands wasprescribeduntil1985forchildrenwith 3!" delayedgrowth.Thehormonewasobtainedfromhumanpituitaryglands,whicharefoundin #"# thebrain.Later,afewpeoplewhotookthishormonedevelopedararenervoussystem # $ conditioncalled_Creutzfeldt_ԄJakobDisease(_CJD_,forshort)._CJD_Ԁhasnotbeenassociatedwith #!% growthhormonepreparationsavailablesince1985.R3y݌$"&$$ Ќ  "R3"  0  R32ey3  0$$  Insulinfromcows(Bovine,orbeef,insulin) isaninjectedmaterialusedtotreatdiabetes. &g$( IfthisinsulinwasimportedintotheUSfromcountriesinwhich MadCowDiseasehasbeen 'W%) found,thereisararechanceitcouldcontainmaterialfrominfectedcattle.(Bovineinsulinhas (C&* notbeenknowntotransmit MadCowDisease.)R3݌)/'+$$ Ќ  "R3"  0  R32ey3  0$$  HepatitisBImmuneGlobulin(_HBIG_) isaninjectedmaterialusedtopreventinfection _+)- AFTERanexposuretohepatitisB._HBIG_ԀdoesnotpreventhepatitisBinfectionineverycase, O,). sopersonswhohavereceived_HBIG_Ԁaredeferredfromdonatingbloodfor12months. R3)݌;-*/$$  X _k  X8::XXd9XXd8 _X8::XXd:XXd8 _  ь      INFORMEDCONSENT X   I,theundersigned,havereviewedandunderstandthedonoreligibilityinformationandtheblooddonation 0 process.IagreeNOTtodonatebloodorplasmafortransfusiontoanotherpersonorforfurthermanufacture  ifIhaveAIDS,apositiveHIVantibodytest,orifanyoftheactivitiesorsignsandsymptomsassociatedwith  AIDSapplytome.Iunderstandthatmybloodwillbetestedforlaboratoryevidenceofinfectiousagents  capableoftransmissionthroughbloodtransfusionincluding,butnotlimitedto,theAIDSvirus,hepatitisB,  andotherviruses.IunderstandthatIwillbenotifiedoftestresultsthatareimportanttomyhealthandmay t affectmyeligibilitytobeablooddonor.IfmyHIV,hepatitis,orothertestresultsareconfirmedpositivemy  ` bloodwillnotbetransfusedandmynamewillbecomepartofalistofpermanentlydeferredblooddonors.  L  Iunderstandthattestresultsandmedicalhistoryinformationwillnotbereleasedwithoutmywrittenconsent,  8  exceptasrequiredbystatelaw.Ihavetruthfullyansweredallmedicalquestions.Iamvoluntarilydonating | $  mybloodtobeusedasdeterminedbyAustinCommunityCollege,andI,atmyownrisk,forgood h   consideration,herebyreleaseAustinCommunityCollege,anditsstafffromallclaimsanddemandsincidental T  toorrelativetothedonationofthisblood.  @   DonorSignature___________________________________0 ` Date____________________`$`$ DonorPrintedName________________________________  InterviewerSignature_______________________________ 0 ` Date____________________H`$`$ InterviewerPrintedName___________________________ x   Isthisindividualeligibletodonatebloodbasedontheinformationgiven?YESNO  <  G XGX{e  +|)- ^k  ^8::XXd:XXd8 ^    Procedure:Physical#GX{eX G#  X  Materials:  D 1.0  Capillarypuncturesupplies0$$ 2.0  Twomicrohematocrittubes$$ 3.0  CoppersulfatesolutionORMicrohematocritcentrifuge$$  Procedure:    1.0  Askthedonoriftheirweightexceeds110lbsandnoteitontheform. ` $$ 2.0  Takethedonor'spulse,temperatureandbloodpressureandrecordbelow. 