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Standard precautions
A group of infection prevention practices in any setting in which healthcare is delivered
5 moments of hand hygiene
Before touching a patient
Before carrying out a procedure
After body fluid exposure risk
After touching a patient
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
Iniating the session
Gathering information
Physical examination
Explanation and planning
Closing the session
Process of initating the session
Preparation (youself, the room, patient notes)
Establishing rapport
Your name, role, purpose
Confirming the patient
Sonsent
Identifying reasons for consulation
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
Look (praecordium): scars, pacemaker box, apex beat, muscle bulk and symmetry, JVP
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