TACS revision

Standard precautions

Standard precautions

A group of infection prevention practices in any setting in which healthcare is delivered

5 moments of hand hygiene

1. Before touching a patient

2. Before carrying out a procedure

3. After body fluid exposure risk

4. After touching a patient

5. After touching patient surroundings

Temperature sites + average temperature

• Tympanic: 36.64C

• Oral: 36.57C

• Axillary: 35.97C

• Rectal: 37.04C

Temperature >38.5C indicates

Significant fever

Temperature <34C indicates

Possible hypothermia

55-95bpm

Normal pulse rate

12-20 breaths per minute

Normal respiratory rate

>25 breaths per minute indicates

Tachypnoea

<8 breaths per minute indicates

Bradypnoea

Kortkoff sounds

sounds heard through the stethoscope when ausculating BP, causedby turbulent blood flow

What causes HTN?

• Stress/ anxiety

• White coat HTN

• Stimulants e.g. caffiene, cocaine, nicotine, amphetamine

• Over-hydration/ full bladder

• Salt, baking soda, liquorice

• Cuff size too small

What do you do if BP is too high?

• Check cuff size (not too small)

• Make sure patient is relaxed

• Measure again after 5 minutes of rest

What causes hypotension?

• Relaxation/ prolonged bed rest

• Recent meal

• Dehydration

• Serious illness

• Endocrine/ neurological conditions

• Cuff size too big

Steps of the Calgary-Cambride guide

1. Iniating the session

2. Gathering information

3. Physical examination

4. Explanation and planning

5. Closing the session

Process of initating the session

1. Preparation (youself, the room, patient notes)

2. Establishing rapport

   1. Your name, role, purpose

   2. Confirming the patient

   3. Sonsent

3. Identifying reasons for consulation

4. Negotiating an agenda

Symptom

Subjective feature which is apparent to the patient

Sign

Objective evidence of a disease, observed or elicited by the clinician

Pain

Sensation of discomfort the patient experiences

Tenderness

Sensation of discomfort the doctor elicits in the patient

Location of aortic valve

2ics RSE

Location of pulmonary valve

2ics LSE

Location of tricuspid valve

4ics LSE

Location of mitral valve and apex beat

L5ics mcl

What does JVP assess?

Right atrial pressure

PPE that is part of standard precautions

• Non-sterile gloves

• Mask

• Eye protection

• Gown/ apron

Associated symptoms for MSK

• Pain

• Stiffness

• Deformities

• Locking

• Instability

• Swelling

• Redness/ change in colour

• Heat

• Weakness

• Numbing/ tingling

• Extra-articular symptoms

• Altered function

Associated symptoms for CV

• SoB

• Palpitations

• Pain (angina, claudication)

• dizziness/ fainting

• oedema

D

Sternal angle

C

Suprasternal notch

Why is the internal jugular vein used to assess R atrial P?

No valves and drains directly into SVC

Waves seen when assessing JVP

a wave (atrial systole) and v wave (ventricular systole)

Process skills in gathering information

• Appropriate open and close-ended questions

• Listens attentively without interrupting

• Facilitative responses

• Picks up verbal and non-verbal cues

• Clarifies

• Periodically summarises info

• Good posture, eye contact, facing patient

Parts of a CV examination

1. Look (praecordium): scars, pacemaker box, apex beat, muscle bulk and symmetry, JVP

2. Feel: apex beat, peripheral pulses, ausculatation, capillary refill

Informed consent

Process to respect the patient’s right to be informed, make their own decision, and refuse or accept care offered to them

Standard precautions include

• Promoting safety climate

• Respiratory hygiene

• Hand hygiene

• Assessing risk of exposure to body fluid and PPE

• Patient care equipment

• Environment cleaning