(1) NHA CCMA GENERAL PATIENT CARE

Edited by ME

Normal oral, tympanic, temporal temperature IS?

AND tell me the locations of where oral, tympanic, and temporal is

98.6 °F (37 °C)

Temporal most common for infants

• Oral: In the mouth, specifically under the tongue.

• Tympanic: In the ear canal.

• Temporal: Across the forehead, specifically scanning over the temporal artery.

Normal adult BP range

120-90/80-60 

I like to write if I forget:

+180 or +120 

 s2 180-140 or 120-90 

S1 140-130 or 90-80 

E 130-120/80-60 

N 120-90/80-60 

H -90 or -60 

Start w/ 120-90/80-60 and 130-120/80/60, AND everything else is OR

hypotension adult BP range

-90 or -60

I like to write if I forget:

+180 or +120 

 s2 180-140 or 120-90 

S1 140-130 or 90-80 

E 130-120/80-60 

N 120-90/80-60 

H -90 or -60 

Start w/ 120-90/80-60 and 130-120/80/60, AND everything else is OR

elevated adult BP range

130-120/80-60

I like to write if I forget:

+180 or +120 

 s2 180-140 or 120-90 

S1 140-130 or 90-80 

E 130-120/80-60 

N 120-90/80-60 

H -90 or -60 

Start w/ 120-90/80-60 and 130-120/80/60, AND everything else is OR

stage 1 hypertension BP range

140-130 or 90-80

I like to write if I forget:

+180 or +120 

 s2 180-140 or 120-90 

S1 140-130 or 90-80 

E 130-120/80-60 

N 120-90/80-60 

H -90 or -60 

Start w/ 120-90/80-60 and 130-120/80/60, AND everything else is OR

hypertensive crisis

+180 or +120 

I like to write if I forget:

+180 or +120 

 s2 180-140 or 120-90 

S1 140-130 or 90-80 

E 130-120/80-60 

N 120-90/80-60 

H -90 or -60 

Start w/ 120-90/80-60 and 130-120/80/60, AND everything else is OR

stage 2 hypertension BP range

180-140 or 120-90

I like to write if I forget:

+180 or +120 

 s2 180-140 or 120-90 

S1 140-130 or 90-80 

E 130-120/80-60 

N 120-90/80-60 

H -90 or -60 

Start w/ 120-90/80-60 and 130-120/80/60, AND everything else is OR

underweight BMI is?

Below 19=underweight 

• When in doubt Just remember 19-25=normal, 25-30=overweight and go from there 

 

• Below 19=underweight 

• 19-25=Normal 

• 25-30=overweight 

• Over 30=obese 

• SPECIFICALLY: 

• 30-35=obese class 1 

• 35-40=obese class 2 

• 40+=obese class 3 

normal BMI is?

19-25=Normal 

• When in doubt Just remember 19-25=normal, 25-30=overweight and go from there 

 

• Below 19=underweight 

• 19-25=Normal 

• 25-30=overweight 

• Over 30=obese 

• SPECIFICALLY: 

• 30-35=obese class 1 

• 35-40=obese class 2 

• 40+=obese class 3 

overweight BMI is?

25-30=overweight 

• When in doubt Just remember 19-25=normal, 25-30=overweight and go from there 

 

• Below 19=underweight 

• 19-25=Normal 

• 25-30=overweight 

• Over 30=obese 

• SPECIFICALLY: 

• 30-35=obese class 1 

• 35-40=obese class 2 

• 40+=obese class 3 

obese BMI is?

Over 30=obese 

• When in doubt Just remember 19-25=normal, 25-30=overweight and go from there 

 

• Below 19=underweight 

• 19-25=Normal 

• 25-30=overweight 

• Over 30=obese 

• SPECIFICALLY: 

• 30-35=obese class 1 

• 35-40=obese class 2 

• 40+=obese class 3 

obese class 1 BMI is?

