Basic Clinical Skills Practical

Introduction

• Introduce yourself (name)

• Introduce your role (medical assistant)

• initiate a fluid conversation

SAMPLE

• Signs and Symptoms

• Allergies

  • “do you have any allergies”

• Medications

  • “what medications are you currently taking?”

• Past Medical History

  • “what medical problems have you been diagnosed with?”

• Last Oral Intake

  • “what was the last thing you ate or drank?”

• Events leading up to injury/illness

  • “what were you doing before or during the injury?”

OPQRST

• Onset

  • “how did your symptoms begin?” 

  • “did it start rapidly or were the symptoms gradual?”

• Provocation/Palliation

  • “does anything make the symptoms better or worse?”

• Quality

  • “can you describe the type of pain you are feeling, for example is it sharp, dull…?”

• Region/radiation

  • “where do you feel your pain, does it radiate anywhere else?”

• Severity

  • “on a scale of 1 -10, 1 being no pain at all and 10 being the worst pain of your life, where would you rate your pain”

• Time

  • “when did the pain first begin and how long did it last?”

Heart Rate and Respiratory rate

• ask patient to grab their shoulder

• 15 seconds for heart rate

• 15 seconds for respiratory rate

• report your results to your patient

Blood pressure

• align with brachial artery

• make sure stethoscope is on the diaphragm side

• report results to patient

Height and Weight

• ask patient to take their shoes off and step backwards on the scale

• report results to patient

lung sounds

• ask patient to take their shirt off

• stethoscope switched to diaphragm 

• report results to patient

  • “clear and equal bilaterally”

heart sounds

• ask patient to take their shirt off

• stethoscope switched to bell side

• aortic - 2nd intercostal R sternal border

• pulmonic - 2nd intercostal L sternal border

• tricuspid - 4th/5th intercostal L sternal border

• mitral - 5th intercostal midclavicular line

• report results to patient

EKG

• prep site by cleansing with alcohol

• place electrodes at correct locations

• limb leads and chest leads

Precordial (chest) leads

• V1: 4th intercostal @ R sternum

• V2: 4th intercostal @ L sternum

• V4: 5th intercostal @ Midclavicular (BEFORE V3)

• V3: directly between V2 and V4

• V5: 5th intercostal @ anterior axillary

• V6: 5th intercostal @ midaxillary line

limb leads

• right and left arm

• right and left leg

• don’t place on bone

O2 administration

• Nasal Cannula

  • 1-6 L/min

  • prongs facing downwards

• Partial non-rebreather

  • 10-15 L/min

  • bag should be filled before placing on patient (hold down middle)

  • tighten string and metal band

• Bag-valve mask

  • 15 L/min

  • squeeze until you see chest rise and fall

Urine Dip steps

• open container and take out strip

• open urine sample carefully

• dip strip until all tiles are submerged

• dab urine on paper towel

• close lid on urine sample

• do glucometry then come back to analyze

urine dip analysis

• leukocytes - white blood cells? infection?

• nitrites - uti?

• protein - kidney disfunction?

• pH - problems with kidney?

• Blood - problems with kidney or urinary tract?

• Specific gravity - more “stuff” in urine?

• Ketones - body burning fat instead of sugar for energy?

• Bilirubin - liver problems"?

• glucose - diabetes?

• report results to patient

Blood glucose steps

• prepare supplies

  • alcohol wipe, gauze, band-aid, lancet, test strip, glucometer)

• Explain procedure to patient

  • “now I will be testing your blood glucose level, which requires me to prick your finger. Which finger do you prefer?”

• clean finger

• insert strip into glucometer

• press CAPPED lancet onto finger

• apply pressure with gauze and place band-aid

• put lancet and strip into biohazard bin

• report results to patient