ALL clinical skills

What are the critical points of hand hygiene?

• Before each episode of direct care

• Clean/aseptic procedures

• Afteer each episode of direct care

• After cpmtact with bolidy fluids

• After cpmtact with objects in the patient environment

• After removal of gloves

Hands must be decontaminated by soap instead of hand sanitiser when

• You have applied sanitiser several times

• Your hands are visibly soiled

• Your hands are potentially contamited with bodily fluids

• You are caring for a patient who has vomiting or diarrhoea

• You went to the toilet

• You are handling food

What can you not use when washing hands?

• Bars of soap

  • Nail brushes

What is most frequently missed when washing hands?

Thumbs and fingertips

What is respiration split into?

External respiration= drawing air into the lungs

Internal respiration= process of gas exchange between lungs, blood and tissue

How do you assess external respiration

• Observe respiratory rate

• Observe depth, pattern and effort of breathing

eg. are the struggling to speak? are they using accessory muscles in their neck for regular breathing?

How do you assess internal respiration?

• Consider skin pallor/ cyanosis (bluish discoloration)- for ppt w darker skin check inner lower lip and palms

  • Restlessness and confusion (hypoxemia- low O2 in blood)

What is a pulse oximeter?

• Estimates the oxygen saturation of haemoglobin delivered to tissue

• 94-98% on patients that are acutely ill

• or 88-92% where the patient is at risk of hypercapnic respiratory disorder- abnormally high CO2 lvls (eg. COPD)

A patient should rest at least 5 mins before assessment

What are the normal resting rates of patients

Age Rate

Newborn 30-50

2-12years 20-30

Teen 12-20

Adult 12-20

Abnormalities in a patients chest or spine can cause difficulties breathing

What is stridor?

• High-pitched wheezing sound caused by distrupted airflow in the larynx or lower bronchiol tree

• It can indicate airway obstruction by foreign bodies or tumors

• It’s a noisy inspiration (like snoring in deep sleep)

What are the Patterns of respiration

• Bradypnoea= slow, regular respiration below 12- can cause oxygen deprivation. Associated w alcohol consuption, over-sedation, metabolic and cws disorder

• Tachypnoea= rapid, regular respiration above average. Associated w pneumonia, respiratory insufficiency, lesions in the respiratory centre of the brain, fever or panic attack

• Prolonged expiration= COPD (chronic obstructive pulmunary disorder)

• Cheyne-strokes respiration= slow, shallow breaths which gradually become rapid and deep, and then slowly subside to 12-20 seconds of apnea. Cycles of 45s-3mins. Due to raised intracranial pressure, celebral anoxia, drug overdose, meningitis, congestive heart failure, end stage renal disease or terminal stage cancer

• Dyspnoea= difficult breathing. Associated w pulmunary embolism, pneumothorax, advanced cancer, pericarditis, angina and general, severe chest pain

• Orthopnea= SOB because of lying flat. Can be fixed by sitting up

What is the order of examinaion for the respiratory system

• Inspection

• Palpitation

• Percussion (tapping on chest to mobalise lung secretion)

  • Ausculation (listening to internal sounds of the body)

What is pulse oximetry

• Measures the saturation of haemoglobin in the arterial blood

  • They measure saturation and pulse, and are placed on the fingers and areas

What is silent hypoxia

• All vital signs are good but spO2 is low

What is hypoxoemia

low level of oxygen in the blood`

In what patients are pulse oximeter readings less accurate

• Patients w black or brown skin

• Patients w bad blood flow to capillaries

Why are pulse oximeters not precise

• They don’t show how hard the cardiovascular and respiratory system worked to get the oxygen in the blood

• The adequacy of ventilation, or the level of haemoglobin in the blood

What is the mechanism behind oxymeters

• Red light detects oxygenated and deoxygenated haemoglobin

• If the ppt is cold, has peripheral vasoconstriction or painted/dirty nails an ear probe is more reliable

What is the aim of assessing a pulse

• To see the pulse rate, rhythm and strenght

• Its important to determine a ppt’s normal pulse rate so you can monitor changes due to the disease or medication

How do you determine ventricular rate

• Place stetoscope on the 5th intercostal muscle

  • This is known as monitoring the apex beat ( a pulse deficit)= the ventricles are too weak to create a pulse rate

What happens if a ppt has a low pulse

• Can cause inaccuracy in the pulse oximeter and blood pressure monitors

• ECGs w low pulse may be read as low cardiac output instead

Where do you usally take pulse

Radial artery

• Cartoid, femoral and brachial pulses are also used

How is core temperature taken

• Can only be done invasevly by putting a probe down the oesophagus or bladder

What is pyrexia

• Increase in body temperature (up to 38.9C could be mild to moderate)

• Severe pyrexia does not correlate to severe infection

When do you have to closely monitor temperature

• Post-operation or critically ill

• Receiving blood transfusions

• Have conditions that impact metabolic rate (hyporthyroidism)

• Have infections

• Are in an increased risk of infection

What are the diff ways to measure temp

• Disposable thermometers= inaccurate but single use so not risk of hygiene

• Electronic temperatures (mouth/auxillary/rectum), easy and provde quick results, expensive and require probe covers

• Tympanic= fast, most accurate, non-invasive, however its at risk of poor technique