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Z Year3 Clinical Skillz > Injection OSCE > Flashcards

Injection OSCE Flashcards

1
Q

After your introduction and your confirmation of patient how do you explain the procedure?

A
  • I have been asked to administer an injection for you which will be inserted into your muscle/ fatty tissue/just under the skin.
  • I’ll just be giving you some medication using a small needle.
  • You will feel a sharp scratch and there might be a little pain, but I will do my best to keep you as comfortable as possible.
  • Would that be okay?
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2
Q

What else can you ask?

A

Do you mind me asking what has brought you to hospital?

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3
Q

How can you show empathy?

A
  • Patient might say “I fell over and hurt my arm and it really hurt so I need an injection for the pain”
  • In which case show empathy for e.g: “I’m really sorry to hear that but you’ve done the right thing by coming into hospital and hopefully this injection will help feel you better.”
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4
Q

After the patient consenets what do you need to check?

A
  1. Are you in any pain currently? Are you comfortable?
  2. I’m not prescribing but I am administering the drug.
  3. Do you know what injection you’re having?
  4. Patient may say something like “morphine for the pain” or “heparin because they said my blood is too thick” or “insulin because my blood sugar is high” etc
  5. Okay, that’s correct.
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5
Q

What do you say to the examiner?

A

Ideally I would like to check with the patients’ notes to ensure correct drug and dose is given to the right person

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6
Q

What questions should you ask the patient before?

A
  1. Are you allergic to latex gloves?
  2. Have you received x drug in the past?
  3. If yes: Did you have any adverse reactions to it?
  4. Ask specific allergens for different drugs (see table below) e.g. If morphine sulphate: Are you allergic to sulphur?
  5. How are you with needles?
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7
Q

If they have needlephobia what can you say?

A
  • “I understand that it can be a bit daunting but I will try my best to make it as quick and painless as possible.
  • But if at any point, you would like me to stop, please let me know”
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8
Q

What is haloperidol used for?

A

antipsychotic

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9
Q

What type of drug is chlorpromazine lorazepam and diazepam?

A

benzodiazapine

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10
Q

What type of drug is prednisolone?

A

steroid

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11
Q

What is ketamine used for?

A

inducing agent for anaesthesia

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12
Q

What is naloxone used for?

A

reversal of opiate overdose

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13
Q

What is codeine used for?

A

opiate analgesic

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14
Q

What is morphine used for?

A

opiate analgesic

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15
Q

What is methotrexate?

A

immunosupressant

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16
Q

What is metoclopramide?

A

antiemetic

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17
Q

What is streptomycin?

A

aminoglycoside antibtioic

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18
Q

What are examples of vitamin B12 that can be given IM?

A
  1. cyanocobalamin
  2. hydroxocobalamin
  3. methylcobalamin
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19
Q

What vaccines can be given IM?

A
  1. Gardasil (cervical cancer)
  2. Hepatitis A vaccine
  3. Influenza vaccines
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20
Q

What are examples of IM drugs?

A
  1. Haloperidol
  2. Chlorpromazine
  3. Lorazepam
  4. Diazepam
  5. Prednisolone
  6. Penicillin
  7. Sex hormones (such as test)
  8. Ketamine
  9. Naloxene
  10. Codeine
  11. Morphine
  12. Methotrexate
  13. Metoclopramide
  14. Streptomycin
  15. Vit B12
  16. Vaccines
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21
Q

What are examples of subcut injections?

A
  1. LMWH
  2. Rapid insulin
  3. Short insulin
  4. Long insulin
22
Q

What are examples of rapid insulin?

A
  1. Insulin lispro/ Humalog
  2. Insulin aspart/ NovoRapid
  3. Insulin glulisine/ Apidra
23
Q

What are examples of short insulin?

A

soluble insulin/ Actrapid

24
Q

What are examples of long insulin?

A
  1. Insulin glargine/ Lantus
  2. Insulin detemir/ Levemir
  3. Insulin degludec/ Tresiba
25
Q

What are examples of intradermal injections?

A
  1. Tuberculin test/ PPD (tuberculosis testing aka Heaf test)

2. Allergy skin testing (skin prick test)

26
Q

What do you say to patient after questions?

A

Okay X I’m going to start collecting my equipment now

27
Q

How do you clean the tray?

A

inside, sides of the inside, sides of the outside, back. DO NOT GO FROM OUTSIDE BACK TO INSIDE

28
Q

What equipment do you collect?

A
  1. Two pairs of non-sterile gloves
  2. One syringe
  3. Blunt needle
  4. Alcohol swab
  5. Gauze
  6. Take the appropriate needle: Blue intramuscular 22G, Orange intradermal or subcutaneous 25G (Green 21G buttocks IM not needed)
  7. Drug chart
  8. Sharps bin nearby
29
Q

After you collect equpiment what do you say to examiner?

A

All of the equipment I am using in date and the drug is also in date

30
Q

What are the 1st half of steps for the inejction?

A
  1. Wash hands and put on first gloves.
  2. Open the blunt needle packet at the non-needle end.
  3. Open syringe packets and take syringe into right hand
  4. Load the blunt needle onto the syringe
  5. Take the lid off the medicine bottle
  6. Insert the blunt needle into the bottle
  7. Draw up the specified volume using ANTT ensuring that the needle is below the fluid level to reduce the number of air bubbles.
31
Q

What should you do if there are air bubbles?

A
  1. hold the syringe vertically and draw some air into the syringe which will help the bubbles float to the top
  2. If the air bubbles still do not rise to the top, try flicking the syringe with your nail.
32
Q

What is the next few steps?

