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Flashcards in Introduction into Clinical Practical Skills Deck (28)
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What is the purpose of Aseptic Non-Touch Technique

- protect the key parts when you perform a procedure
- the key parts are the parts that will come in direct contact with the patient


What are the 4 stages of handwashing

1, preparation: Wetting hands under tepid water before applying liquid soap, antimicrobial preparation
2. washing - the hands must be rubbed together vigorously or a minimum of 20 seconds
3. rinsing - hands should be rinsed thoroughly
4. drying: drying with paper towels


Name the steps of the washing of the hands

- rubbing hands palm to palm
right palm over left dorm with fingers interlaced
- palm to palm with fingers interlaced
- backs of fingers to opposing palms with fingers interlocked
- rotational rubbing of left palm callused in right palm and vice versa
- rotational rubbing, backwards and forwards with clasped fingers of right hand in left palm and vice versa
- rotating the right palm over the left wrist joint and vice versa and repeat on each side


before engaging in Aseptic Non-Touch Technique what do you have to do

- bare below the elbow
- remove wrist and hand jewellery
- make sure that finger nails are short, clean and free of nail polish
- cover cuts and abrasions with waterproof dressings


What steps were involved in undertaking setting up an intravenous infusion ?

- wash your ands
- introduce to the patient and confirm there name, date of birth and if they have an allergies
- permission and pain
- expose the patient
- reposition the patient

- observe cannula site for any signs of inflammation or misplacement
- double check the prescription with another member of staff

five rights
- right patient
- right drug
- right dose
- right route
- right time

- Clean the dressing trolley with the alcohol right
- gather the equipment and check the expiratory dates as you go along

What you will need
- plastic tray
- correct bag of fluid
- correct administration set
- saline flush
- alcohol wipe
- sharps bin
- alcohol hand gel
- gloves and apron

remove the outer wrapper on the fluid bag and check it for transparency
- check its in date
- hang it on a drip stand
- twist of the cap attached to the fluid bag
- open he fluid administration set
- unravel the tube making sure to keep hold of both ends - key parts that must remain sterile
- clamp the tube by using the roller clamp do this by rolling the tube downwards
- remove the cap from the spike - key part and must remain sterile
- push the spike with a twisting motion into the cork
- squeeze the drip chamber several times until it fills halfway with fluid
- prime the tube with fluid by opening the roller clamp slowly
- allow the fluid to pass slowly through the roller clamp till it reaches the end
- air bubbles must not be infused
- remove the easily
- drain it into a sink or pot until the bubbles are clear
- stretch the tube tightly and flick it with a finger which encourages the bubbles to rise to the end of the tube
- now close the clamp
- remove the gloves and wash your hands
- put on a clean pair of gloves to connect the drip to the cannula
- bring the tray containing the alcohol wipe and saline flush closer to the patient
- clean the cap on the cannula with an alcohol wipe
- open the clamp
- make sure there are no air bubbles in the saline syringe
- flush the cannula to make sure it is clean
- then close the clamp
- remove the cap from the administration tube exposing the key part and connect it to the cannula
- open the clamp again to allow the fluids to infuse
- set the drip rate according to the transfusion and sign the drug chart
- and make a note of the procedure int he patients notes


How do to venepuncture

- Introduce yourself
- explain the procedure
- confirm the patients details
- wash hands - ANTT

- make sure the equipment you will use is clean and safe to use
- first clean the tray with detergent wipes and then allow it to dry
- then wipe with 70% of alcohol solution wipes and allow it to air dry again
- if it is not allowed to air dry it is not aseptic

