1
Q
How do you initiate any procedure with a patient?
A
- Gather equipment
- Introduce yourself
- Identify patient
- Explanation and rationale
- Informed consent
2
Q
What equipment do you need to take vital obs from a patient?
A
- Sphygmomanometer
- Stethoscope
- O₂ sats probe
- Thermometer and covers
- Watch with seconds hand
- Clinell wipes
- Pillow
- Alcohol hand wash
3
Q
How do you measure someone’s blood pressure?
A
- Reposition with arm at level of heart
- Check arm for any contraindications to taking blood pressure
- “This will just involve me tightening a cuff on your arm twice and deflating it each time. It won’t hurt but it might be a bit uncomfortable”
- Place cuff 2cm above antecubital fossa
- Inflate cuff and obtain an estimated systolic pressure whilst palpating the radial pulse
- Deflate cuff
- Correctly place stethoscope over brachial artery
- Re-inflate cuff 10-30 above the estimated systolic pressure, then whilst auscultating the brachial artery, deflate the cuff at 2mm/Hg/second to obtain systolic and diastolic pressure readings
4
Q
What pre-assessment questions are required before taking vital obs?
A
- Are you comfortable?
- In the last 30 mins, have you…
a) eaten a large meal or had a cold drink?
b) had a hot bath?
c) smoked a cigarette?
d) undertaken vigorous exercise? - Are you on any BP lowering medication?
- Do you use a hearing aid or have an ear infection?
- Do you have an arterio-venous fistula?
- Have you had any operations on your ams, axillae, or breasts?
- Do you have any pain, swelling, or weakness in your arms?
5
Q
What are the contraindications for blood pressure readings being taken on the arm?
A
- Bruising / swelling / broken skin
- Local infection
- IV lines and cannulas on that side
- Weakness due to stroke
- Arteriovenous shunt for renal dialysis
- Lymph node removal / radiotherapy on that side
- Recent surgery on the arm
6
Q
How do you measure tympanic temperature?
A
- Ask patient if they use a hearing aid or have an ear infection / pain
- “This will just involve a small thermometer in your ear for several seconds - it will not be uncomfortable”
- Place disposable cover on probe
- Insert at correct angle
- Activate and wait for the signal from the thermometer
- Record reading
- Dispose of the disposable cover
7
Q
How do you measure pulse rate?
A
- Locate radial artery
- Palpate radial artery for 1 minute (or 15 seconds and multiple by 4)
- Note the rhythm of the pulse - check if pulse is regular
- Record your findings on the obs chart
8
Q
How do you measure respiratory rate?
A
- Whilst appearing to be palpating the radial artery and measuring pulse rate, count the resp rate of the patient for one minute (or 15sx4)
- One respiration consists of the full cycle of inspiration and expiration
- Record findings
9
Q
How do you measure oxygen saturation?
A
- Make sure the finger is well perfused (i.e. no tight jewellery)
- “I need to measure the amount of oxygen in your blood by attaching this probe onto the end of your finger - this is a completely painless procedure”
- Select finger which doesn’t have a false nail / nail polish
- Attach saturation probe
- Switch on the machine
- Observe and record oxygen saturation
- Note if the patient was breathing room air, or was on oxygen - if oxygen as being delivered, record percentage of oxygen
10
Q
What equipment do you need for venepuncture?
A
- Blood request forms and notes
- Butterfly needle
- Barrel
- Blood sample tubes / culture bottles
- Sharps bin
- Clinell wipe x2
- Tourniquet
- Gauze
- Cotton wool and tape
11
Q
How do you prepare equipment / patient for venepuncture?
A
- “I’ve been asked to take a small blood sample from you today. All that will involve is one small needle to the inside of your elbow, and will feel like a sharp scratch.”
- “There are some potential complications; pain, bleeding, swelling, bruising, and infection, but I will try to minimise this as much as possible.”
- “In the last 30 minutes, have you smoked? Eaten a large meal? Had a hot or cold drink? Had a hot bath? Exercised vigorously?
- “Have you ever had an artery-venous fistula? An operation on your arm, armpit, or breasts? Do you currently have any pain, swelling, or weakness in your arm? Do you have any allergies?”
- Assess arm and check for local contraindications - RASHES OR BROKEN SKIN
- Put pillow under patient’s arm and apply tourniquet ~5cm above antecubital fossa
- Identify suitable site by inspection and palpation
- REMOVE TOURNIQUET
12
Q
What are the contraindications for venepuncture?
A
- Broken skin
- Arteriovenous fistula
- Local infection
- Hard / cord like veins on palpation
- Breast / axillary / arm surgery
- Breast / axillary lymph node removal or radiotherapy
13
Q
How do you use a butterfly device to obtain blood cultures / samples?
A
- Remove protective cap from blood culture bottle, disinfect rubber septum with wipe and allow to dry
- Apply tourniquet 5-10cm above intended site and identify vein
- Clean site as per local policy - DO NOT REPALPATE
- Open butterfly device and connect to vacutainer using aseptic technique
- “Sharp scratch”
- Remove safety sheath from butterfly needle, stretch skin below the site and insert the needle (bevel upwards) at an angle of 45º
- Advance needle until flashback of blood appears
- Secure butterfly to patient’s arm using tape across wings
- Attach vacutainer to blood culture bottle and allow required amount of blood to collect - AEROBIC BEFORE ANAEROBIC
- Attach blood sample tubes to vacutainer to collect blood - invert tubes to mix
- Release the tourniquet BEFORE REMOVING NEEDLE
- Remove needle in smooth movement, apply pressure with cotton wool, and dispose of needle in sharps bin
- Label samples correctly and complete relevant forms
- Aftercare of patient
14
Q
What order must you collect blood cultures and samples?
