Procedures Flashcards
Urine dip (11)
- 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
What patient details should be checked in all procedures? (3)
- Name
- DOB
- Hospital number
What should be checked in the colour of urine? (3)
- Red: blood = cancer/infection? Check morphology and culture
- Brown: myoglobin? bilrubin=liver failure
- Dark: Dehydration
What should be checked for in the clarity of urine? (2)
- Cloudy = UTI
- Frothy = nephrotic syndrome
What should be looked for in the odour of urine? (2)
- Offensive = UTI
- Sweet = glycosuria
What further investigations could be suggested for a urine drip? (3)
- Raised WCC: culture
- Macroscoptic haematuria: morphology and culture - if negative then USS ultrasound for stones/endoscopy for cancer
- Raised glucose: capillarly blood glucose
What does a high pH in urine indicate?
Systemic acidosis
What does a high specific gravity in urine indicate?
Diabetes insipidus
What does protein in urine indicate?
Nephrotic syndrome
What do nitrites in urine indicate?
UTI
What does bilrubin in urine indicate?
Bilary tract obstruction
What does urobilinogen in urine indicate? (2)
- Malaria
- Haemolytic anaemia
How should peak flow be assessed? (17)
- 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
What is a normal peak flow value in men?
Up to 100 l/min lower than predicted
When is a peak flow diary useful? And for how long? (3)
- Over 2 weeks
- Least variation: best controlled
- Dinural?
How to use a metered dose inhaler? (MDI) (18)
- 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
How to take care of an MDI? (4)
- Remove metal canister
- Cleaning plastic casing
- Under warm running water
- Dry thoroughly inside and out
How is a dry powder inhaler used differently? (2)
- Quick and deep breathing
- Click to release
Why should the mouth be washed after steroid use? (2)
- Minimise GI absorption
- Minimises oral candidiasis
Things to check when explaining procedures to patients (7)
- Wash hands
- Patient details
- Check understanding of what it is/why used?
- Patient summarise
- Observe and fine tune
- Any concerns/questions
- Patient info leaflet
Why use a spacer? (4)
- 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
How is a spacer used? (8)
- 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
How should a spacer be taken care of? (4)
- Wash with detergent
- Once a month
- Leave to air dry (NOT wiped - static electricity)
- Replace 6 months
What type of inhaler needs a spacer?
MDI
When is an MDI inhaler difficult to use and why? (2)
Children and elderly:
- Requires good co-ordination
- Needs strong inspiration
What happens when an MDI is used badly?
Reduced efficacy, can land on back of mouth and tongue not lungs
What is peak flow used for? (4)
- Monitor progress of asthma
- Age/sex/gender peak flow
- Asthma attacks symptoms
- Any triggers
Good advice for inhaler? (3)
- “Not like movies”
- “Breathe out fully so next breath in has all the drug”
“Maintain composure even if panicky.”
Brown inhaler
12-24 hrs 1x day
