NHA CCMA GENERAL PATIENT CARE

Normal oral, tympanic, temporal temperature

98.6 °F (37 °C)

Temporal most common for infants

Normal axillary temperature

97.6 °F (36.4 °C)

Normal rectal temperature

99.6 °F (37.6 °C)

MOST ACCURATE b/c fully in a body cavity

When is body temperature lowest?

morning

When is body temperature highest?

late afternoon

How to convert Celsius to Fahrenheit

F = (C x 9/5) + 32

How to convert Fahrenheit to Celsius

C = 5/9 (F-32)

Ways to determine pulse

Auscultation or palpation

Average HR newborn (birth to 1 month)

120-160/min

Average HR infant (1-12 months)

80-140/min

Average HR toddler (1-3 y/o)

80-130/min

Average HR preschool (3-5 y/o)

80-120/min

Average HR school-age (6-15 y/o)

70-100/min

Average HR adult

60-100/min

Apical pulse

Pulse taken with a stethoscope and near the apex of the heart

Commonly used for infants

Determining respiratory rate

Count respirations while the pt thinks they are obtaining pulse

Cound for 30s and multiply by 2

DO NOT say "breathe normally" or "take deep breaths"

Respiratory rate in newborns

30-50/min

Respiratory rate in adults

12-20/min

Blood pressure range in infants and children

60/30 - 100/80 mmHg

Blood pressure range in adults

100/60 - 140/80

Normal blood pressure

less than 120/80

Elevated blood pressure

120-129/<80

Stage 1 hypertension

130-139/80-89

Stage 2 hypertension

more than 140/90

Procedure for pulse oximetry

Check capillary refill

Wipe site with alcohol

Breathe as normal

Earlobe, finger, toe, nose

NO nail polish!

Low reading = cold fingers

Elevated reading = CO poisoning, hyperventilation

Normal oxygen saturation

95% or higher

BMI < 18.5

underweight

BMI 18.5-24.9

normal

BMI > 24.9

overweight

BMI > 30

obese

Intradermal needle gauge and length

Gauge = 27-28

Length = 3/8 in

Subcutaneous needle gauge and length

Gauge = 25-26

Length = 1/2-5/8 in

Intramuscular needle length and gauge

Gauge = 20-23

Length = 1-3 in (dep on muscle and pt size; for peds pt can be from 5/8-1 in)

1st Korotkoff sound

systolic pressure (sharp tapping due to surge of blood that was occluded)

2nd Korotkoff sound

swishing sounds as more blood flows through artery

3rd Korotkoff sound

sharp tapping sounds

4th Korotkoff sound

soft tapping sound that begins to muffle

5th Korotkoff sound

diastolic BP (silence as blood moves freely)

Deltoid injection

90 degrees

DO NOT ASPIRATE VACCINES

Use for vaccinating adults and older children, DO NOT use for infants/children < 3 y/o

Dose should not exceed 1 mL

Massage after administration

Ventrogluteal muscle injection

90 degrees

DO NOT ASPIRATE VACCINES

Deep IM injections, larger doses, viscous meds

Vastus lateralis injection

90 degrees

DO NOT ASPIRATE VACCINES

Use for vaccinating and medicating infants/children < 3 y/o

Subcutaneous injection

45 degrees

Abdomen, anterior thigh, upper outer arm, upper back under shoulder

DO NOT ASPIRATE VACCINES, INSULIN, HEPARIN

If insulin or heparin, DO NOT massage

If heparin, inject SLOWLY

Pinch the skin

If obese, use 90 degrees angle!

Rotate the sites if regularly used

Intradermal injection

10-15 degrees

Forearms, upper back, skin of upper chest

DO NOT ASPIRATE

Expect to see a wheal, DO NOT massage or apply pressure

TB or allergy testing

Wheezing

Whistling sound heard on expiration that is the body's attempt to expel trapped air

Rales

Clicking, crackling sounds heard on inspiration (moist or dry)

Ronchi

Common rattling snoring sounds often associated with chronic lung diseases

Eye ointment

Apply in thin ribbon along conjunctival sac from inner to outer canthus

Close eye and roll eyeball after administration

Do not let tip of containers touch the pt!