A
- Aerobic
- Anaerobic
- UandEs (yellow)
- FBC (purple)
15
Q
What equipment is required for establishing peripheral intravenous access?
A
- Cannula
- Sterile bung
- Clinell wipe
- Tourniquet
- Transparent dressing
- Syringe
- 0.9% sodium chloride injection for flush (CHECK EXPIRY DATE)
- Alcohol gel hand wash
16
Q
How do you establish peripheral intravenous access?
A
- “I’ve been asked to put a cannula into your hand today. All that will involve is one small needle to the back of your hand. This will then allow us to put a small plastic tube into your hand so we can give you drugs and fluid. It will be a sharp scratch when we put the needle in, but besides that there won’t be any pain. There are some complications, such as bleeding, bruising, infection, but I will do my best to minimise that for you.”
- Position patient’s arm, tourniquet, and identify suitable vein without any contraindications (NOT antecubital fossa or wrist)
- Remove tourniquet
- Apply tourniquet ~5-10cm above intended site, and recheck vein by palpating
- Clean the site - DO NOT REPALPATE
- Remove equipment from packaging using aseptic technique - fill syringe with saline
- “Sharp scratch”
- Stretch the skin BELOW the site and insert the needle at 15-25º angle
- Advance until flashback appears
- Lower the angle, slightly withdraw the needle from the cannula until a secondary flashback appears, and advance fully into vein
- Release the tourniquet
- Apply pressure on the vein proximal to the cannula, then remove the needle and discard into sharps bin
- Whilst maintaining proximal pressure, attach a bung to the end
- Secure the cannula with transparent dressing
- Flush cannula with 5ml of sodium chloride 0.9% to ensure patency
- Label cannula with time, date, and signature
17
Q
What equipment is required for an intravenous infusion?
A
- Fluid prescription chart
- 500ml bag of sodium chloride 0.9%
- Intravenous infusion set
- Drip stand
- Clinell wipe
- 0.9% sodium chloride ampule for flush
- Syringe
- Infusion rate calculation sheet
18
Q
How do you set up an infusion?
A
- Ask patient if they have any known drug allergies
- Check cannulation site for contraindications
- “I’ve been asked to set up a drip for you today to put some fluid through your cannula which will hopefully make you feel a bit better and stay hydrated. Firstly, I will flush the cannula with some saline to make sure it’s still working, I will then set the drop up which will stay attached to your hand. It will not hurt but you may feel some cold going up your arm. Stop me at any time f you are in pain or discomfort.”
- Establish what fluid is to be infused, the volume of fluid, the rate at which is will be given, and the time and date of the prescription
- Collect fluid and check it against the prescription chart - CHECK EXPIRY DATE
- Observe fluid for any discolouration or particulate matter
- Remove infusion bag for outer plastic covering and check of signs of leakage or puncture
- Open intravenous administration “giving set”, uncoil and check for any kinks
- Close the roller clamp on the giving set
- Remove seal from entry port of the infusion bag aseptically
- Carefully remove cover from spike
- Spike the infusion bag entry port aseptically
- Place infusion bag on drip stand and half fill the drip chamber with fluid (by squeezing it)
- Loosen the cap slightly on the end of the giving set
- Open the roller clamp and prime the line
- Replace cap on the end of the giving set to maintain asepsis until line is connected to the cannula
- Wipe the cannula with a clinell wipe and allow to dry, then flush the cannula with 5ml saline
- Connect giving set to cannula
- Find out number of drops that will constitute 1ml of fluid and calculate desired flow rate
- Commence infusion
- Record all relevant information on patient’s fluid prescription sheet
- Aftercare
19
Q
What is the calculation for flow rate for an infusion?
A
Volume (ml) / time (hrs) x drops per ml / 60 = drops per minute
20
Q
What do you need to make up drugs for parenteral administration?
A
- Drug chart
- Needle x1
- Syringes x3
- 0.9% sodium chloride x 3
- Drug
- Clinell wipe x2
21
Q
How do you make up drugs for parenteral administration?
A
- Ask patient for any known drug allergies
- “I’ve been asked to put some drugs through your cannula today to hopefully make you feel a bit better. Firstly, I will flush the cannula through with some saline to make sure it’s still working. I will then put the drugs through before flushing it through with some more saline to ensure it’s all gone through the cannula. It will not hurt but you may feel your arm getting colder. Please stop me at any time if you are in pain or discomfort.”
- Check drug chart for NAME, DOSE, and ROUTE of ADMINISTRATION of drug
- Collect drug and check it against drug chart - CHECK EXPIRY DATE
- Check name, dose, and expiry date of diluents (0.9% sodium chloride)
- Remove protective cap from vial and clean the injectable bung with clinell wipe
- Open and prepare equipment (attach needle to syringe)
- Draw up diluent with needle
- Inject diluent into vial
- Whilst keeping needle in the vial and attached to syringe, release plunger to allow air from vial to enter into the syringe - this will equalise pressure between syringe and vial
- Mix the powder and the diluent
- Inject air back into vial
- Invert the syringe, keeping the vial uppermost
- Release plunger, keeping bevel within solution
- Allow the syringe to fill - ensure all solution is drawn up into syringe
- Remove syringe from vial, and remove needle from syringe and discard
- Cap off the syringe with the drawn up solution
- Prepare 2 saline flush syringes, and leave syringes in vial for identification
- Wipe bung with clinell wipe and allow to dry
- Flush cannula with saline flush
- Inject drug via cannula slowly - observe patient whilst injecting drug
- Flush cannula again with saline
- Record all relevant information on drug chart
- “Let myself or one of my colleagues know if you have any reaction to the drug, like itching, wheezing.”
Phase 2a Medicine
flashcards
Decks in class (5)
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