Clincal skills 1-10 Flashcards
1
Q
What are the key points to document during enema administration?
A
- Document the procedure, care given, decisions, and planned care.
- Document the outcome with reference to the Bristol Stool Chart.
- Monitor the patient for any adverse effects.
- Assist the patient with getting dressed if required.
2
Q
What does ‘asepsis’ mean?
A
‘Asepsis’ means an absence of potentially pathogenic microorganisms.
3
Q
What is ‘aseptic technique’?
A
‘Aseptic technique’ is a set of practices preventing transfer of pathogenic microorganisms to susceptible body sites or sterile equipment.
4
Q
What should you do to maintain a clean environment when performing aseptic technique?
A
- Carry out in a clean, dust-free environment.
- Minimise ward-cleaning activities nearby during procedures.
- Close windows and turn off fans to reduce contamination.
- Wait at least 30 minutes after cleaning for dust to settle.
5
Q
What are the steps for assessing respiration?
A
- Assess respiratory rate, depth, and pattern.
- Observe breathing effort (e.g., difficulty speaking, use of accessory muscles).
- Assess internal respiration (e.g., skin pallor, cyanosis).
- Conduct a risk assessment before any procedure.
6
Q
What is apnoea and how should it be responded to?
A
Apnoea (breathing stops) is an emergency. If a patient is not breathing and non-responsive, call for help and begin chest compressions.
7
Q
What is the purpose of cardiac monitoring?
A
- Continuous assessment of the heart’s electrical activity using an ECG.
- Mainly used to assess heart rate and rhythm.
- Used to detect arrhythmias.
8
Q
What are the differences between three and five electrode systems in cardiac monitoring?
A
- Three-electrode system monitors leads I, II, and III.
- Five-electrode system monitors leads I, II, III, aVR, aVL, aVF, and a single chest lead (V1-V6).
9
Q
What is the Bristol Stool Chart used for?
A
The Bristol Stool Chart helps with the objective classification of stool type or consistency.
10
Q
What are the key steps for rectal suppository insertion?
A
- Decontaminate hands.
- Check patient identity and reasons for extra caution.
- Explain the procedure, reasons, and risks.
- Obtain and document consent.
11
Q
What should be considered when measuring blood pressure (BP)?
A
- Use upper arm cuffs for accuracy.
- Palpate brachial or radial artery.
- Follow local cleaning guidelines to prevent cross-infection.
12
Q
What are the components of systolic and diastolic pressure?
A
- Systolic pressure: pressure when ventricles contract.
- Diastolic pressure: pressure when ventricles relax.
13
Q
What is the correct technique for manual blood pressure measurement?
A
- Wash hands or use hand sanitiser.
- Gather clean and working equipment (correct cuff size).
- Ensure the arm is supported at the level of the heart.
14
Q
What is the significance of Korotkoff sounds in blood pressure measurement?
A
- Systolic pressure (K1): first tapping sounds heard.
- Diastolic pressure (K5): point at which Korotkoff sounds disappear completely.
15
Q
What should be done after measuring blood pressure?
A
- Record findings in patient notes, including any unusual circumstances.
- Remove cuff and decontaminate equipment.
- Decontaminate hands.
16
Q
What are the key principles for measuring Peak Expiratory Flow (PEF)?
A
- Review the trend of readings over time.
- Record exposure to triggers or illness.
- Document factors affecting readings.
17
Q
What is required for gaining informed consent for medicines administration?
A
- Patients must be aware of the risks and benefits of the medicine to give informed consent.
- Consent must be given voluntarily and without undue pressure.
18
Q
What should be checked in the Medication Administration Record (MAR)?
A
- Identify any intentional or unintentional omissions in documentation.
- Record the omission code and reason if a dose is omitted.
19
Q
What should you do if a patient is showing signs of poor tissue oxygenation?
A
- Restlessness and confusion can indicate poor tissue oxygenation.
20
Q
What is the importance of documenting the patient’s condition during monitoring?
A
Document observations using a track and trigger system (e.g., NEWS2). Inform appropriate staff if the patient’s condition worsens.