The procedure
- with gloves on place the tourniquet
- look and feel for a vein
- once you have decided on a vein, clean the area with an alcohol wipe for 30 seconds and allow to dry for 30 seconds
- now get the needle ready, remove the white cap and attach the vacutainer device
- then pull the pink safety back and pull the green cap off
- needle is now exposed
- warn the patient that they can feel a shape scarthc
- with the bevel facing up hold the skin taut with the other hand - this helps anchor the vein as you place the needle in
- go into the vein at a 30 degree angle and you should fill give as you go into the vein
- get the blood bottles and start taking the blood
- once you are done taking blood do not take the needle out yet, take the toniquet off
- get the cotton wool ready and take the needle out and put it into a sharps bin
- apply pressure or tape with the gauze
- thank the patient
- wash your hands and get rid of your waste


What equipment do you need for a venepuncture

- plastic tray
- gloves
- sharp box
- pair of gloves
- cleaning produces for the tray - detergent wipes and 70% alcohol wipes
- apron
- face mask
- tourniquet
- gauze
- alcohol wipe
- vacutainer tube
- vacutainer needle
- collection bottle for blood


how do you place an IV cannula

- introduce yourself
- explain the procedure
- confirm the patients details
- wash hands

- make sure the equipment you will use is clean and safe to use
- first clean the tray with detergent wipes and then allow it to dry
- then wipe with 70% of alcohol solution wipes and allow it to air dry again
- if it is not allowed to air dry it is not aseptic

- put the tourniquet on
- palpate and feel a good vein
- clean the area
- allow to dry for 30 seconds
- get the cannula
- put the wings down
- pull the back to make sure it works
- go to the area but don't touch it
- pull the skin taut
- warn the patient about a sharp scratch
- advance the cannula in
- then you can see here a bit of flashback - means you have the vein
- undue the tourniquet
-advance the cannula in as you pull the needle out
- take the gauze and put it underneath
- here press at the top
- take the needle out fully
- and put it in the sharps bin
- take the extension set and fix it all up
- take the gauze away
- clean up around the area
- then you apply the cannula dressing - look around and flush it through to make sure everything still is okay
- take the syringe out
- place it over the cannula
- date inserted the cannula written down on the patient -document in the notes


equipment you will need to place an IV cannula

- Sharps box
- tray
- cleaning produces for the tray - detergent wipes and 70% alcohol wipes
- gloves
- gauze
- alcohol wipe
- face mask
- tourniquet
- gauze/cotton wool
- alcohol wipes
- cannula dressing
- saline flush
- extension set
- cannula


what do you use for ophthalmoscopy

an ophthalmoscope


What is an ophthalmoscope for

- its for looking at the inside back of the eyes the fundus
- the fovea, the optic disc, the macula, the posterior pole of the retina
- usually done with eye drops to open up the pupil and dilate the pupil


How much of the back of the eye does the ophthalmoscope let you see

- only capable of seeing a 1/3 of the back of the eye


What parts of the eye are at the back of the eye

- the fovea, the optic disc, the macula, the posterior pole of the retina


what equipment do you need for an ophthalmoscopy

an ophthalmoscope
- take the handle and the ophthalmoscope piece, push it in and twist
- once you done that you need to turn it on
- press the green button and rotate it round
the light will come on the further round it is rotated the more light is produced
- one the other side the dial can change the shape of the projection and any colours
- large disk that you want when your starting off
- can change the numbering the windows - should be on 0 - only useful for refocusing if you are not using glasses
- at the bottom unscrew to release the battery
- button which changes filters and shapes - red and green filter useful for looking at blood


How to do ophthalmoscopy

- "I would like to examine the back you your eye "
- warn then about dazzle
- asks them to focus on a fixed distance point and keep looking there
-warn that you will dim lights and will get close to their face

