Clinical Skills

What are the 2 C’s to remember before ANY examination?

CLEAN and CONSENT

What does the CLEAN step entail before any examination?

Ensure hands are clean, gel hands before and after touching a patient and use gloves near bodily fluids

What does the CONSENT step entail before any examination?

ALWAYS get permission before touching a patient

What does the acronym STTSH mean?

See, touch, taste, smell, hear

How should you use a stethoscope?

• Turn it on!

• Use diaphragm (flat face) for most uses

• Use bell for low frequencies

• Used to auscultate respiratory and heart sounds

What is the name for a blood pressure monitor?

Sphygmomanometer

What is blood pressure?

Measure of the pressure that the circulating blood exerts against the arterial walls: cardiac output x peripheral vascular resistance

What is the examination sequence for a manual BP check?

• rest patient for 5 minutes

• Measure BP in both arms

• Support arm comfortably at heart level and have no tight clothing constricting the upper arm

• Apply cuff to upper arm

• Palpate the brachial pulse or radial

• inflate cuff until pulse is impalpable and inflate another 30mmHg

• Slowly reduce pressure 2-3mmHgs until you hear the first Korotkoff sound and record toe reading - systolic

• Continue to deflate until the sound disappears - record diastolic when sounds completely disappear

How many readings can you take of BP in one arm in 30 minutes?

2

How do you use a tympanic digital thermometer?

• Do NOT touch the probe cover when putting on or discarding

• Turn machine on

• Check no discharges

• Pull up pinna and take reading from external auditory meatus

What is a pulse?

Ejection of blood from the left ventricle into the systemic arterial circulation creates a pressure wave - travels faster than blood flow

What is the radial pulse?

At radial bone side of the wrist

What is the brachial artery?

Inner side of the biceps

Where is the carotid artery?

On the side of the neck between larynx and anterior border of the sternocleidomastoid muscle

Where is the femoral artery?

In the groin

Where is the posterior tibial artery?

Behind the inner ankle

Where is the dorsalis pedis artery?

Best felt in groove between 1st and 2nd metatarsals - can be absent or abnormally sited in 10% of subjects

What is a resting heart rate usually between?

60-90bpm

What is a bradycardia heart rate usually?

< 60bpm

What is a tachycardia bpm usually?

>100bpm

What can irregular rhythm of the heart be due to?

Ectopic beat or atrial fibrillation

What is a large pulse volume due to?

Reflection of large pulse pressure - physiological or pathological

What can a low pulse volume be due to?

Reduced stroke volume

What can be used to assess pulse character and volume?

Larger pulses - brachial, carotid, femoral

What is the character of the pulse?

Waveform or shape of arterial pulse

What does a pulse oximeter measure?

Arterial oxygen saturation by determining proportion of haemloglobin that is oxygenated

What is urinalysis used for?

Screening e.g., random for diabetes or for selective hypertensive patients, diagnosing UTIs, monitoring drug compliance e.g., rifampicin

What are the different markers for urinalysis?

Blood, Leukocytes, Nitrite, Specific gravity, glucose, protein, ketones and pH

What observations should you make when completing urinalysis?

Wear gloves, observe if fresh/warm, labelled, is it definitely urine, observe colour, cloudiness, blood and always discard in clinical bins

What does the presence of leukocytes mean in urinalysis?

infection or inflammation, usually in UTIs - normal result is negative

What does presence of nitrites mean in urinalysis?

Indicates bacterial infection and supports UTI diagnosis - should be negative

What does specific gravity mean in urinalysis?

Conc of solutes in urine and reflects hydration and kidney function - should be 1.005-1.030

What does a high specific gravity mean?

Dehydration, proteinuria, glycosuria

What does a low specific gravity?

Overhydration, impaired kidney concentrating ability

What does glucose in the urine inidcate?

Diabetes, can be pregnancy or kidney tubule disorders - usual result is negative

What does protein in the urine indicate?

Kidney damage, hypertension or diabetes - should be negative

What can ketones indicate in the urine?

Diabetes ketoacidosis - should be negative

What should the usual pH range be in urine?

4.5-8 - can be influenced by other factors

What is BMI a measure of?

An individuals height and weight to calculate if their weight is healthy

What does BMI take into consideration?

Variations in body shape and provides a healthy weight range

How do you calculate BMI?

Weight/Height x height

What equipment do you need to take someones blood glucose?

Gloves, glucose meter, test strips, single use lancet and cotton swab

How do you complete a capillary blood glucose measurement?

• Introduce yourself, explain the procedure and obtain consent

• Clean your hands and put on gloves

• Clean patient’s fingertip and allow to dry

• Insert the test strip into the glucose meter after checking it is in
  date

• Prick the side of the patient’s finger with the lancet (no lower than
  the nail bed) and gently massage to promote bleeding

• Apply this drop of blood to the test strip until the meter confirms an
  adequate sample has been received

• Give the patient the swab to stop the bleeding and safely dispose
  of gloves, lancet and test strip

• Clean your hands

What is a normal range for blood glucose?

4-5mmol/L when fasting, up to 7.8mmol/l 2 hours after eating

What does QRISK3 calculate?

Risk of an individual developing a heart attack or stroke over the next 10 years

What does NEWS2 measure?

Detects deterioration in adults - better identifies patients likely to be septic, improved scoring for respiratory failure and recognises importance of new-onset delirium or confusion

What is an example sheet for NEWS2?