21
Q
What is the protocol for electrode placement during cardiac monitoring?
A
- Peel off each electrode covering just before attaching.
- Place electrodes firmly.
- Keep the centre of the chest clear for potential chest compressions.
22
Q
What should be done if a flat-line trace is observed during cardiac monitoring?
A
- If patient is awake, likely a disconnected wire. If unresponsive, attempt to rouse, call for help, and assess for cardiac arrest.
23
Q
What are the signs of medication side effects that should be monitored?
A
Common side-effects, risks and benefits, and alternative treatments.
24
Q
What should be checked carefully in the Medication Administration Record (MAR)?
A
Medication Administration Record (MAR)
Check for omissions, validity, and legibility.
25
What is the procedure if a dose is omitted in the MAR?
Record the omission code and reason
## Footnote
Ensure to document appropriately.
26
What should be confirmed with the patient regarding allergies?
Confirm allergies with the patient
## Footnote
Document clearly in the MAR.
27
What must be checked to ensure the right administration of medicine?
Right person, medicine, dose, date, time, route, and method
## Footnote
Valid and legible prescription is essential.
28
What should be done before administering any medication?
Establish if the indication for the medicine still applies
## Footnote
Identify any additional risks.
29
What is the preferred method of nebuliser administration for certain medications?
Mouthpiece preferred for glaucoma risk with anticholinergics
## Footnote
Use for corticosteroids to protect eyes/skin.
30
What should be done after nebulisation is complete?
Document care given on the MAR
## Footnote
Check if post-treatment peak flow measurement is needed.
31
What is the target oxygen saturation range for oxygen therapy?
Usually 94-98% or 88-92%
## Footnote
Corresponds to the NEWS2 chart.
32
What should be monitored in the first 5 minutes of oxygen therapy?
Monitor SpO2
## Footnote
Document concentration of inspired oxygen.
33
What should be recorded accurately on the NEWS2 chart?
All information regarding oxygen therapy
## Footnote
Include device and flow rate.
34
What is the first action to take when placing a patient in the recovery position?
Ensure safety of yourself, patient, and observers
## Footnote
Check for response.
35
What should be done if the patient is unresponsive?
Call for help
## Footnote
Check and open the airway.
36
How should the airway be opened if spinal injury is suspected?
Use jaw-thrust maneuver
## Footnote
Avoid head-tilt/chin-lift.
37
What should be done if a patient is not breathing normally?
Start CPR
## Footnote
Gasping/agonal breathing is not considered normal.
38
What is the normal human core temperature range?
36°C to 37.5°C
## Footnote
Changes may indicate infection or deterioration.
39
What should be done before taking an oral temperature?
Do not take temperature 15-30 minutes after hot/cold food/drink
## Footnote
Ensures accurate reading.
40
What should be checked before using a tympanic thermometer?
Check for earache, discharge, or wax buildup
## Footnote
If concerned, examine the ear.
41
What types of stomas are there?
* Ileostomy: effluent is liquid
* Colostomy: effluent consistency varies
* Urostomy: diverts urine
## Footnote
One-piece and two-piece appliances are available.
42
What should be done after changing a stoma appliance?
Document the change, condition of stoma/skin, and patient participation
## Footnote
Important for ongoing patient care.
43
What is essential to ensure when cutting a template for a stoma appliance?
Correctly sized template to prevent damage or leakage
## Footnote
Stoma size can change, especially when newly formed.
44
What is the procedure for emptying a drainable appliance?
Position disposable bowl to collect contents and lower opening into the bowl
## Footnote
Document care and output on fluid balance chart.
45
What should be done to ensure good hygiene after using a thermometer?
Wash hands after
## Footnote
Ensures infection control.
46
What is the first step in the procedure for using a disposable appliance?
Position disposable bowl to collect contents
47
What should be done after opening or undoing the closure device of the appliance?
Lower the opening into the bowl and allow to drain
48
What is a recommended action if needed during the drainage process?
Gently squeeze the pouch
49
What should you do after using the appliance?
