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Clinical > Procedures > Flashcards

Procedures Flashcards

1
Q

Urine dip (11)

A
  • Wash hands
  • Put gloves/goggles/apron (PPE)
  • Check patient details
  • Check date on bottle
  • Check correct urine
  • Colour (blood)
  • Clarity (cloudiness - infection? Froth - protein?)
  • Dip stick in, take it out, shake it
  • Put vertically on horizontal bottle and wait correct times
  • Dispose of all PPE
  • Document and further investigations
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2
Q

What patient details should be checked in all procedures? (3)

A
  • Name
  • DOB
  • Hospital number
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3
Q

What should be checked in the colour of urine? (3)

A
  • Red: blood = cancer/infection? Check morphology and culture
  • Brown: myoglobin? bilrubin=liver failure
  • Dark: Dehydration
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4
Q

What should be checked for in the clarity of urine? (2)

A
  • Cloudy = UTI

- Frothy = nephrotic syndrome

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5
Q

What should be looked for in the odour of urine? (2)

A
  • Offensive = UTI

- Sweet = glycosuria

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6
Q

What further investigations could be suggested for a urine drip? (3)

A
  • Raised WCC: culture
  • Macroscoptic haematuria: morphology and culture - if negative then USS ultrasound for stones/endoscopy for cancer
  • Raised glucose: capillarly blood glucose
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7
Q

What does a high pH in urine indicate?

A

Systemic acidosis

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8
Q

What does a high specific gravity in urine indicate?

A

Diabetes insipidus

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9
Q

What does protein in urine indicate?

A

Nephrotic syndrome

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10
Q

What do nitrites in urine indicate?

A

UTI

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11
Q

What does bilrubin in urine indicate?

A

Bilary tract obstruction

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12
Q

What does urobilinogen in urine indicate? (2)

A
  • Malaria

- Haemolytic anaemia

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13
Q

How should peak flow be assessed? (17)

A
  • Explain procedure and consent
  • Hold horizontally
  • Check gauge on meter moves freely
  • Set to zero
  • Demonstrate?
  • Apply new mouthpiece
  • Patient not put finger on slide scale/in way of gauge
  • Patient stand
  • Full inspiration
  • Seal lips around mouthpiece
  • Blow as hard and fast as possible
  • Emphasis not length of expiration being measured
  • Demonstrate if hard?
  • Set back to zero, 2x attempts
  • Record highest reading
  • Document: l/min
  • Dispose mouthpiece
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14
Q

What is a normal peak flow value in men?

A

Up to 100 l/min lower than predicted

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15
Q

When is a peak flow diary useful? And for how long? (3)

A
  • Over 2 weeks
  • Least variation: best controlled
  • Dinural?
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16
Q

How to use a metered dose inhaler? (MDI) (18)

A
  • Check expiration date
  • Test the inhaler : pointing the mouthpiece away and pressing on the canister
  • Patient can test this front of mirror to see mist: not being fully inhaled if seen
  • Remove cap
  • Shake
  • Hold inhaler with index finger on canister
  • Thumb on the bottom of mouthpiece
  • Patient stands/sits straight
  • Tilt head slightly back
  • Exhale fully
  • Put mouthpiece of the inhaler in mouth
  • Between teeth with lips gently closed around mouthpiece, form a seal
  • Take deep breath in: press on cannister
  • Inhale slowly and deeply
  • Aim for back of throat not mouth
  • Hold breath for slow 10 secs
  • Exhale slowly=away from the inhaler
  • If repeat wait 30secs-1min
  • 2 or more puffs
  • Replace cap
17
Q

How to take care of an MDI? (4)

A
  • Remove metal canister
  • Cleaning plastic casing
  • Under warm running water
  • Dry thoroughly inside and out
18
Q

How is a dry powder inhaler used differently? (2)

A
  • Quick and deep breathing

- Click to release

19
Q

Why should the mouth be washed after steroid use? (2)

A
  • Minimise GI absorption

- Minimises oral candidiasis

20
Q

Things to check when explaining procedures to patients (7)

A
  • Wash hands
  • Patient details
  • Check understanding of what it is/why used?
  • Patient summarise
  • Observe and fine tune
  • Any concerns/questions
  • Patient info leaflet
21
Q

Why use a spacer? (4)

A
  • Improve drug deposition to the lungs
  • Can’t master aerosal technique: children/elderly
  • Reduces drug in mouth
  • Slower speed drug coming out inhaler, more time to breathe
22
Q

How is a spacer used? (8)

A
  • Put index finger on top of cannister and thumb under
  • Remove inhaler cap
  • Shake
  • Attach inhaler to spacer
  • Breath out into spacer as possible
  • Seal lips airtight around mouthpiece: tight seal
  • Release 1 dose into spacer
  • Breathe in deep and slow (3-4 breathe)
  • Too fast: whistling sound
  • Remove spacer from mouth and breathe outside the spacer
  • Rinse mouth for oral thrush
23
Q

How should a spacer be taken care of? (4)

A
  • Wash with detergent
  • Once a month
  • Leave to air dry (NOT wiped - static electricity)
  • Replace 6 months
24
Q

What type of inhaler needs a spacer?

A

MDI

25
Q

When is an MDI inhaler difficult to use and why? (2)

A

Children and elderly:

  • Requires good co-ordination
  • Needs strong inspiration
26
Q

What happens when an MDI is used badly?

A

Reduced efficacy, can land on back of mouth and tongue not lungs

27
Q

What is peak flow used for? (4)

A
  • Monitor progress of asthma
  • Age/sex/gender peak flow
  • Asthma attacks symptoms
  • Any triggers
28
Q

Good advice for inhaler? (3)

A
  • “Not like movies”
  • “Breathe out fully so next breath in has all the drug”
    “Maintain composure even if panicky.”
29
Q

Brown inhaler

A

12-24 hrs 1x day

Clinical (21 decks)

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