A
  1. Once air is at the top, push the plunger until some medication drips out.
  2. Re-sheath the blunt needle.
  3. Twist the blunt needle off and put the needle into the sharps bin.
  4. Open the injection needle packet (blue or orange) and connect it to the syringe.
  5. Place the prepared injection in the tray.
  6. Take off gloves
  7. Wash hands (cheating technique).
  8. Put on 2nd pair of gloves.
33
Q

What advice to you give to patient?

A
  1. With every drug, unfortunately there is a chance of an adverse reaction
  2. Not that this would happen to you but it’s better for you to be aware.
  3. It’s quite common for people to get a rash but it is nothing to worry about.
  4. However there is a small risk of a severe allergic reaction where your tongue and neck might swell, you might feel dizzy and feel like your heart’s racing
34
Q

How do you reassure the patient after explaining possible adverse reaction?

A

But don’t worry, in the slight chance that this may happen, we have all the facilities to deal with this and ensure your safety

35
Q

What do you get the patient to do after saying the cautionary advice?

A
  • Can you just repeat what I said back to me?

* Perfect!

36
Q

What do you need to warn the patient about esp with LMWH?

A

there may be a risk of bleeding leading to bruising as this is a blood thinning drug but it’s nothing to worry about

37
Q

After explaining cautionary advice what do you do?

A

confirm site of injection: where would you like me to inject the medication?

38
Q

Where do you inject for subcut?

A

we tend to inject it into parts of your body where there is more fat distribution like the tummy. Would that be okay?

39
Q

Where do you inject for IM?

A

we tend to inject this medication into your upper arm and lower thigh. Which of these would you prefer?

40
Q

Where do you inject for intradermal?

A

we tend to inject just under the skin in a visible area like your hand, would that be okay?

41
Q

What is important to check before administering drug?

A
  • Right patient - Check hospital number
  • Right drug
  • Right dose- Just to confirm, I am giving you x ml of this drug into your muscle /fat /skin.
  • Right route
  • Right time and date
42
Q

What are the next steps?

A
  1. Clean skin

2. UNsheath needle

43
Q

How do you clean the skin?

A
  1. Clean skin using alcohol swab for 30s.
  2. “I’m going to clean the skin. It might feel a little cold.”
  3. To the examiner: “Due to the aseptic technique, I cannot wear a wrist watch. Would you mind timing 30 seconds for me?”
44
Q

How do you do an IM injection?

A
  1. Spread skin horizontally with left hand using thumb and index finger. (“I’m going to hold your skin taut now to make the injection more comfortable”).
  2. Insert ⅔ needle into skin at 90 degrees leaving ⅓ outside of the skin. Don’t push needle all the way through skin.
  3. Stop spreading your skin horizontally with your left hand
45
Q

How do you do an intradermal injection?

A
  1. Spread skin horizontally with left hand using thumb and index finger. (“I’m going to hold your skin taut now to make the injection more comfortable”).
  2. Inject at 15 degrees with full length of needle.
  3. Stop spreading your skin horizontally with your left hand
46
Q

How do you inject a subcut?

A
  1. Pinch skin with left hand to gather the fatty layer. (“I’m going to pinch your skin gently now”)
  2. Insert ⅔ needle into skin at 45 degrees leaving ⅓ outside of the skin. Don’t push the needle all the way through the skin.
    (FOR INSULIN, the angle is 90 degrees and insert the full length of the needle as the needle is short).
  3. Stop pinching skin with your left hand
47
Q

How do you actually inject the drug?

A
  1. Stabilise the syringe with your left hand.
  2. Pull the plunger a bit with your right hand and look for blood aspiration due to entry of needle into a vein. (Checks that the needle is in the correct place).
  3. Whilst stabilising the syringe, push plunger so that medication is injected at a rate of 1ml per 10 seconds without pushing the needle deeper into the skin.
    (If intradermal, look for a wheal on the skin).
48
Q

After the drug is injected what are the steps?

A
  1. Pause and withdraw needle completely.
  2. Re-sheath and put in sharps bin.
  3. Put the gauze on site and press down.
  4. Take gloves off and put them in the tray.
49
Q

How do you reassure the patient after that experience?

A
  1. “Well done X, the needle’s out now. Now that it’s done, how are you feeling?”.
  2. Patient may say they are in pain. In this case, say “I’m really sorry that it feels sore but you can take paracetamol to relieve the pain- 2 tablets 8 hours apart should be fine”.
50
Q

What are the key final 5 steps?

A
  1. Advise patient
  2. Document procedure
  3. Risk analysis
  4. Bribing patient
  5. Bribing examiner
51
Q

How should you advise the patient?

A
  1. Thank you X, the injection has successfully been completed. I will just tell you a bit about how to look after it.
  2. (If not said previously) The site of the injection might become a bit sore over the next few days but you can relieve the pain by taking 2 paracetamol tablets, 8 hours apart.
  3. There may some bleeding but this is not a problem, just put some pressure on the area with a cotton pad.
  4. Also, if you experience any of the symptoms of a severe allergic reaction that I mentioned earlier like the tongue swelling, then please seek medical attention.
    • Finally, please avoid massaging that area, because the medication might leak out of its desired space
52
Q

How do you document the procedure?

A
  1. “Please may I have the patient’s notes to document the procedure?”
  2. Patient’s name
  3. DOB, hospital number, site and indication of injection, drug and dose given, allergies, date, position (medical student), signature.

Z Year3 Clinical Skillz (9 decks)

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