8 $$ 3.0  Properlyperformthecapillarypunctureprocedureandcollect2microhematocrittubes(referto h  LaboratoryExercise4). Overfill oneofthecapillarytubes.T $$ 4.0  Usingtheoverfilledmicrohematocrittube,allow1dropofbloodtofallintothecoppersulfate 0 solution.$$ 5.0  Observefor15seconds,recordresults.$$ 6.0  Withtheremainingcapillaryblood,performaspunmicrohematocrit(refertoLaboratoryExercise t 4).`$$ 7.0  Recordtheresultsofthemicrohematocrit,usingproperunits.8$$ Recordyourresultsinthefollowingspaces.POINTSWILLBEDEDUCTEDFORNOTUSINGCORRECT T UNITS. @  Pulse ________________________________   Temperature __________________________  !  BloodPressure _______________________ "x #  CopperSulfate (circleone):ACCEPTABLEUNACCEPTABLE %@#&  Hematocrit: ___________________________ t'%(  Basedonthephysicalexamcircleoneofthefollowing:0  ACCEPTEDREJECTED 󀀀0!$$P)&*!$!$  -+/  GXGX{e  EXERCISE_11:_0 P BLOODDONORINTERVIEWANDPHYSICALEXAM#GX{eXG# XP $P $      P Name_____________________________Date_________________ h Points:18 @ Thefollowingquestionsareworth0.5pointeachunlessotherwiseindicated.  ! ! Q(#3yR"R3"  R32#  1  .3  0    Howoftenmayanindividualdonateaunitofblood(1point)?R3݌ $$ Ќ  "R3"  R32#  2  .3  0    Statetheacceptablevaluesforeachofthefollowingusingthecorrectunits(1pointeach):R3!݌ \ $$ Ќ  0  weight:4 $$ 0  temperature:d $$ 0  pulse:<$$ 0  bloodpressure:$$ 0  Hematocrit:$$ Foreachofthefollowingsituationsstatetheappropriatedeferraltime(ifany).Refertothechartsinyour X laboratoryexercise. D "R3"  R32#  3  .3  0    Recentlyhadmajorsurgeryandreceived2unitsofblood.R3݌t$$ Ќ  "R3"  R32#  4  .3  0    Hadleukemiabuthasbeeninremissionfor10years.R3 ݌8$$ Ќ  "R3"  R32#  5  .3  0    Hadhepatitisatage9.R3 ݌ !$$ Ќ  "R3"  R32#  6  .3  0    Releasefromprisonafter3years.R3݌#h!$$$ Ќ  "R3"  R32#  7  .3  0    Traveledtoamalarialendemiccountryandtookantimalarialdrugswithinthepast6months.R3݌&,$'$$ Ќ  "R3"  R32#  8  .3  0    Recentlyreceivedatattoo.R3݌H)&*$$ Ќ  "R3"  R32#  9  .3  0    Hasrecentlygottenaringinsertedintohis/herbellybutton.R3݌ ,)-$$ Ќ   -+/ _"R3 "  R32#  10  .3  0    AdmitstohavingusedIVdrugsoncebackin1974.R3݌X$$ Ќ  "R3 "  R32#  11  .3  0    Recentlyhadababy.R3݌$$ Ќ  "R3 "  R32#  12  .3  0    Receivedmoneyforsexbackin1981.R3݌$$ Ќ  "R3 "  R32#  13  .3  0    Wasrecentlydiagnosedwithsyphilis(THINKINGQUESTION:Discussthereasonforyouranswer).R3݌ L $$ Ќ  "R3 "  R32#  14  .3  0    Receivedtherabiesvaccineafterbeingbitbyastraydog.R3 ݌@ $$ Ќ  "R3"  R32#  15  .3  0    Marriedtoahemophiliac.R3݌$$ Ќ  Listthedeferraltimesforthefollowingimmunizations: \ "R3"  R32#  16  .3  0    Measles(rubeola)R3F݌4$$ Ќ  "R3"  R32#  17  .3  0    HepatitisImmuneSerumGlobulin(HBIG)R3"݌d $$ Ќ  "R3"  R32#  18  .3  0    HepatitisBvaccineR3݌<$$ Ќ  "R3"  R32#  19  .3  0    Germanmeasles(rubella)R3݌$$ Ќ  "R3"  R32#  20  .3  0    MumpsR3݌$$ Ќ       P  "R3"  R3 2#  21  .3  0    OralpolioR3  ݌ l!$$ Ќ  "R3"  R3| 2#  22  .3  0    YellowfeverR3|  ݌"D #$$ Ќ  "R3"  R3U 2#  23  .3  0    Themedicalhistoryisobtainedbyaskingtheindividualspecificquestions.Thesequestionsser% > vetwo L&#' purposes,whatarethey(2points).