TDOCs Flashcards
(72 cards)
1
Q
Explanation of getting midstream urine sample?
A
Retract foreskin / part labia, start to urinate, get midstream sample, then finish urinating
2
Q
Indications for NG tube? (4)
A
unable to swallow
unsafe swallow
drain stomach
inadequate nutrition
3
Q
Contraindications for NG tube? (5)
A
Base of skull fracture Trauma to nasopharynx, oropharynx, larynx Varices Tumour Coagulopathy
4
Q
Signs of base of skull fracture (3)
A
Battle sign (mastoid bruise)
Raccoon eyes
CSF rhinorrhea
5
Q
Complications of NG (3)
A
misplacement into trachea & feeding into it
bleeding
perforation of oesophagus
6
Q
equipment for NG
A
tube lube syringe ph strips plaster vomit bowl tissues & water
gloves, apron, gel
7
Q
how to measure tube?
A
NEX
nose
ear
xiphisternum
THEN MARK TUBE
8
Q
what pH should it be
A
<5.5
9
Q
Allen’s test - describe results
A
<6 seconds return of circulation = positive
6-10 seconds return = borderline, check other hand
>10 seconds = negative - use other arm or femoral artery
10
Q
Contraindications of ABG (5)
A
local infection presence of fistula PVD anticoagulation (relative) inadequate collateral circulation
11
Q
What angle of needle for ABG?
A
45 deg against flow of blood
12
Q
How many mls of blood for ABG?
A
1-2 mls
13
Q
What other information needed for ABG reader machine?
A
temperature and oxygen % the patient is on
14
Q
Barriers to wound healing?
local (3)
general (4)
A
LOCAL
foreign bodies
infection
dead tissue
GENERAL poor health / malnutrition steroids environment poor vascularity
15
Q
what can be done to protect wound bed?
A
Debridement
Reduction of bacterial burden with silver, chlorhexadine, iodine, honey
16
Q
what does TIME stand for regarding wounds?
A
Tissue - debride
Inflammation - antimicrobials
Moisture - adjust exudate or dessication - wounds heal best in semi-occlusive moist environments
Edges - let them advance
17
Q
How long should a surgical dressing be left on for
A
at least 2 days, then depends.
it takes 48 hours for a surgical wound to form its own optimal environment
18
Q
what areas are swabbed for MRSA?
A
groin, armpit, nostrils
19
Q
paediatric airway manoeuvres?
A
Infant: sniff air
Child: head tilt chin lift
20
Q
paediatric chest compressions?
A
(one person) two fingers for infant, 4 cm
heel of one hand for child, 5cm
21
Q
Choking in a child?
A
if effective cough- encourage.
If inefffective cough:
infant: 5 back blows
child: 5 back blows, move onto 5 abdo thrusts
22
Q
Indications for airway expert involvment?
A
sats <90 on high flow
pH <7.3
paCO2 > 6
paO2 <8
23
Q
Indications for catheter? (5)
A
Retention surgery monitor u/o hypotonic bladder (MS, MND, stroke) urodynamics
24
Q
contraindications
A
acute prostatitis
recent surgery locally
cancer
haematuria
25
Gage of catheter per gender?
12-16 female
| 10-14 male
26
catheter material
Latex
Hydragel (long-term antibacterial)
Silicone - hypoallergenic
Silver Alloy antibacterial
27
What allergies to ask about with catheter?
Latex, chlorhexadine
28
Why use instillagel?
Reduces pain
dilates urethra
reduces trauma
29
What is paraphimosis?
When retracted foreskin cannot be returned to its normal anatomic position
urological emergency
30
How can paraphimosis be treated?
Emergency circumcision
Dextrose solution to reduce oedema
Midazolam
31
what is the length of the male and female urethras?
The female urethra, about 4 cm in length, is fused with the anterior wall of the vagina.
The male urethra, about 15-20 cm in length, comprises three parts: prostatic, membranous, and spongy.
