Baptist Health Clinical Skills Assessment

6 times to perform hand hygiene

1. before touching a patient

2. before performing an aseptic task/handling invasive medical devices

3. before moving a soiled body site to a clean body site on the same patient

4. after touching a patient or the patient’s immediate environment

5. after contact with bodily fluids

6. after glove removal

times to use soap and water

before eating, after using the restroom, when hands are visibly soiled, after exposure to C-diff, after exposure to patients with known norovirus outbreaks

time-out protocols

1. Correct patient with 2 patient identifiers

2. Correct procedure is being prepared

3. Correct body site and laterality if appropriate

4. All must be performed immediately prior to the procedure with you

5. All must be confirmed by comparing to the order in EPIC

Anaphylaxis

A severe, life-threatening allergic reaction that can occur within minutes of exposure to an allergen. It is a medical emergency that requires immediate treatment.

Signs/symptoms of anaphylaxis

Trouble breathing, hives, swollen tongue/throat, tightness of throat, hoarseness, feeling faint or weak, sudden collapse (from BP drop), feeling of doom, low BP, high HR, abdominal discomfort/pain, nausea/vomiting, diarrhea, and cardiac arrest or death

administering epipen

1. Remove the blue safety release cap

2. Swing and firmly push the orange tip against the outer upper thigh until it clicks

3. Keep the injector firmly against the thigh for 10 seconds

AED pad placement adults

anterior-lateral (anterior pad to the right of the sternum below clavicle, other pad lateral under left pectoral muscle/breast) and anterior-posterior position (anterior pad to the left of sternum below chest/breast, other pad posterior left of the spine just below scapula at the heart level)

AED pad placement children

patients under 8 years, use anterior-posterior (anterior pad ona the front chest wall and back pad on the center of children’s back)

elements for successful defibrillation

ensuring pads are completely adhered to victims skin, remove all jewelry, shave excessive chest hair, never place AED on breast tissue, dry chest (no moisture), and adequate pressure to push pads onto patient

hypterension

130/80 mmHg or higher for all adults

rules/guidelines for taking BP

Take BP last of all vital signs, sit quietly with back supported and feet flat, sit for at least 5 minutes no talking, arm should be supported at heart level (not hanging), have patient empty bladder if needed

EKG

painless procedure to evaluate the heart rate and rhythm, patients should undress from the waist up and a drape should be offered to provide privacy, patient should lie flat on the bed, if possible, remove all jewelry, patient should remain quiet and still during procedure, chest area may need to be shaved, clean areas with alcohol wipes if skin is unclean, sweaty or lotioned

subcutaneous injections

meant to be deposited into the fatty layer of tissue just under the skin, to be absorbed much more slowly because there is little blood flow to fatty tissue (45 degree angle)

injection sites: triceps, belly, glutes, thighs(45-degree

intramuscular injections

meant to be deposited deep into muscle tissue, to be absorbed quickly due to greater blood supply in muscles, allow absorption of larger doses, less painful for medications irritating to other tissues (90-degree angle)

deltoid injections

typically used for IM injections of smaller quantities, find thickest point of this muscle about 2 inches below acromion process (most vaccines administered here)

SIRVA (shoulder injury related to vaccine administration)

Too High: risk of injection into shoulder joint/bursa, can cause inflammation (bursitis, frozen shoulder, etc), too far to the side: can injection into the axillary nerve, Too low: can inject into radial nerve

Vastus lateralis IM injeciton site

preferred for infants to 12 months, site is middle 1/3 of thigh and outer aspect

wound care

MAs can deal with surface-level wounds only (can prepare and sanitize materials required for wound care, remove/appropraitely dispose of old wound dressings, clean a wound with nontoxic antibacterial cleaning agents, apply topical medications, such as antibioitic or pain ointments, as directed by a physician or other provider

Steps for MA’s with basic wound care

1. Perform hand hygiene to help avoid infection

2. Using aseptic technique, remove old dressing and allow physician or provider to view for quantity and quality of drainage on dressing

3. Remove gloves and perform hand hygiene

4. Clean wound as directed

5. Apply antibacterial ointment as directed