Ear medication

Kids under 3? Ear should be facing up and pull EARLOBE DOWN AND BACK

Adults? Ear should be facing up and pull PINNA UP AND BACK

Do not let tip of containers touch the pt!

Ensure room temp (cold = dizzy, hot = pain/burns)

Keep head tilted 5-10 mins and dry runoff with cotton balls

Eye drops

Look up, close eyes and move back-forth, do not keep blinking

Apply parallel and above the eye

Do not let tip of containers touch the pt!

Ear irrigation

removes cerumen from auditory canal

ensure it is body temperature b/c too cold = dizzy, too hot = burns

tilt head in direction of affected ear to facilitate irrigation and drainage and pull pinnae up and back

when procedure is completed and fluid is drained, insert cotton applicator (NOT deep)

do not use too much water or be too rapid b/c can cause pain and dizziness

Contraindication of ear irrigation

Contraindicated if tympanic membrane is torn

Abrasion

Scrape/rub, superficial wound affecting often knees/elbows

Incision

Open injury typically caused by sharp object causing straight cut; can cause profuse bleeding

Laceration

Open injury that is jagged in nature and caused by a sharp object; bleeding can be profuse

Puncture

Open wound caused by an instrument that delivers a stab; small with limited bleeding

Contusion

Closed injury (bruise) caused by blunt force trauma

Concussion

Closed head trauma in which the brain has been jolted/shaken

Strain

stretching or tearing of muscle or tendon

Sprain

stretching or tearing of ligaments

Fracture

Break in a bone

Open/compound (skin is broken) or closed/simple (skin is not broken)

Anaphylaxis

Severe allergic reaction in which there is circulatory shutdown and respiratory distress, resulting in shock

Administer oxygen/epinephrine and call 911

Acute abdominal pain

General symptom that can be life-threatening

Keep pt NPO, emesis basin, monitor VS for shock, keep warm

Bleeding

Internal or external

Arterial more serious than capillary

Burns

Electrical, chemical, thermal

1st degree = first layer (sunburn)

2nd degree = subcutaneous layer (blistering)

3rd degree = muscle and bone (black, dry, charred)

Assess using rule of nines

Choking

Airway obstruction, may be unable to speak/breathe and holding the neck

ask "are you choking?" and if they cannot breathe/talk, perform Heimlich, if unconscious, CPR and foreign body removal

Diabetic coma

hyperglycemia

administer insulin

Insulin shock

hypoglycemia

administer glucose

Seizure

Assist pt to lying position

Protect from injury

Tilt head to prevent aspiration

Time the seizure

Stay with pt and observe

If they continue, call 911

Syncope

Fainting

Pale, diaphoresis, chills, nausea, dizziness

Shock

Hypotension, weak pulse, tachypnea, tachycardia, cold, pale, sweaty skin, bluish skin

Anemia

Irregular heartbeat, fatigue, dizziness, pale skin

Transient ischemic attack (TIA)

Cephalgia, vertigo, temporary paralysis on one side of body

"mini stroke"

Oral medication administration

Mouth for quick absorption into bloodstream

MOST COMMON ROUTE

Solids: for multiple-dose bottles, pour pills into the lid first, then medicine cup

Liquids: pour in separate medicine cup (not lid) on flat surface, read at bottom of meniscus at the dose mark and "palm" the label to prevent distortion if meds drip

Sublingual medication administration

Under tongue; bypasses digestive system, absorbed into bloodstream quickly

Example = nitroglycerin tablets and spray

Buccal medication administration

Btwn cheek and gums; bypasses digestive system, resulting in smaller doses for therapeutic effects

Designed to melt while held in cheek area and absorb into bloodstream quickly; DO NOT chew/swallow

Inhalation medication administration

Used for targeted areas like the bronchial passages; can be delivered via a nebulizer