30-35=obese class 1 

• When in doubt Just remember 19-25=normal, 25-30=overweight and go from there 

 

• Below 19=underweight 

• 19-25=Normal 

• 25-30=overweight 

• Over 30=obese 

• SPECIFICALLY: 

• 30-35=obese class 1 

• 35-40=obese class 2 

• 40+=obese class 3 

obese class 2 BMI is?

35-40=obese class 2 

• When in doubt Just remember 19-25=normal, 25-30=overweight and go from there 

 

• Below 19=underweight 

• 19-25=Normal 

• 25-30=overweight 

• Over 30=obese 

• SPECIFICALLY: 

• 30-35=obese class 1 

• 35-40=obese class 2 

• 40+=obese class 3 

obese class 3 BMI is?

40+=obese class 3 

• When in doubt Just remember 19-25=normal, 25-30=overweight and go from there 

 

• Below 19=underweight 

• 19-25=Normal 

• 25-30=overweight 

• Over 30=obese 

• SPECIFICALLY: 

• 30-35=obese class 1 

• 35-40=obese class 2 

• 40+=obese class 3 

age range for newborn/infant

0-1 yr

IM needle gauge, length, and angle

20-23 G, 1-3", 90 degrees

Injection type	Needle Gauge & Length	Angle	Location
Intramuscular (IM)	20-23 G x 1-3"	90°	1. deltoid ≤ 1 mL 2. ventrogluteal > 1 mL 3. vastus lateralis (pediatrics)
Subcutaneous (SC)	25-26 G x 5/8"	45°	1. lower abdomen 2. fatty part of upper arm 3. outer thigh
Insulin (SC)	31 G x 1/4"	90°	(Locations shared with Subcutaneous above)
Intradermal (ID)	27-28 G x 3/8	5-15°	1. mid forearm (PPD testing) 2. back (allergy testing)

SC needle gauge, length, and angle

25-26 G x 5/8", 45° or 90 degrees if pt is big

IM injection site

1. deltoid ≤ 1 mL (less than 1 mL)

2. ventrogluteal > 1 mL (more than 1mL)

3. vastus lateralis (pediatrics)

Injection type	Needle Gauge & Length	Angle	Location
Intramuscular (IM)	20-23 G x 1-3"	90°	1. deltoid ≤ 1 mL 2. ventrogluteal > 1 mL 3. vastus lateralis (pediatrics)
Subcutaneous (SC)	25-26 G x 5/8"	45°	1. lower abdomen 2. fatty part of upper arm 3. outer thigh
Insulin (SC)	31 G x 1/4"	90°	(Locations shared with Subcutaneous above)
Intradermal (ID)	27-28 G x 3/8	5-15°	1. mid forearm (PPD testing) 2. back (allergy testing)

Insulin SC needle gauge, length, and angle

31 G x 1/4", 90°

SC (w/ and w/out insulin) injection site

1. lower abdomen

2. fatty part of upper arm

3. outer thigh

Injection type	Needle Gauge & Length	Angle	Location
Intramuscular (IM)	20-23 G x 1-3"	90°	1. deltoid ≤ 1 mL 2. ventrogluteal > 1 mL 3. vastus lateralis (pediatrics)
Subcutaneous (SC)	25-26 G x 5/8"	45°	1. lower abdomen 2. fatty part of upper arm 3. outer thigh
Insulin (SC)	31 G x 1/4"	90°	(Locations shared with Subcutaneous above)
Intradermal (ID)	27-28 G x 3/8	5-15°	1. mid forearm (PPD testing) 2. back (allergy testing

Intradermal (ID) needle gauge, length, and angle

27-28 G x 3/8, 5-15°

ID injection site

1. mid forearm (PPD testing)

2. back (allergy testing)

type	Needle Gauge & Length	Angle	Location
Intramuscular (IM)	20-23 G x 1-3"	90°	1. deltoid ≤ 1 mL 2. ventrogluteal > 1 mL 3. vastus lateralis (pediatrics)
Subcutaneous (SC)	25-26 G x 5/8"	45°	1. lower abdomen 2. fatty part of upper arm 3. outer thigh
Insulin (SC)	31 G x 1/4"	90°	(Locations shared with Subcutaneous above)
Intradermal (ID)	27-28 G x 3/8	5-15°	1. mid forearm (PPD testing) 2. back (allergy testing)

age range for toddler

1-2 yr

age range for preschool

3-5 yr

age range for school age

6-15 yr

age range for adult

15+ yr

Normal axillary temperature

97.6 °F (36.4 °C) - remember, its one degree lower than oral

Normal rectal temperature

99.6 °F (37.6 °C) - remembers, its one degree higher than oral

MOST ACCURATE b/c fully in a body cavity

When is body temperature lowest?

