Module 9 - Patient Care Flashcards
Good interviewing techniques
Use Active listening, open-ended questions
Restatement, reflection, and clarification
Be aware of nonverbal communication - posture, gesture, eye contact
Parts of the intake process/rooming
Obtaining chief complaint: subjective information from pt
Performing a drug reconciliation: update med list
Documenting allergy status
Completing personal and family history: objective information, collected once and routinely reviewed
Preventive services/screenings: Often performed during routine exams, includes visual acuity testing, measurements, mini-mental state examinations for dementia, etc
Normal temperature readings
Oral, Tympanic, Temporal: 98.6F
Axillary temperature: 97.6F
Rectal temperature: 99.6F
+- 1 degree
Proper palpation technique for heart rate, three main pulse sites
Use second and third fingers; push artery against a bone
Radial - thumb side of wrist, most common site
Brachial - inside the upper arm, most common for children
Carotid - in the neck just below the jaw bone, most common for emergency
Proper auscultation technique for heart rate
Listening to the heart beat at the apex of the heart, can be incorporated when taking blood pressure
Factors for evaluation of pulse
Rate, rhythm, strength
Ex: 70/min, regular, thready
(thready = faint, bounding = strong)
Normal adult heart rate
60 to 100/min; younger than 15 have faster heart rate
Factors for evaluation of respirations
rate, rhythm, depth
Normal adult respirations, newborn respirations
Adult 12 to 20, newborn 30 to 50
Abnormal sounds during respiration evaluation
Wheezing (high pitched, narrow airways), rales (small clicking or bubbling), rhonchi (sounds that resemble snoring)
Notify provider
Blood pressure manual measurement; what does systolic and diastolic pressure indicate
Systolic is when first tapping sound is heard, blood begins to surge into artery occluded by cuff.
Diastolic is when last sound disappears completely, blood is flowing freely.
Korotkoff sounds
Distinct sounds heard through the cardiac cycle;
Phase I: systolic pressure; blood begins to surge into artery
Phase II: swishing sound as more blood flows through artery
Phase III: sharp tapping as more blood flows
Phase IV: soft tapping which begins to muffle
Phase V: Diastolic pressure
Normal blood pressure readings, hypertension readings
Infants and children: 100-80 / 30-60
Adult: 100-140 / 60-90
Hypertension is 140/90 or higher; 120-139/80-89 is prehypertension
Pulse oximetry locations, possible interferences, normal result
Locations: Finger, toe, earlobe
Nail polish, anything that blocks light can interfere
Reading of 95% or higher considered normal
Interpreting pain
Observe the patient to gather cues: grimacing, holding body parts
Ask patients to rate pain on scale of 1 to 10. Can ask additional questions to determine location, onset, characteristics, whether methods for relief have been effective
Anthropometric measurements
Height, Weight, BMI, and head circumference (pediatrics)
Method for determining height
Patients should stand erect looking forward without shoes. Leveling bar needs to sit squarely on top of head
Method for determining weight; lb to kg conversion
Obtain in private area, be timely and efficient.
Make sure scale is balanced, review record to determine baseline weight.
Assist patient on and off scale, monitor stability as needed
1 lb = 2.2 kg
BMI calculation and interpretation
weight in kg / height in m^2
18.5 to 24.9 is considered normal
<18.5 is underweight
>24.9 is overweight
>30.0 is obesity
Methods for determining height, weight, head circumference in an infant/small child
Height: Lay the infant flat on a paper-covered table. Record from top of head to heel of flexed foot.
Weight: Weigh infants without clothing or diaper, use infant scale if possible
Head circumference: Using a tape measure, measure at widest area (right across eyebrows). Repeat to confirm results
Fowler’s position
Sitting with exam table raised. “sitting position”. Used for exams involving eyes, ears, nose, throat, chest.
Low-Fowlers = 15 to 30, Semi-Fowlers = 30 to 45, High-Fowlers = nearly vertical (90*)
Sims’ position
“lateral position” Lying on the left side with the left leg slightly flexed and the right leg flexed at a 90* angle. Can involve a pillow placed between the knees. Exams involving the rectum, enemas
Knee-chest position
Prone and bent at the waist resting on the knees with the arms above the head.
Gynecological or rectal exams, treatments of spinal adjustments
Jack-knife position
Lying over an exam table that is lifted in the middle.
Rectal exams or instrumentation
Lithotomy position
Lying flat on the table with buttocks at the end of table and feet resting in stirrups.
Female pelvic exams
Dorsal recumbent
Lying flat on back with knees bent.
Catheterizations
Genital examination of younger children
Prone
Lying flat on the abdomen with the arms above the head.
Exams involving the back of the body, including bottoms of feet.
Supine
Lying flat on the back with the arms down to the side.
Exams involving the front of the body, administration of CPR.
Trendelenburg/ modified trendelenburg
Legs elevated above the head to force circulation to vital organs
Shock (requires a specific table)
What is necessary before an injection?
Name of medication, dosage, time, route of administration.
Need consent for administration.
Tell the patient what the medication is, what it is given for, dosage, and route.
Check the medication three times: first to compare order to medication, second after medication is prepared, and third immediately prior to administering medication
Necessary equipment/supplies for an injection
Correct syringe and needle, alcohol swabs to wipe off vial/skin preparation, gauze pad to apply pressure after administration.
Adhesive bandage available if there is bleeding at the site.
Sharps container located nearby.
Biohazard container for disposal of other contaminated items.
Nonsterile gloves and appropriate PPE for invasive procedure.
Proper needle safety per OSHA
Easily accessible sharps container, self-sheathing or safety needles. Never recap a used needle.
How to keep equipment sterile before injection
Needles and syringes must be sterile. Check expiration date of solutions, evaluate container integrity.
Use alcohol swabs on vial stopper. Do not introduce the needle into the vial more than once - dulls the needle and increases likelihood of contamination.
Do not allow solutions to run down needle. Do not place exposed needle on tray or countertop. Only recap clean needle if absolutely necessary.
Needle gauge and length; requirements for intradermal, subcutaneous, and intramuscular injections
Gauge range from 14 (largest) to 31 (smallest)
Length ranges from 3/8 to 4 inches
Intradermal: 27-28 gauge, 3/8 in
Subcutaneous: 25-26 gauge, ~1/2 in
Intramuscular: 20-23 gauge, 1-3 in
Finding intramuscular injection sites and use case: Deltoid, Ventrogluteal, Vastus lateralis
Deltoid: 1-2 inches below acromion; used for many vaccines, > 3 yrs old, dose usually less than 1ml
Ventrogluteal: Palm over greater trochanter of femur, use opposite hand for hip (thumb facing anterior). Place middle finger on posterior iliac crest and spread index finger. Give injection where the V is made between the index and middle finger; site is used when deep IM injections are prescribed or when larger quantities of medicines are needed
Vastus lateralis: mid to upper outer thigh; used for vaccines and medication < 3yrs old
Technique/angle for intramuscular injections, proper site
90* angle, do not aspirate vaccines but do aspirate most other types of medications
Either Deltoid, Ventrogluteal, or Vastus lateralis depending on use case
