Clinical Skills

Question 1

When is it not safe to take a syringe ABG?

Answer 1

• When there is poor circulation
• When there is an infection at the intended puncture site
• When there are full thickness burns at the puncture site
• When the patient is experiencing Reynaud’s phenomenon
• When the patient has a anti- or pro-coagulation disorder that is unmanaged
• When there is poor collateral blood flow

Question 2

When taking blood from the radial artery for an ABG, the patient’s arm should be slightly ___.

Answer 2

When taking blood from the radial artery for an ABG, the patient’s arm should be slightly dorsiflexed.

Question 3

What angle should you advance the syringe in the radial artery when taking ABG?

Answer 3

30 degrees from the arm

Question 4

How do you know when to stop driving the needle into the arm?

Answer 4

When you appreciate blood in the syringe. Hold this position and allow the syringe to fill on its own with the pressure supplied by the arterial system.

Remeber, go SLOW

Question 5

For how long should pressure be applied after taking blood from the radial artery?

Answer 5

3-5 minutes

Question 6

So you have blood in the syringe and took it out of the patient’s arm. Now what?

Answer 6

Flip the syringe so it is needle-up. Carefully push the plunger to remove air from the syringe.

Attach the end cap to ensure anaerobic conditions.

Send to the lab.

Question 7

How to open a patient’s airway for insertion of gas tubes

Answer 7

Question 8

Jaw-thrust maneuver

Answer 8

Question 9

Oropharyngeal airway placement

Answer 9

• Measure the device for proper positioning and use
  
  • The proper size of an oropharyngeal airway should extend from the corner of the mouth to the lower aspect of the earlobe
• Open the airway with your index finger and thumb and insert the oropharyngeal airway in the inverted position
• Advance to the patient’s hard palate
• Rotate 180 degrees
• Ensure the proximal part of the device rests on the mouth opening and the distal end lies in the hypopharynx
• Ensure the tongue is not obstructing the airway or been pushed back into the posterior pharynx by the device

Question 10

One handed bag-mask technique

Answer 10

Question 11

Nasopharyngeal airway placement

Answer 11

Question 12

Two handed bag-mask technique

Answer 12

Question 13

Limb lead attachment

Answer 13

Question 14

What might interfere with lead placement on a patient’s trunk?

Answer 14

Hair!

Clip hair on the chest that may impede sticking of the electrodes

Question 15

Defibrillation electrode attachment

Answer 15

Question 16

“Shockable rhythms”

Answer 16

• Ventricluar fibrillation
• Pulseless ventricular tachycardia

Question 17

What to do if you aren’t sure whether or not the patient’s ECG indicates defibrillation

Answer 17

Select the “analyze” mode on the defibrillator. It will tell you.

Question 18

Delivering a shock

Answer 18

Hit “charge”

Yell “clear!” and ensure nothing and nobody is touching the patient

Hit “shock”

Question 19

GI bugs that need contact precautions and those that don’t

Answer 19

• Do: C. difficile and norovirus
• Don’t: MRSA and VRE (vancomycin-resistant enterococci)

Question 20

Most important modifiable risk factor for acquiring a catheter-acquired UTI is from an indwelling catheter is. . .

Answer 20

. . . how long the catheter is in place.

Daily risk of acquiring a UTI ranges from 3 to 10%, and so a patient with an indwelling catheter placed for 1 month has nearly a 100% chance of developing a UTI during this period.

Question 21

Routine cleaning of indwelling catheters

Answer 21

Question 22

Foley catheters drain primarily by. . .

Answer 22

. . . gravity!

So, they must be kept in a dependent position AT ALL TIMES in order to work.