morning

When is body temperature highest?

late afternoon

Ways to determine pulse

Auscultation or palpation

• Auscultation: The act of listening to the internal sounds of the body. Healthcare providers typically use a stethoscope to auscultate the heart, lungs, and intestines, or to listen for Korotkoff sounds when measuring blood pressure.

• Palpation: The act of using the hands and fingers to feel the body during a physical examination. This technique is used to assess the texture, size, consistency, location, and tenderness of internal organs and tissues, or to locate a pulse.

RR for 0-1yr

30-50

• 0-1 yr: 30-50 

• 1-2 yr: 20-40 

• 3-5 yr:20-30 

• 6-15yr:20-25 

• 15+ yr:12-20 

• Trend: both your lower and higher RR number goes down as you age 

• Why? The younger you are, the smaller your lungs so you need to breath faster to get enough oxygen 

• BP 

RR for 15+ yr

12-20

• RR (respiration rate) 

• 0-1 yr: 30-50 

• 1-2 yr: 20-40 

• 3-5 yr:20-30 

• 6-15yr:20-25 

• 15+ yr:12-20 

• Trend: both your lower and higher RR number goes down as you age 

• Why? The younger you are, the smaller your lungs so you need to breath faster to get enough oxygen 

BP for 0-1 month

85-65/50-35 (85/50) 

•  

• 0-1 month: 85-65/50-35 (85/50) 

• 1-2 months:100-70/55-35 (100/55) 

• 1-2yrs: 105-85/60-40 (105/60) 

• 6-9 yrs:115-100/75-55 (115/75) 

• 9-11 yrs:120-100/80-60 (120/80) 

• 11-15 yrs:130-110/80-65 (130/80) 

• 15+ yrs: 120-90/80-60 (120/80) 

• Trend: as you get other, both the sytolic and distolic increase 

• This is pressure. As you get get bigger, you need more pressure to get things across the body 

• HR 

BP for 1-2 yr

105-85/60-40 (105/60) 

• BP 

• 0-1 month: 85-65/50-35 (85/65) 

• 1-2 months:100-70/55-35 (100/55) 

• 1-2yrs: 105-85/60-40 (105/60) 

• 6-9 yrs:115-100/75-55 (115/75) 

• 9-11 yrs:120-100/80-60 (120/80) 

• 11-15 yrs:130-110/80-65 (130/80) 

• 15+ yrs: 120-90/80-60 (120/80) 

• Trend: as you get other, both the sytolic and distolic increase 

• This is pressure. As you get get bigger, you need more pressure to get things across the body 

BP for 15+ yr

120-90/80-60 (120/80)

• 0-1 month: 85-65/50-35 (85/65) 

• 1-2 months:100-70/55-35 (100/55) 

• 1-2yrs: 105-85/60-40 (105/60) 

• 6-9 yrs:115-100/75-55 (115/75) 

• 9-11 yrs:120-100/80-60 (120/80) 

• 11-15 yrs:130-110/80-65 (130/80) 

• 15+ yrs: 120-90/80-60 (120/80) 

• Trend: as you get other, both the sytolic and distolic increase 

• This is pressure. As you get get bigger, you need more pressure to get things across the body 

HR for 0-1 yr

100-160

• HR 

• 0-1 yr: 100-160 

• 1-2 yr:100-140 

• 3-5 yr:80-120 

• 6-15 yr:75-120 

• 15+ yr: 60-100 

• Trend: as you get older, the HR gets lower 

• Why? As you get older, your heart gets more efficient so it needs to beat less to circulate all the blood 

HR for 15+ yr

• 15+ yr: 60-100 

• HR 

• 0-1 yr: 100-160 

• 1-2 yr:100-140 

• 3-5 yr:80-120 

• 6-15 yr:75-120 

• 15+ yr: 60-100 

• Trend: as you get older, the HR gets lower 

• Why? As you get older, your heart gets more efficient so it needs to beat less to circulate all the blood 

Apical pulse (where is it taken and who is it for)

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"

Normal oxygen saturation

95% or higher

1st Korotkoff sound

The first Korotkoff sound is a sharp tapping that corresponds to the systolic blood pressure.