Must hold medication in lungs as long as possible to be effective

When using inhalers/nebulizers, can become shaky/dizzy due to meds and hyperventilation; coach on proper breathing techniques

Topical medication administration

Designed to react locally and systemic absorption is minimal

Can serve as barrier to prevent irritants from damaging skin/treat local condition (acne, athlete's foot)

Liniments (higher oil concentration) for dried or cracked skin

Lotions for itching/inflammation

Monitor for skin irritation or rxn and instruct to apply as Rx

Transdermal medication administration

For continuous slow absorption of meds; used for smoking cessation (nicotine patches), pain meds, hormone delivery

Avoid touching meds when applying the patch

Can shower

Dispose of patch in container inaccessible to children

Place on area without hair on abdomen or upper arm (not below elbows/knees b/c less absorption); monitor skin for irritation but do not apply lotion

Rotate sites and when switching patches, leave old one on for 30 mins after applying new one to maintain therapeutic levels in blood

Extended release medication

Consistent amount of medication to use over period of time

Take it same time each day

Drink with water, NEVER crushed!

How to prepare examination table for the next patient

1:10 bleach

Roll up paper tightly and quickly to minimize transmission of contaminants on paper

Pillow below paper

Signs of infection

Redness/swelling, hot, drainage, foul odor, fever, malaise, lymphangitis

Dressing vs Bandage

Dressing = sterile, cover wound

Bandage = non sterile, cover dressings

Sterile field

Open flaps away from you first

1 inch around is not sterile

Open packages to drop onto the sterile field

Clean vials with alcohol

Hands above waist

NEVER leave sterile field unattended, reach over sterile field, turn your back to the sterile field

Removing sutures/staples

Suture scissors and forceps are needed

Crusting/exudate need soak with saline before

Remove every other suture or staple first and replace each with an adhesive closure strip; if the incision remains securely closed, remove the rest with the same process

For sutures, grasp knot with forceps and cut close to the knot, then pull in the direction of the wound so the wound doesn't rip apart

Count total number of sutures/staples at the end

If any sign of suture line separation (gaping) is evident during the removal process, leave the remaining sutures in place, document a description, and report it to the health care provider

Exams for which Fowler's position is used

EENT, chest

Exams for which semi-Fowler's position is used

Chest, or if pt cannot lay flat/SOB

Exams for which Sims' position is used

Rectal exams, enemas, rectal temperature

Exams for which knee-chest position is used

Gynecological or rectal exams and treatments of spinal adjustments

Exams for which jack-knife position is used

Rectal exams or instrumentation (sigmoidoscopy)

Exams for which lithotomy position is used

Female pelvic exams

Exams for which dorsal recumbent position is used

Catheterizations, genital exams for younger children

Exams for which prone position is used

Exams involving the back of the body including the bottoms of the feet

Exams for which supine position is used

Exams involving the front of the body, CPR

Exams for which (modified) Trendelenburg position is used

Shock

Procedure for performing CPR

Ascertain responsiveness

Activate emergency medical systems

2 rescue breaths, check carotid artery for pulse

If no pulse, 100-120 compressions/min with ratio of 30 chest compressions:2 rescue breaths

Heat exhaustion

faint or dizzy; nausea/vomiting; sweaty; cool, pale, clammy skin; rapid and weak pulse; cramps

Heat stroke

hot, red, dry skin; tachycardia and strong pulse; rapid, shallow breathing; high body temperature; headache; may lose consciousness; nausea or vomiting

Cervical cryosurgery

Refrain from sexual activity 1 month after procedure

Pain should not last 1 week

Heavier menstrual flow next cycle

Watery discharge for up to 1 week

Removing a tick

Grasp tick near its head, close to where it enters skin

Use tweezers to pull tick away slowly

Collect tick for testing

Glucose testing

Check code on glucose cuvettes compared to glucometer before testing

Obtain blood sample after inserting test strip into glucometer

Do not touch testing pad

Do not apply first drop of blood (contaminated)

Blood should drop on test pad and saturate, do not smear