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OSCE > Clinical skills > Flashcards

Clinical skills Flashcards

1
Q

Seven rights of medication administration?

A
  1. Right person: ask the patient to confirm their details and then compare this to the patient’s wrist band (if present) and the prescription. You should use at least two identifiers.
  2. Right drug: check the labelled drug against the prescription and ensure the medication hasn’t expired.
  3. Right dose: check the drug dose against the prescription to ensure it is correct.
  4. Right time: confirm the appropriate time to be administering the medication and check when the patient received a previous dose if relevant.
  5. Right route: check that the planned route is appropriate for the medication you are administering.
  6. Right to refuse: ensure that valid consent has been gained prior to medication administration.
  7. Right documentation of the prescription and allergies: ensure that the prescription is valid and check the patient isn’t allergic to the medication you are going to administer.
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2
Q

Post procedure care: sub cut?

A

Warn the patient that it is normal for the injection site to be sore for one or two days.
Advise that if they experience worsening pain after 48 hours they should seek medical review.
Reiterate the potential complications of subcutaneous injections including haematoma formation, persistent nodules, local irritation and rarely anaphylaxis.

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3
Q

Risks of subcut injection?

A

Haematoma formation,
Persistent nodules,
Local irritation
Rarely anaphylaxis

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4
Q

What gage needle for s/c?

A

26/30 gage

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5
Q

What to ask pt before procedures involving needles?

A 
Bleeding disorder
Blood thinning medications
Phobia of needles
Allergies (drug, plaster, tape)
Any fistula 
Any lymph node removal
Any procedure where arm should be avoided
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6
Q

How to perform subcut injection?

A

Remove bubbles
Pinch skin between index finger and thumb
Pierce skin at 45-90 degrees

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7
Q

Consent: s/c injection

A

Today I need to administer some medication, this will involve an injection under the skin. You may briefly experience a sharp scratch as the needle is inserted. The procedure does involve some risks which include bleeding, bruising, a persistent lump at the injection site and a small chance of infection or serious allergic reaction.
The benefits of this procedure are that this is a prescribed medication and it has been deemed necessary by prescriber and it has been decided this is the most appropriate route for the drug to be delivered.

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8
Q

What should you ask a patient about previous s/c injections?

A

Had one before?
If so - recent?
If recent, where - vary site to avoid thickening of the skin which may compromise delivery

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9
Q

Which way should the bevel face when inserting a needle at 45-90 degrees?

A

UPWARDS

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10
Q

Venepuncture: equiptment

A 
Torniquete
Gauze
Plaster/Tape
Blood collection device - monovette needle
Sample tubes
alcohol swab
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11
Q

Pre-existing medical conditions that contraindicate venepuncture in a particular arm?

A

Arterio-venous fistula
Lymphoedema,
A stroke affecting the movement of a limb

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12
Q

How long clean and dry for venepuncture?

A

Clean the site with an alcohol swab for 30 seconds and then allow to dry completely for 30 seconds

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13
Q

Consent for venepuncture?

A

Today I need to take a blood sample, which involves inserting a small needle into your vein. You may briefly experience a sharp scratch as the needle is inserted, but this should not be painful.
The procedure does involve some risks which include bleeding, bruising, a persistent lump at the injection site and a small chance of infection, which I will minimise by cleaning the area before hand and using aseptic techniques.

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14
Q

Post procedure care - venepuncture?

A

Warn the patient that it is normal for the injection site to be sore for one or two days.
Advise that if they experience worsening pain after 48 hours they should seek medical review.
Advise to alert staff if bleeding does not stop.
Reiterate the potential complications of venepuncture including haematoma formation, persistent nodules, local irritation and rarely infection.

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15
Q

Order of blood bottles and what each colour is used for?

A

White - VVirus - virology
Brown - BIOCHEM - U&Es, LFTs, Bone profile, CRP, tumour makers, TFTs
Green - GOOEY BLOOD - coagulation studies - fill to full draw
Orange - OMG heart attack - Troponins
Purple - PEOPLE with diabetes - HbA1c
Pink(/red) - Blood - FBC, PTH
Yellow - YOU MIGHT BE IN DKA - Glucose, lactate

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16
Q

Equiptment for canulation?