Prostatic – passes through the prostate gland. The ejaculatory ducts (containing spermatozoa from the testes, and seminal fluid from the seminal vesicle glands) and the prostatic ducts drain into the urethra here. It is the widest and most dilatable portion of the urethra.
Membranous – passes through the pelvic floor and the deep perineal pouch. It is surrounded by the external urethral sphincter, which provides voluntary control of micturition. It is the narrowest and least dilatable portion of the urethra.
Spongy – passes through the bulb and corpus spongiosum of the penis, ending at the external urethral orifice. In the glans penis, the urethra dilates, forming the navicular fossa. The bulbourethral glands empty into the proximal urethra.
32
Obstructions in male catheterisation
infrapubic angle
prepubic angle
- can be diminished by holding the penis upwards during urinary catheterisation.
It is also important to note the three constrictions in the male urethra – the internal urethral sphincter, external urethral sphincter, and external urethral orifice.
33
MUST? describe
malnutrition universal screening tool
BMI <20=1pt <18.5= 2pt
unplanned weight loss in last 3-6 months >5%=1pt >10%=2pt
acute illness & lack of food 5 days = 2pt
score 2 - refer to dietician
score 1 - document food for 3 days
34
cautions with ipratropium NEBs?
deliver via mouthpiece for glaucoma patients for anticholinergics (ipratropium) so it doesn't hit their eyes
C/I in urinary retention
35
side effects of NEBs?
tremor/tachy/headache with SABA
| dry airways with Ipratropium
36
how much O2 should be used to drive NEBs?
6-8 litres
37
advise to patient on NEBs?
breathe through mouth and don't talk
38
where to take BM sample?
patient preference
not thumb or index
side of finger
39
order of BM test?
```
switch on monitor
insert test strip (checking expiry date)
lancet finger & dispose sharp bin
collect blood
document reading
```
40
what veins may be cannulated
```
medial cubital
basilic
cephalic
dorsal arch
metacarpals
```
41
C/I for cannulation
local infection
fistula for dialysis
lymph node removal
patient refusal
42
Risks of cannulation? (3)
Phlebitis
Haematoma
air embolism
43
Suction indications Yankeur & fine bore
wide bore rigid sucker (Yankeur) – by direct vision only, cheek pockets
fine bore flexible suction catheter – used in conjunction with a naso-pharyngeal tube when oral access is not possible
44
Sign of partial airway obstruction
noisy breathing, snoring, gurgling, periods of apnoea followed by hyperventilation
45
Risks of airway maintenance
invoking gag reflex
inducing vomiting
causing trauma to soft tissues,
46
How to size OP/guedel?
Angle of mandible to incisor
47
C/I OP airway?
consciousness, oral trauma
48
How to size NP?
top of nose to tragus
49
C/I NP airway? (5)
```
# base of skull
# mid-third of face
nasal polyps
deviated septum
coagulopathy
```
50
indications for MRSA swab
elective admissions
existing wound
ITU
previous MRSA
51
how to swab nostril
rotate at least 4 times
52
How to take salbutamol inhaler?
```
start to breathe in
seal lips round inhaler and press
breathe in further, slowly
hold breath for 10 seconds
breathe our through nose
wait 30-60 seconds before 2nd dose
```
53
skin prep for ECG?
may need:
shaved
cleaned
exfoliated with paper towel/abrasive tape
54
placement ECG leads?
RYGB in a clockwise circle from right arm
Red - right forearm proximal to wrist
Yellow - left forearm proximal to wrist
Green - left ankle
Black - right ankle
```
V1 - 4th ICS right sternal edge
V2 - 4th ICS left sternal edge
V3 - in between
V4 - 5th ICS MCL
V5 - in between
V6 - same level, Mid-axillary line
```
55
order of venepucture bottles?
