Clinical Skills - Interpreting Findings

Normal fasting blood glucose range for non-diabetic

4.0-5.9 mmol/L

Peak flow counselling

red dial towards you/mouth piece

stand or sit up straight

take a deep breath (max breath)

tight seal around the mouthpiece

blow as hard and fast as you can

write down the score

3x in a row with short rest in between

should all be the sameish but dw if they vary a little

use max of 3 as your peak flow

How to interpret a single peak flow reading?

varies by height, age and sex

“normal” is individual to each patient

measured bd everyday for 2 weeks and looking for pattern of variability to diagnose asthma

note down the personal best when healthy to compare with when checking for asthma

% of patients personal best for peak flow

80% of personal best - this kind of variability is expected and is fine

70% of personal best - if symptomatic then treat them, if asymptomatic then check inhaler technique at next check in

<50% of personal best - symptoms → refer to A&E

Steps for capillary blood glucose test

• prepare device by putting strip in the bottom

• wait for the flashing blood drop sign

• lance the side of your fingertip (not the bottom or the actual tip)

• put the lancet in the sharps bin

• squeeze to get a drop of blood

• touch the drop to the front edge of the yellow window of the stripe - when you see the sand timer flash you have enough blood

• record the result and dispose of the used strip in a clinical waste bin

MSU

Mid stream urine sample

• midstream flow sample

• clean catch in a sterile container

tips for urinalysis

PPE - may have contamination on outside of bottle

CLOSE THE BOTTLE AFTER DIPPING!!

Steps to urinalysis

• introduce

• inspect the colour and smell

  • blood?

  • weird colour - due to meds?

  • cloudy?

• check dipstick expiry

• dip stick in and wipe off excess

• hold it horizontally

• wait 30s before checking first result which is glucose at the bottom of the stick

Summary of results for dipstick

haematuria - caused by infection, benign mass, cancer, urinary tract stones, renal conditions vasculitis or menstruation

leucocytes - infection

nitrites - infection

protein - infection, diabetes, renal disease or myeloma

glucose - diabetes/sepsis

ketones - uncontrolled diabetes, eating disorder

ACR - kidney disease (follow up with lab confirmation)

bilirubin and urobilinogen - liver disease and bile duct obstruction

UTI diagnosis

2-3 symptoms of:

• dysuria

• nocturia

• urine cloudy to naked eye

dipstick not needed

1 symptom - dipstick needed

Dipstick diagnosis in men

not to be used to rule out infection as they are unreliable

Haematuria

if unexplained then investigate !!

common causes include:

• uti

• meds causing colour

• menstruation

• kidney stones

worries? cancer!!

Glucouria

glucose in urine

causes:

• diabetes - not a diagnostic tool

• renal tubular disease

• sglt2i

Ketones

breakdown product of fatty acid metabolism

normally absent in tests

causes:

• poorly controlled diabetes

• lack of carbs in diet - e.g. ED

DKA

caused by severe insulin deficiency

symptoms:

• thirst

• urinary frequency

• abdominal pain

• nausea

• diarrhoea

• weight loss

• sob

• lethargy

• confusion

• blurred vision

• breath smells like acetone