Post on 24-Feb-2016
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CVT Exam RoomMED 250
Daymar CollegeLisa H. Young, RN,BSN, Med.
Interpersonal Communication
• Verbal Communication• Written Communication• Symbolic Language• English as a second language• Nonverbal Communication• Listening
Pain
• Acute or Chronic
• Types of pain
• Pain Assessment (Pain Scale)
Clinical Environment and Safety
• Occupational Safety and Health Administration (OSHA)
• Emergency Plan– Hepatitis B Vaccinations– TB Skin test (PPD test)
Medical Records & Documentation
• Consent to Release Information
• Medical Forms
• Charting (SOAP)
• Patient History
Vital Signs
• Temperature (Oral / Aural / Axillary / Rectal)
Vital Signs
• Pulse– Apical– Radial
Vital Signs
• Respirations• Oxygen Saturation
Vital Signs• Blood pressure– Sphygmomanometer (cuff widths)– Stethoscope– Brachial artery– Kortikoff sound
• Average blood pressure readings– Newborn: 80/50 mmHg– Infant: 90/60 mmHg– Child 3 – 6 yrs.: 100/60 mmHg – Child 10 yrs.: 110/60 mmHg– Child 14 yrs.: 130/60 mmHg– Adult: 120/80 mmHg– Elderly > 60 yrs. : 155/95 mmHg
• Systolic pressure: highest pressure• Diastolic pressure: lowest pressure• Pulse pressure• Hypertension• Malignant Hypertension• Hypotension• Classifications
BP Classification Normal Pre-Hypertensive
Hypertension
SBP (mmHg) 119 or below
120 to 139 140 or above
DBP (mmHg) 79 or below
80 to 89 90 or above
Normal Vital Signs
Height and Weight Measurement
• Height
• Weight
Physical Examination
• Review of systems
• Palpation / Percussion / Auscultation/ Inspection/Mensuration/Manipulation
• Glasgow Coma Scale
Eyes Opening Response
Spontaneous-open with blinking at baselineOpens to verbal command, speech, or shoutOpens to pain, not applied to faceNone
4 points
3 points
2 points
1 point
Verbal Response
OrientedConfused conversation, but able to answer questionsInappropriate responses, words discernibleIncomprehensible speechNone
5 points4 points
3 points
2 points1 point
Motor Response
Obeys commands for movementPurposeful movement to painful stimulusWithdraws from painAbnormal (spastic) flexion, decorticate postureExtensor (rigid) response, decerebrate postureNone
5 points4 points
3 points
2 points
1 point
Review of Systems• Hematologic• Endocrine• Psychiatric• Neurological• Eyes• Cardiovascular• Respiratory• HEENT• Gastrointestinal• Integumentary• Musculoskeletal• Urinary• Genital
Procedures / Diagnostic Test for the Cardiovascular System
• Aneurysmectomy• Angiography• Angioplasty• Arterial blood gases• Artery graft• Artificial pacemaker• Cardiac catheterization• Cardiac enzymes
• Cardiac MRI• Cardiolysis• Cardiorrhaphy• Cardioversion• Commissurotomy• CABG• Doppler
ultrasonography• Electrocardiogram
Physical Examination • Positioning the patientSitting positionFowler’s position / Semi-Fowler’s positionDorsal recumbent positionProne positionTrendelenburg positionKnee-chest position Jackknife position (proctologic)Lithotomy positionSims’ position
Aseptic Hand Washing
Non-Sterile Gloving
Medication Administration
• Conversions– Move the decimal point 3 places to the left or right– Large to smaller: move to the right (L > S)– Small to large: move to the left (S >L)– Change 200 mg to mcg = 200, 000 mcg– Metric scale: kg-hg-dag-g-dg-cg-mg X X mcg
Medication Administration
• Apothecary & Metric Equivalencies– 1000 ml = 1 liter– 1cc = 1 ml– 1 ounce = 30 cc or 30 ml– 1 dram = 4 ml– 1 grain = 60 mg– 1 tablespoon = 15 ml– 1 teaspoon = 5 ml
Injection Administrations
Injections
Subcutaneous Injection
Intradermal Injections
Intramuscular Injections
Z-Track Injections
• Medication is sealed deeply within the muscleand allows no exit path back into the subcutaneous tissue and skin
• Used when giving dark-colored medication solutions or irritating to the tissue
Capillary Stick
Clinical Laboratory Improvement Amendments (CLIA)
• Federal act• Quality standards • Health Care Financing Administration (HFCA)• Certification by Secretary of Health and
Human Services• Center of Disease (CDC)• Category of testing
Venipuncture
Basics of Hematology Testing• WBC count• RBC counts • Hemoglobin• Hematocrit• Platelet counts• MCV, MCHC, and MCH• ESR or sed rate• Blood typing
Blood Chemistry Testing
• Glucose• Electrolytes (sodium, potassium, chloride,
CO2)• Creatinine• BUN• Total protein • Albumin• Bilirubin levels
Blood Tube Collection
• Vacutainer Collection– Red– Blue– Green – Purple
– Reversed order if from an IV site
Blood Tubes
Labeling Blood Sample
• Patient’s surname, first and middle• Patient’s ID number• Date, time and initials of the collector
Venipuncture Procedure
• Assemble equipment• Approach patient in a friendly, calm manner. Gain the patient’s cooperation• Identify the patient correctly• Properly fill out appropriate requisition forms, indicating the test(s) ordered• Verify the patient’s condition.• Check for allergies• Position patient• Wash hands• Place tourniquet (2 inches above)• Locate desired vein and clean puncture site• Apply gloves• Insert needle, bevel up, at a 15 degree angle• Aspiration of the blood into syringe• Remove tourniquet.• Remove needle. Apply pressure (3 min.) Dressing app;lied.• Dispose of contaminated materials/supplies• Mix and label tubes• Deliver specimen(s) to laboratory.
Complications with Blood Collection• Fainting• Hematomas• Petechiae• Edema• Obesity• IV therapy• Damaged, Sclerosed, or occulded Veins• Hemoconcentration• Hemolysis• Collapsed Veins• Allergies• Thrombosis• Burned or Scarred Areas• Infections• Upper extremity on the side of a previous mastectomy• Superficial veins
Butterfly Venipuncture
Venipuncture with Vacutainer
Suture and Staple Removal
Clean Catch Urine Specimen
Urine Dipstick Analysis
Culture Testing
• Wound• Throat• Bacteria• Fecal
Ordered Tests
• Blood chemistry test• Hematology and coagulation• Microbiology• Blood serum• Centrifuge