How to explain a peak flow?
- Pull the counter (the red arrow) back as far as it will go to the top.
- Stand or sit upright
- Take the deepest breath you can.
- Make sure your mouth makes a tight seal around the mouthpiece.
- Blow as hard and fast as you possibly can into the meter.
- Write down your score
- Do this three times in a row, with a short rest in between.
- Use the highest of these scores to fill in your peak flow diary.
How to do a finger prick test?
- wash hands
- prepare lancing device
- insert strip into meter, in direction of arrow
- make sure code matches up
- lance the side of the finger
- gently squeeze to get drop of blood
- touch blood to edge of strip
- result is displayed, dispose of strip
What is blood sugar target for non-diabetic?
4-5.9mmol/L before meals
under 7.8mmol/L after meals
What is blood sugar target for T2DM?
4-7mmol/L before meals
under 8.5mmol/L after meals
What is blood sugar target for T1DM?
4-7mmol/L before meals
under 9mmol/L after meals
What is blood sugar target for T1DM in children?
4-8mmol/L before meals
under 10mmol/L after meals
How to perform urinalysis?
PPE: wash hands, gloves (+/-apron)
Introduce, explain, consent
Inspect Colour? Smell?
Appearance cloudy (turbid) or bloody
Dipstick
Check strip expiry date
Dip stick in and wipe off excess urine
Top tip: screw the lid back on
Hold strip horizontally
Time when to read each section
Dispose of strip and gloves in clinical waste, wash hands
How to explain findings of urinalysis?
Haematuria - infection, BPH, kidney problems, menstruation
Leukocytes - infection
Nitrites - infection
Protein - infection, diabetes, renal disease
Glucose - diabetes, sepsis
Ketones - uncontrolled diabetes, eating disorders
ACR - high over 3mmol/L, kidney disease
Bilirubin and urobilinogen - Liver disease, bile duct obstruction
What to remember for clinical skills?
Introduce, explain, consent
- Capacity to consent
- Explain the purpose of the examination
- Explain what will happen during the examination
- Give them an opportunity to ask any questions
PPE + hygiene
Communication (verbal and non-verbal)
Results
Document the findings and plan. Consider whether the results need further action/investigation
What do you need to collect when giving an IM injection?
Alcohol wipe, gauze, syringe, drawing up needle, injecting needle, medication
How to locate the IM injection site?
Find bone on top of shoulder
go an inch down into deltoid muscle
What is the procedure for an IM injection?
Introduce, explain, consent.
Contraindications? Check for allergies, bleeding disorders, anticoagulants.
PPE: wash hands, gloves.
Identify the correct site for IM injection
Stretch the skin at the site
Insert the needle quickly at a 90°angle
Aspirate to check no blood
Depress the plunger slowly
Gently remove the needle and release traction.
Apply light pressure with a gauze swab if bleeding occurs. Plaster if needed
What is palliative care?
Treatment, care and support for people with a life-limiting illness
What is end-of-life care?
Palliative care received in the last twelve months of life
Principles of communication in end of life care
- Communication is straightforward, appropriate and timely, and is delivered sensitively, taking account of the circumstances, needs and abilities of the person and their carers.
- Good, clear and straightforward information is provided to the person and their carers.
- Communication methods are regularly reviewed to ensure effective appropriate communication, based on the patients condition.
- Communication reflects an understanding of and respect for the persons cultural and spiritual needs
Strategies to help with palliative care consultations
S: Setting – privacy, environment.
P: Perception – where is the patient?
I: Invitation – how much information do they want?
K: Knowledge – the information they want.
E: Emotion – allow time for patient express emotions and respond empathetically.
S: Strategy or summary – where to from here, safety net the patient.
How do you diagnose HTN?
- measure BP in both arms
- if BP betweem 140/90 mmHg and 180/120 mmHg, offer ABPM
What is the goal BP for someone under 80?
- Clinic BP < 140/90 mmHg
- ABPM/HBPM < 135/85 mmHg
What is the goal BP for someone over 80?
- Clinic BP < 150/90 mmHg
- ABPM/HBPM < 145/85 mmHg
