Clinical Skills Final Flashcards

What is the first thing to do when drawing blood?

Place the tourniquet

What is the second thing to do when drawing blood?

Ask the patient to make a fist to increase bloodflow

What is the third step when drawing blood?

Cleaning the area with an alcohol pad

What is the fourth step when drawing blood?

Remove the packaging from the needle and inspect for deformities

How should the butterfly needle be held when drawing blood?

Hold the plastic wings between the thumb and pointer finger

What direction should the needle be facing when inserted to draw blood?

“Eye to the sky” - or with the hole facing upwards

What angle should the needle be held at when inserted to draw blood?

15° Angle

How do you know if you have successfully entered a vein when drawing blood?

A flash of blood will appear in the tubing

What are the four chambers of the heart?

Right atria, right ventricle, left atria, and left ventricle

What does the superior vena cava carry?

Deoxygenated blood from the upper body to the right atrium

What does the inferior vena cava carry?

Deoxygenated blood from the lower body to the right atrium

What prevents backflow and unidirectional flow of blood in the heart?

Valves

What are the two kinds of valves?

Semilunar and atrioventricular

What type of cardiac cell creates tension within the cell and causes the heart to contract?

Contractile cell

What type of cardiac cell depolarizes to create rhythm in the heart?

Conductive (or pacemaker) cells

Which node of the heart is known as the pacemaker node?

Sinoatrial (SA) Node

Which node of the heart maintains the rhythm and depolarizes, causing the atria to contract?

SA Node

Which node of the heart sends a signal to the Bundle of His, causing the ventricles to contract?

Atrioventricular (AV) Node

What causes cardiac arrest?

A disruption in the electrical signals

What are the two types of cardiac arrest?

Ventricular fibrillation and Atrial fibrillation

What is CPR?

An emergency lifesaving procedure performed when the heart stops beating

What prevents the delivery of oxygen to the organs?

Cardiac arrest

In what three scenarios should you perform CPR?

1. The patient is not breathing

2. The patient is taking gasping breaths

3. The patient’s heart has stopped beating

What occurs in a heart attack?

Blood flow to the heart is blocked?

What type of problem is cardiac arrest?

Electrical

What type of problem is a heart attack?

Circulation

What is the first thing you should do when performing CPR?

Check the scene

What is the second thing you should do when performing CPR?

Check the patient for responsiveness, pulse, and breathing

What is the third thing you should do when performing CPR?

Tell someone to call 911 and someone else to find an AED

What is the fourth thing you should do when performing CPR?

Start compressions

What is the rate compressions should be performed at?

30 compressions at a rate of 100 per minute (Stayin’ Alive)

What is the fifth thing you should do when performing CPR?

Open airways and deliver breaths

How many breaths should you deliver after 30 compressions?

Two breaths six seconds apart

What is the sixth step you should do when performing CPR?

Use an AED

Where should the pads for an AED be placed?

One pad on upper right chest and one on the left lower chest

What are the two main parts of the circulatory system?

Systemic Circulation and Pulmonary Circulation

What type of blood does systemic circulation move?

Oxygenated blood from heart to the tissues and deoxygenated blood from the tissues to the heart

What type of blood does pulmonary circulation move?

Deoxygenated blood from the heart to the lungs and oxygenated blood from the lungs to the heart

In what direction does blood flow in arteries?

Away from the heart

In what direction does blood flow in the veins?

Back to the heart

What do veins contain to prevent backflow of blood?

Valves

What is the Skeletal Muscle Pump?

It uses the valves in veins to push blood against gravity and low pressure back to the heart through the pressure muscles put on veins when they contract

What is a volume reservoir?

Veins act as volume reservoirs to carry a large volume of blood back to the heart

What is venous return?

The amount of blood returned to the heart

What causes varicose veins?

They occur when the walls of veins and valves become damaged, enlarged, and twisted

What are the risk factors for varicose veins?

• Being female

• Old age

• Long periods of standing

• Obesity

• Being inactive

What is the treatment for varicose veins in mild to moderate cases?

Compression socks

What is the treatment for varicose veins in severe cases?

• Sclerotherapy

• Laser treatment

• High ligation

• Vein stripping

What are the two types of IVs?