- hold the ophthalmoscope so that your right eye is examining there right eye
- should be at 15 degrees form the central line
- narrow angle
- ask the patient to look over the should r
- put the ophthalmoscope right next to your eye
- hand on their brow or shoulder and start to move in
- should be able to see the red reflex early on and follow that in
- then you should be able to see the retina
- change the focus of the dial to bring it into focus
- follow the blood vessels until you reach the optic disc
- the optic disc is the nasal side of the retina
- check all 4 quadrants
- once you have had a good view pull out


where does the optic nerve come from

the optic disc
- fovea is in the centra part fo the optic disc


what can look wrong in ophthalmoscopy

- dark patches - micro aneurysms
- larger patches - haemorrhages present on the retina
- copper and silver wires
- papilloma - swelling of the optic disc - raised intracrhail pressure


what is Otoscopy

- looks inside the ear


Why do we do otosopy

- so we can see the external auditory canal that looks into the tympanic membrane or eardrum
- can see problems with the ear drum, canal and middle ear


what is bad to otoscopy

- can cause harm to the patient especially if you scratch the external auditory canal or move the head
- whenever the patient moves the device moves as well


What is the equipment for an otoscopy

- handle piece - has the battery section in it
- the handle piece attaches to the otoscope attachment
- slot it in and twist
- turn it on - use the green button and move it round the shoulder
- want to chose a speculum - want the biggest speculum possible to fit through - want to use a clean one
- to fit them on you just push and twist
- use a fresh one for each time you do it - otherwise infection can transfer


how to do an otoscopy

- I like to examine your ear now to have a look at the inside of it is that okay
The examination
- look at the outer ear, extenral acoustic meats and the canal
- ask them if they have any pain
- look around the outside part of the ear
- redness, swelling, abnormalities, discharge, scar, pre-aricular nodes and generally from discharge
- then test the mastoid process
- don't hold it like a hammer and hold it like a pen
- sitting down and with the little finger you push and brace against the patients face so it moves together as a unit and avoids damaging the ear canal
- because the ear canal is curved you need to straighten it by pushing backwards and upwards on the pinea
- sensitive part of the canal especially the inner part
- look at each quadrant of the ear drum


equipment you will need for IM and SC injections

- tray
- cleaning produces for the tray - detergent wipes and 70% alcohol wipes
- face masks
- apron
- sharps bin
- gloves
- needles - to draw up and delivery the medication
- gauze or cotton wool
- patient prescription chart
- syringes
- the drug to be administered


how to do an IM and SC injection

- Wash your hands
- prepare your tray
- - make sure the equipment you will use is clean and safe to use
- first clean the tray with detergent wipes and then allow it to dry
- then wipe with 70% of alcohol solution wipes and allow it to air dry again
- if it is not allowed to air dry it is not aseptic

- put the equipment into the tray
- attach the drawing up needle to the syringe
- check the details on the medication - name and expiratory date
- draw the drug up using the syringe and drawing up needle
- after the drug is drawn up remove the drawing up needle and put in the sharps bin
- attach the administration needle in - IM injections this can be a green needle which is 21 gauge or a blue needle which is 23 gauge
- prior to the iM and SC injection the site does not ned to be routinely cleaned unless the skin is completely soiled, but many hospitals still clean it with an alcohol wipe
- should adhere to local hospital guidelines
- with your non dominant hand stables the skin and with the dominant hand take the needle and insert it 90 degrees into the skin
- draw back the plunger to ensure that you have not enter a vein and then press the plunger down to deliver the blood
- wait a few seconds before withdrawing the needle espicaly if it is a large volume
- dispose of the sharp and apply pressure over the injection site with the cotton wool
- then check the site for bleeding
- check the patient is okay after the administration of the medication
- document - batch number and expiry date of the drug in the patients notes/drug chart


where would you inject an IM injection

- mid - anterior and mid-lateral areas of the quadriceps
- mid - deltoid
- upper outer quadrants of the gluteal muscles


where would you inject an subcutaneous injection

- upper outer arm
- lower abdomen
- upper outer thigh


Why do they not recommend using alcohol wipes before an SC injection

- hardened skin at the injection site


what is difference when using an SC injection

- blue needle is used
- bunch the skin between the thumb and forefinger to life adipose tissue from the underlying muscle
- with the dominant hand inner the needle into the skin at 45 degrees
- do not draw back
- press plunger down to deliver the drug