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Clinical Skills Flashcards

1
Q

What are the indications for taking an ABG?

A
  • check for severe / chronic breathing problems
  • evaluate treatment
  • measure acid/base balance
  • measure oxygen and carbon dioxide levels when mechanically ventilating
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2
Q

Where to take an ABG from.

A

Radial artery

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3
Q

What are the absolute contraindications to ABG?

A
  • peripheral vascular disease of the limb
  • cellulitis surrounding the site
  • arteriovenous fistula
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4
Q

What are the relative contraindications to ABG?

A

Impaired coagulation:
- anticoagulation therapy
- liver disease
- low platelets <50

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5
Q

What are the risks of ABG, and how would you reduce them?

A
  1. Infection: observe ANTT, clean patient’s skin, use PPE.
  2. Adverse reaction: check allergy status, monitor patient.
  3. Pain: painful procedure but over quickly.
  4. Missing the artery: if you miss, you can have another attempt with the patient’s permission (maximum of 2 attempts).
  5. Bleeding and bruising - apply pressure post procedure for 5 minutes, followed by a dressing.
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6
Q

How to gain informed consent.

A
  • ensure risks and benefits are explained in jargon-free language that the patient can understand
  • check patient understanding by asking them to repeat the information back to you
  • ensure the patient is happy to proceed
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7
Q

What immediate action should be taken if you acquire a needle-stick injury?

A
  • wash exposed area with soap and warm water
  • encourage free bleeding of wound
  • cover wounds with waterproof dressing
  • complete online datix form and inform your senior
  • seek advice from occupational health and present at A&E if required
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8
Q

Upon completion of ABG, what steps should you take?

A
  • apply pressure for 5 minutes
  • expel all air out of ABG syringe and label with patient sticker (including FiO2 and temperature)
  • arrange transfer of samples (ice if >15 mins)
  • document procedure in patient notes
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9
Q

What are the indications for IM injection?

A
  • patient is unable to take oral medication
  • medication unavailable in the oral form
  • medication is not absorbed by the alimentary tract
  • medication is altered by intestinal secretions
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10
Q

What should be checked before administering medication?

A
  • patient’s 3 points of iD
  • right drug, right dose, right route, right time
  • check patient allergy status is recorded on the chart
  • gain informed consent
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11
Q

What are the risks of IM injection and how are these mitigated?

A
  1. Infection: observe ANTT and use PPE.
  2. Adverse reaction: check patient’s allergy status and monitor patient.
  3. Pain: feel like a sharp scratch, will aspirate pre-injection to check placement, then inject slowly and stop if increased levels of pain are experienced.
  4. Bleeding and bruising: choose an appropriate injection site and size of needle.
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12
Q

What are the contraindications of performing an IM injection?

A
  • bleeding disorders (e.g. haemophilia)
  • anticoagulant use (e.g. warfarin, apixaban)
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13
Q

What are the seven rights of medication administration?

A
  1. Right person.
  2. Right drug.
  3. Right dose.
  4. Right time.
  5. Right route.
  6. Right to refuse.
  7. Right documentation of the prescription and allergies.
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14
Q

What size needle can be used to administer intramuscular injection?

A
  • 21G
  • 23G
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15
Q

Name some common sites for IM injection.

A
  • deltoid
  • ventrogluteal
  • vastus lateralis
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16
Q

Give a brief overview of how to administer IM injection to the deltoid site.

A

Commonly used for administration of small volume IM injections, for example vaccines.

  1. Position patient with their arm relaxed.
  2. Expose patient’s upper arm and shoulder.
  3. Palpate the lower edge of the acromial process and administer the IM injection approximately 2.5cm below this.
17
Q

Give a brief overview of how to administer IM injection to the ventrogluteal site.

A

Allows access to gluteus medius and minimus while avoiding blood vessels and nerves, so that higher volumes of medicines can be given.

  1. Position patient prone, semi-prone or supine (whichever is more comfortable).
  2. Place the palm of your hand over the greater trochanter of the patient’s hip, with your thumb pointing anteriorly.
  3. Extend your finger to touch the anterior superior iliac spine, and post your middle finger towards towards the iliac crest to form a V shape.
  4. Insert the needle between your index and middle fingers.
18
Q

Give a brief overview of how to administer IM injection to the vastus lateralis site.