Smarter Simplify - Korotkoff sounds:

1. The first Korotkoff sound is a sharp tapping that corresponds to the systolic blood pressure.

2. The second Korotkoff sound is a swishing/whooshing sound that is heard as the cuff is deflated.

3. The third Korotkoff sound is a thump that is softer than the first sound.

4. The fourth Korotkoff sound is a softer, blowing, muffled sound that fades.

5. The fifth Korotkoff sound is silence, which corresponds to diastolic blood pressure.

2nd Korotkoff sound

The second Korotkoff sound is a swishing/whooshing sound that is heard as the cuff is deflated.

Smarter Simplify - Korotkoff sounds:

1. The first Korotkoff sound is a sharp tapping that corresponds to the systolic blood pressure.

2. The second Korotkoff sound is a swishing/whooshing sound that is heard as the cuff is deflated.

3. The third Korotkoff sound is a thump that is softer than the first sound.

4. The fourth Korotkoff sound is a softer, blowing, muffled sound that fades.

5. The fifth Korotkoff sound is silence, which corresponds to diastolic blood pressure.

3rd Korotkoff sound

The third Korotkoff sound is a thump that is softer than the first sound.

Smarter Simplify - Korotkoff sounds:

1. The first Korotkoff sound is a sharp tapping that corresponds to the systolic blood pressure.

2. The second Korotkoff sound is a swishing/whooshing sound that is heard as the cuff is deflated.

3. The third Korotkoff sound is a thump that is softer than the first sound.

4. The fourth Korotkoff sound is a softer, blowing, muffled sound that fades.

5. The fifth Korotkoff sound is silence, which corresponds to diastolic blood pressure.

4th Korotkoff sound

The fourth Korotkoff sound is a softer, blowing, muffled sound that fades.

Smarter Simplify - Korotkoff sounds:

1. The first Korotkoff sound is a sharp tapping that corresponds to the systolic blood pressure.

2. The second Korotkoff sound is a swishing/whooshing sound that is heard as the cuff is deflated.

3. The third Korotkoff sound is a thump that is softer than the first sound.

4. The fourth Korotkoff sound is a softer, blowing, muffled sound that fades.

5. The fifth Korotkoff sound is silence, which corresponds to diastolic blood pressure.

5th Korotkoff sound

The fifth Korotkoff sound is silence, which corresponds to diastolic blood pressure.

Smarter Simplify - Korotkoff sounds:

1. The first Korotkoff sound is a sharp tapping that corresponds to the systolic blood pressure.

2. The second Korotkoff sound is a swishing/whooshing sound that is heard as the cuff is deflated.

3. The third Korotkoff sound is a thump that is softer than the first sound.

4. The fourth Korotkoff sound is a softer, blowing, muffled sound that fades.

5. The fifth Korotkoff sound is silence, which corresponds to diastolic blood pressure.

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

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 (procedure - what you do and what the pt does)

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

t in strain stands for 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

warmth, redness, swelling, and pain

think: You can think he WRPS (wraps) the infected area 

Redness (rubor)  

• Rubor means redness 

• You can think of rubor like ruby, its red 

Warmth (calor) 

• Calor means warm 

• You can think calor is like carlories, and when you burn those, you generate heat 

Swelling (tumor) 

• I guess tumor means swelling 

• Tumors grow in size, so they almost swell up 

Pain (dolor) 

• Dolor means pain 

• You can think dolor sounds like dull-er, so like dull pain 

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 procedure

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