Peripheral IV and Antecubital IV

Where is a peripheral IV inserted?

The back of the hand in the dorsal root arch

Where is an antecubital IV inserted?

Inner elbow in the medial cubital vein

When should an antecubital IV be used?

For shorter procedures

When should a peripheral IV be used?

For longer procedures or surgeries

When placing an IV, does the needle stay in the patient?

No, it is removed and a hollow catheter remains

Normal saline solution contains what percent NaCl?

0.9% NaCl and is isotonic

Lactated ringer solution contains what?

NaCl, sodium lactate, potassium chloride, and calcium chloride

Is lactated ringer solution buffered?

Yes

How should you place an IV?

Just like drawing blood

What is considered bradychardia (slow heart rate)?

HR < 60 bpm

What heart rate is considered tachycardia (fast heart rate)?

HR > 100 bpm

What is a normal heart rate?

HR 60 - 100 bpm

What is asystole?

Heart has no rhythm (no heart rate)

What can a fast heart rate indicate?

• Excited states

• Hypokalemia (low potassium)

• Anemia

• Overactive thyroid/hyperthyroidism

What can a slow heart rate indicate?

• Could be a sign of heart attack

• Hyperkalemia (high level of potassium)

• Underactive thyroid/hypothyroidism

What acronym should be remembered for an ECG?

PQRST

P: SA node depolarized

Q: Initial depolarization of ventricles

R: Early depolarization of ventricles along Bundle of His

S: Depolarization of ventricles along Perkinje Fibers

T: Repolarization of ventricles

How do ECGs read heart rhythms?

It uses a 12 lead system, each with its own location

How long is each ECG segment?

Six seconds in length

What are non-shockable rhythms?

• Pulseless Electrical Activity (PEA)

• Asystole

What are shockable rhythms?

• Ventricular fibrillation

• Ventricular tachycardia

What is blood pressure?

The force that blood exerts against the walls of arteries

What is systolic blood pressure?

The phase in which the heart contracts and blood pressure rises. It measures the force your heart exerts on the walls of your arteries every time it contracts.

What is diastolic blood pressure?

The phase when the heart relaxes and blood pressure falls. It measures the pressure in the arteries when the heart is relaxing in between contractions.

What is considered a normal BP?

Less than 120 systolic/80 diastolic

What is considered prehypertension?

120-139/80-89

What is considered Stage 1 hypertension?

140-159/90-99

What is considered Stage 2 hypertension?

Anything 160/100

What is considered hypotension?

Below 90/60

What can cause high BP?

• Plaque buildup on arteries

• LDL (low-density lipoprotein) > HDL (high-density lipoprotein)

• Medication

What instruments can be used to determine BP?

Sphygmomanometer and stethoscope

The first vibration heard when taking BP is which?

Systolic

The second vibration heard when taking BP is which?

Diastolic

Where are the two places you can take a pulse?

Radial and carotid

What are the bronchi in the lungs?

They stem directly from the trachea and split into more narrow secondary bronchi, which then lead to the bronchioles and alveoli

How do the lungs breathe?

They use negative pressure to pull air in and positive pressure to push air out

The lungs are surrounded by what?

The pleural membrane which creates a small layer of hydrophobic fluid that allows the longs to expand and retract

What type of pressure system does intubation use?

Positive pressure system

What is a form of breathing assistance that replicates a negative pressure system?

An Iron Lung

Why is intubation performed?

• Patient cannot maintain their airway

• Cannot breath without assistance

What is an orotracheal intubation?

A procedure where an endotracheal tube is passed through the mouth and vocal cords into the trachea

Is the trachea or esophogeas on top when inserting and ET tube?

Trachea

What are other types of intubation?

• Laryngeal mask intubation —> through the mouth into the trachea

• Nasotracheal intubation —> through the nostril into the trachea

• Oropharyngeal intubation —> through the mouth into the trachea

What is capnography?

A modern technology that monitors the concentration of CO2

What are the two main things to avoid when intubating?

• Avoid chipping the teeth with the laryngoscope

• Avoid mainstem intubation (insertion of the tube into only one lung)

What law describes the movement of air from the atmosphere to the lungs?

Boyle’s Law