Wipe the end of the appliance with tissues
50
What is the next step after wiping the appliance?
Reseal the closure
51
How should waste be disposed of after using the appliance?
Dispose of waste down toilet/sluice
52
What should be done with the bowl used to collect contents?
Dispose of bowl according to local policy
53
What should be documented after the procedure?
Document care, patient participation, and output (volume, consistency) on fluid balance chart
54
What are granulomas in stoma care?
Granulomas are small, red, fleshy growths on the stoma surface
55
What often causes granulomas?
Friction from the appliance
56
What is a common treatment for granulomas?
Silver nitrate application by a healthcare professional
57
What may be used if silver nitrate fails to treat granulomas?
Fludroxycortide tape or liquid nitrogen may be used under specialist guidance
58
What may large granulomas require?
Surgical excision
59
What should be recorded regarding granuloma treatment?
Record all treatments in patient notes
60
Who must regularly reassess appliance fit for granulomas?
Stoma care nurse specialist
61
What chart is used to understand stool characteristics?
Bristol Stool Chart
62
What should be considered when assessing stool?
Changes in appearance, consistency, amount, and odour with patient's general health
63
What should be done after handling faeces?
Wash hands with soap and water
64
What type of container should be used for stool sample collection?
Clean, dry container (sterile if required)
65
What should be done with the lid after collecting a stool sample?
Replace the lid tightly to ensure a seal
66
What should be noted during stool sample collection?
Variations in colour and consistency, using the Bristol Stool Chart
67
What should be done if abnormalities are found in stool?
Collect separate samples of any abnormalities (e.g., worms)
68
What should be completed when sending a stool sample to the lab?
Complete the microbiology form with patient details, investigation required, and clinical history
69
What is essential for specimen collection, storage, and transport?
Compliance with local guidelines
70
What should be done with samples in suspected amoebic dysentery?
Send samples immediately
71
What is a potential risk associated with subcutaneous insulin injections?
Needlestick injuries
72
What act requires employers to ensure health, safety, and welfare of employees?
Health and Safety at Work Act
73
What regulations provide guidance on safe use and disposal of sharps?
Health and Safety (Sharp Instruments in Healthcare) Regulations 2013
74
What must be available to ensure safety during insulin injections?
A sharps disposal container
75
What factor influences the choice of injection site for insulin?
Medication viscosity, volume, and subcutaneous tissue amount
76
What should be done to prevent scarring and hardening at injection sites?
Rotate injection sites
77
What injection sites are appropriate for insulin?
Deltoid areas of arms, abdomen, thighs
78
What should not be used for skin decontamination before insulin injection?
Alcohol, as it can harden skin
79
What is the first step in preparing for a subcutaneous insulin injection?
Gather equipment
80
What should be checked on the MAR before administering insulin?
Right person, medicine, dose, date, time, route
81
What should be ensured if the insulin dose depends on blood sugar?
Test done as per policy
82
What technique is recommended for drawing up insulin?
Aseptic non-touch technique
83
What is the angle for inserting the needle during insulin injection?
90° angle
84
What should be done immediately after removing the needle from the injection site?
Activate safety device
85
What should be done after administering insulin?
Document administration on the MAR
86
What is the purpose of Medication Administration Records (MARs)?
To record needed medicines, times, doses, and routes
87
What types of MARs exist?
Paper-based or electronic
88
What must all MARs contain?
Basic sections: patient ID, allergies, medications
89
What should be checked before administering medication from the MAR?
Each section carefully
90
What should be recorded for regular medicines on the MAR?
Sign and record the time given for each administration
91
What should be included in the recording of 'as-required' medicines?
Time given, indication for use, dose, route, initials
92
What should be done if a medicine is omitted?
Record the relevant omission code and the reason
93
What should urine testing include?
Physical, chemical, and microscopic elements
94
What should be observed in freshly voided urine?
Colour, clarity, debris, and odour
95
What should be done when cleansing surgical wounds?
Assemble non-sterile equipment and warm the wound-cleansing solution
96
What is the first step in the procedure for cleansing surgical wounds?
Prepare a sterile field