A 
Clean procedure tray
Non-sterile gloves
Disposable apron (optional)
Tourniquet
Cannula (size appropriate to the indication for cannulation)
Sterile dressing pack (to provide a sterile field)
Cannula dressing
Luer lock cannula cap or extension set
Gauze swabs
Normal saline 0.9% (10 ml)
Syringe (10ml)
Alcohol swab (2% chlorhexidine gluconate in 70% isopropyl)
Sharps container
17
Q

Consent for cannulation?

A

Today I need to perform cannulation, which involves inserting a small plastic tube into your vein using a needle. This will allow us to administer fluids and medications via the cannula. You may briefly experience a sharp scratch as the needle is inserted. I will then secure it and flush it with sterile salt water to check it is working - this will feel strange but should not hurt.
The procedure does involve some risks which include bleeding, bruising, a persistent lump at the injection site and a small chance of infection, which I will minimise by cleaning the area before hand and using aseptic techniques.

18
Q

After care - cannula?

A

Warn the patient that it is normal for the injection site to be sore for one or two days.
Advise that if they experience worsening pain after 48 hours they should seek medical review.
Advise to alert staff if bleeding does not stop.
Alert staff if it comes out, or becomes painful.
Alert staff if using cannula is painful.
Reiterate the potential complications of venepuncture including haematoma formation, persistent nodules, local irritation and rarely infection.

19
Q

What needle to use for IM?

A

21-23G needle

20
Q

What is the Z-track technique in an IM injection?

A

Gently place traction on the skin with your non-dominant hand away from the injection site, continuing the traction until the needle has been removed from the skin. This application and subsequent removal of traction is known as the ‘Z-track technique’ and helps to keep the administered medication within the muscle. When the traction applied to the skin is released, the alignment of the subcutaneous and muscle layers shifts, locking the medication into the muscle layer.

21
Q

Where to inject IM into arm?

A

2.5cm below the acromial process

22
Q

What must you do IMMEDIATLEY prior to a deep IM injection?

A

Aspirate to ensure you are not injecting into a blood vessel

23
Q

Consent IM injection?

A

Today I need to administer some medication, this will involve an injection under the skin. You may briefly experience a sharp scratch as the needle is inserted. The procedure does involve some risks which include bleeding, bruising, a persistent lump at the injection site and a small chance of infection or serious allergic reaction.
There is also a small risk of injecting into the blood vessel which I will minimise by checking I am not in a blood vessel before I inject. I will clean the area and use aseptic techniques
The benefits of this procedure are that this is a prescribed medication and it has been deemed necessary by prescriber and it has been decided this is the most appropriate route for the drug to be delivered.

24
Q

Screening prior to ABG?

A

Circulation problems
Blood thinners
Needle phobia

25
Q

Consent for ABG?

A

I need to take a sample of blood from an artery in your wrist to accurately assess your oxygen levels. The procedure will be a little painful, however, it should only take a short amount of time. If you want me to stop at any point, just let me know. The procedure does involve some risks which include bleeding, bruising, infection and very rarely permanent damage to the artery being sampled from.

26
Q

ABG contrainidcations?

A

Absolute contraindications: peripheral vascular disease in the limb, cellulitis surrounding the site or arteriovenous fistula.
Relative contraindications: impaired coagulation (e.g. anticoagulation therapy, liver disease, low platelets <50).

27
Q

How oxygen therapy affects ABG results?

A

PaO2 should be greater than 10 kPa when oxygenating on room air in a healthy patient.
If the patient is receiving oxygen therapy their PaO2 should be approximately 10kPa less than the % inspired concentration FiO2 (so a patient on 40% oxygen would be expected to have a PaO2 of approximately 30kPa).

28
Q

What other info required for ABG sample (to input into the machine?

A

Temp

PaO2

29
Q

How long after sample should you get ABG sample to machine?

A

Take the ABG sample to be analysed as soon as possible after being taken as delays longer than 10 minutes can affect the accuracy of results. (use ice if longer)

30
Q

How long apply pressure after ABG

A

3-5 mins

31
Q

How long after release of the ULNAR artery in modified allens should colour return to the patients hand?

A

5 to 15 seconds.

OSCE (14 decks)

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