```
aerobic cultures (blue)
anaerobic culture (pink)
```
56
normal range of vital signs
```
temp - 36.5-37.5
RR - 12-20
HR - 60-100
BP - 90/60-140/90
O2 sats - 94-98%
urine output - 1ml/kg/hr
```
57
risks of injections
```
infection
sterile abscess
non-absorption in oedematous site
haemorrhage
nerve damage (IM)
embolus (aspirate first)
```
58
Needle colour?
red for drawing up
blue or green for IM
brown or orange for SC
brown for ID
59
sites for IM
```
deltoid
gluteus (ventro)
vastus lateralis (anterior lateral)
```
60
Clinical indications for suturing?
To allow healing by primary intention
61
C/I
Inflammation, infection, puncture wounds or animal bites
62
local anathesthetics?
Lidocaine, Bupivacaine, Levobupivacaine
maximum recommended dose dependent on patient’s weight
63
explain rational for not using LA with adrenaline in end-artery sites. i.e. digits, nipple, penis
ischaemia
64
When are sutures removed?
Suture removal - facial sutures 5 days, Abdomen/back 10 days, legs 14 days
65
Indications for transfusion?
Acute blood loss (especially if > 1.5 L in an adult)
Symptomatic anaemia with no easily treatable cause (e.g. treat Fe deficiency anaemia with Fe);
Long term transfusion dependant anaemia
Radiotherapy patient (Hb <100g/L)
Chemotherapy patient (Hb <90g/L)
66
Name the UK independent, professionally-led haemovigilance scheme
SHOT - collects and analyses anonymised information on adverse events and reactions in blood transfusion.
67
Minimum requirements on blood specimens
| sample tube
Surname (correctly spelt)
Forename (in full and correctly spelt)
Date of birth (not age or year of birth)
Hospital number (The NHS number is only acceptable for antenatal/CRM samples)
Gender (and/or on the request form)
Collector’s details
Date and Time specimen collected
68
Patient monitoring during transfusion
15 minutes prior to transfusion of each unit or blood
15 minutes following commencement of the transfusion
On completion of the infusion of each unit of blood
Temperature, pulse, respiratory rate, blood pressure
69
Symptoms patient should be informed to report during transfusion
Feeling that something is wrong, or being unwell in any way
Flushing, or feeling hot and bothered, acute rash,
Shivering or shaking, Progressive agitation
Pain at the cannula site, Shortness of breath
Acute diarrhoea or sudden vomiting, passing red urine
Severe pain especially loin/lower back area, abdomen or chest
70
when checking bag against cross match slip & patients, what details to check?
Ensure the following correspond:
The patient’s surname, the patient’s forenames, date of birth
Hospital number, gender, patient blood group, donor blood group, blood unit number, expiry date
71
types of reactions?
Acute Haemolytic Reaction
Stop transfusion – check identity of patient and label on unit. Inform the haematologist. Send unit + FBC, U&E, clotting, cultures and urine to lab. Treat DIC
Anaphylaxis
Stop transfusion – maintain airway, O2, contact anaesthetist, give IV fluids, give adrenaline/chlorpheniramine/hydrocortisone
Transfusion Related Acute Lung Injury
Stop transfusion – give 100% O2, treat as ARDS – donor should be removed from donor panel.
Non-Haemolytic Reaction
Slow or Stop transfusion – give paracetamol, monitor – if no improvement inform senior.
Allergic Reaction
Slow or Stop transfusion – give chlorpeniramine and monitor closely
Fluid Overload
Slow or Stop transfusion - give 100% O2, and a diuretic (furosemide 40mg IV), monitor
72
Half lives of LA
Procaine and chloroprocaine are the shortest-acting agents (0.25-0.5 hours), followed by lidocaine, mepivacaine, and prilocaine, which have slightly longer durations of action (0.5-1.5 hours). The longer-acting agents include tetracaine (2-3 hours), bupivacaine (2-4 hours), etidocaine (2-3 hours), and ropivacaine