A

Commonly used for immunisations in infants up to the age of 7 months. Patients at risk of anaphylaxis also taught to use this site for administering adrenaline IM injections.

  1. Divide the front of thigh into thirds vertically and horizontally to make nine squares, and inject into the outer middle square.
19
Q

What are the indications for administering a subcutaneous injection?

A
  • medication unavailable in oral form
  • patient unable to take oral medication
  • medication not absorbed by alimentary tract
  • medication is altered by intestinal secretions
20
Q

What are the risks of subcutaneous injection, and how can these be mitigated?

A
  1. Infection: observe ANTT and use PPE.
  2. Adverse reaction: check patient’s allergy status and monitor patient.
  3. Pain: feels like a sharp scratch. You will inject slowly, if increased levels of pain are experienced you will stop.
  4. Bleeding and bruising: you will choose an appropriate injection site and size of needle.
21
Q

Give some medications that are often administered by subcutaneous injection.

A
  • insulin
  • low molecular weight heparin
22
Q

What size needle can be used to administer subcutaneous injection?

A
  • 25G
  • 26G
23
Q

Give some sites where subcutaneous injection can be administered.

A
  1. Abdomen (fastest)
  2. Arms (medium)
  3. Thigh (slow)
  4. Buttocks (slow)
24
Q

What are the purposes of blood cultures?

A
  • detect infections that are spreading through the bloodstream
  • verify that infection is present
25
Q

What are the indications for blood culture?

A
  • pyrexia >38°C
  • focal signs of infection
  • abnormal heart rate, blood pressure, respiratory rate
  • chills or rigors
  • raised or low WCC
  • new or worsening confusion
26
Q

What are the blood culture sites?

A

Fresh venepuncture site must be used (ideally peripheral).

27
Q

What are the risks of taking blood cultures, and how can these be minimised?

A
  1. Infection: observe ANTT, clean the patients skin and use PPE.
  2. Adverse reaction: check patient’s allergy status and monitor the patient.
  3. Pain: the needle will feel like a sharp scratch and the procedure will be over quickly.
  4. Missing the vein: if you miss then you can have another attempt with the patient’s permission (max 2 attempts).
  5. Bleeding and bruising: apply pressure post-procedure followed by a dressing.
28
Q

Give the order in which blood culture collection should happen?

A
  1. Aerobic (blue)
  2. Anaerobic (mauve)

Both bottles must be filled with 10mls of blood.

29
Q

What qualifies as a high risk specimen?

A
  • pts with foreign travel outside of Northern Europe or North America in the last three months
  • samples suspected or known to contain hazardous pathogens (e.g. typhoid, HIV, HCV, HBV)
30
Q

What is the most common contaminant in blood cultures, and how can this be avoided?

A

Staphylococcus is most common contaminant - use ANTT to reduce the risk.

Can give rise to ‘false-positive’.

31
Q

What are the risks of venepuncture, and how can these risks be minimised?

A
  1. Infection: Use ANTT, clean the skin and wear PPE.
  2. Adverse reaction: check patients allergy status and monitor patient.
  3. Pain: needle will feel like a sharp scratch and will be over quickly.
  4. Missing the vein: if you miss, you can have another attempt (with pt permission, max 2x).
  5. Bleeding and bruising: apply pressure post procedure followed by a dressing if you miss the vein.
32
Q

Give the order by which you should take blood bottles in venepuncture?

A
  1. White (virology)
  2. Brown (biochemistry)
  3. Green (clotting)
  4. Indigo (ESR / HbA1c)
  5. Orange (ABG/VBG/trop)
  6. Red (haematology)
  7. Yellow (glucose)
33
Q

Before inserting a cannula, what must you check is prescribed for the patient?

A

0.9% NaCl flush

Also need to check drug chart for any allergies

34
Q

What are the risks of cannulation, and how can these risks be minimised?

A
  1. Infection: use ANTT, clean the skin, wear PPE.
  2. Pain: feel like a sharp scratch and over quickly.
  3. Bleeding and bruising: apply pressure after to stop bleeding and check.
  4. Missing the vein: try once and if miss try again with patient permission (x2 max).
  5. Adverse reaction: check allergy status and monitor.

Miscellaneous (4 decks)

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