Practical Examination/Procedures Flashcards
DRE - up to (not including) insertion
Intro, wash/gel hands, patient ID
Explain; procedure (be formal) and presence of chaperone. Gain VERBAL consent for both.
Ask patient to remove trousers and underwear, lie on left on bed, bottom close to edge and knees drawn up to chest.
Put on gloves and organise disposable cloth with lubricant.
Separate buttocks to examine perianal area;
- shape
- normal anal tone
- ask patient to strain down
DRE - from finger insertion
Lubricate examining finger, place left hand on patient flank and advise them to relax. Insert finger and ask patient to clench to assess anal tone.
Insert finger back and rotate right through 90 and left through 90 assessing the rectal walls posterior and posterolateral walls.
Rotate via shoulder to asses anterior and anterolateral walls and prostate commenting on; size, soft/hard, surface smooth/nodular. With finger maximally inserted ask patient to clench; this may bring down higher up abnormalities to the level of your finger.
Withdraw finger and comment on mucus, stool (colour?), blood, pus.
Thank patient, advise examination finished, offer them a tissue to clean themselves and let them get redressed.
Intramuscular and intradermal injection procedure - drawing up fluid
ID patient, introduce self, explain injection (reasons, procedure, complications), obtain consent
Check correct prescription and gather equipment
Gel/wash hands, put on gloves and disinfect top of vial
Attach needle to syringe and draw up amount of air equivalent to dose required
Withdraw cap from needle, insert into vial and inject air
Invert vial and withdraw medication
Change needle, ensure all air removed from syringe, remove gloves and clean up area.
Intramuscular injection procedure - injection
Take equipment to patient, check ID, obtain consent. Wash/gel hands and put on gloves.
Disinfect skin for at least 30secs and let dry for 30secs.
Stretch skin and insert needle like a dart (quick and smooth) up to needle hub
Aspirate; if no blood aspirated proceed to give injection
Wait 10 secs then remove needle. Dispose of needle and syringe in sharps container.
Clean up, remove gloves, wash/gel hands.
Subcutaneous injection procedure - drawing up fluid
ID patient, introduce self, explain injection (reasons, procedure, complications), obtain consent
Check correct prescription and gather equipment
Gel/wash hands, put on gloves and disinfect top of vial
Attach needle to syringe and draw up amount of air equivalent to dose required
Withdraw cap from needle, insert into vial and inject air
Invert vial and withdraw medication
Ensure all air removed from syringe, scoop up cap, remove gloves.
Subcutaneous injection procedure - injection
Take equipment to patient, obtain consent, gel/wash hands, apply gloves.
Disinfect site (30secs then 30secs dry time)
Pinch skin, insert needle at 45-90, then stabilise needle (stab and grab)
Inject medication, wait 10secs then remove needle
Clean up, remove gloves, wash/gel hands.
Discard equipment
Intradermal injection procedure - injection
Disinfect site (30secs, 30secs dry time)
Position needle bevel upwards at 10-15 to skin, insert needle until bevel not visible
Inject; should form a wheal
Withdraw needle, dispose in sharps bin
Clean up, remove gloves, hand hygiene.
Describe blood glucose measuring
Identify, explain and consent
Prepare patient (make sure they’ve washed their hands
Obtain equipment and check expiry dates
Make sure calibration not required (if required then check that lot number matches machine and strip)
Prepare lancet, hand hygiene, gloves, insert strip
Activate lancet to puncture skin side finger
Express blood onto strip, dispose lancet (SHARPS)
Read result, remove gloves, hand hygiene, document
What are some IM injection sites?
5ml max in vastus lateralis, rectus femoris
4ml max in large muscles
2.5ml max in ventrogluteal
1ml max in deltoid
Describe reconstitution of medication
Inspect equipment and check expiration dates
Hand hygiene, apply gloves
Remove vial cover, cleanse top of vial
Place needle onto syringe
If using a vial; draw amount of air into syringe, insert into vial, inject, invert and withdraw
If IV fluid bag; remove needle cap, insert needle into injection port and withdraw
Check no air bubbles
Inject fluid into vial containing medication to be reconstituted
Invert several times to mix
Remove gloves, hand hygiene
Label syringe
Describe dilution of a medication
Inspect equipment and expiration dates
Hand hygiene, gloves
Cleanse vial and needle port of IV bag
Needle onto syringe, draw medication from vial (draw up air first without removing needle cap, then inject and invert)
Check no air bubbles
Inject into IV bag via needle port using antt
Dispose needle, invert bag
Remove gloves, hand hygiene
Fill out drugs added to this infusion label
