Areas Of Improvement For PCT Exam

1. Postmortem Care

When a patient passes away, healthcare staff must handle the body with dignity, adhere to legal requirements, and accommodate family and cultural considerations.

Key Steps in Postmortem Care:

• Verification & Documentation: Ensure the death is officially recorded by the provider, including the date and time.

• Body Preparation:

  • Close the eyes and mouth, inserting dentures if needed.

  • Remove medical devices unless an autopsy is required.

  • Position the body supine with a pillow under the head to avoid discoloration.

  • Cross the arms over the abdomen or place them at the sides.

  • Replace soiled bandages and clean the body.

  • Dress the patient in a clean gown and cover them with a clean sheet up to the shoulders.

• Family Considerations:

  • Allow family time with the body in a respectful environment (dim lights, remove soiled materials).

  • Offer to stay or provide privacy.

• Final Steps:

  • Wrap the body in a shroud and attach identification tags (on the toe, shroud, and personal belongings).

  • Arrange transportation to the morgue or funeral home.

  • Emotional Support: Postmortem care can be emotionally taxing, so healthcare staff should take time to process grief.

2. Recognizing and Reporting Critical Values

Technicians must recognize life-threatening values in blood glucose, vital signs, and oxygen saturation and report them immediately.

Blood Glucose Monitoring:

• Blood glucose is measured via glucometer using a dermal puncture.

• Reference Ranges:

  • Fasting (8+ hours): 70-110 mg/dL (adults).

  • Postprandial (after meals): Below 140 mg/dL (adults under 50).

  • Critical Values:

    • Below 40 mg/dL (females) or 50 mg/dL (males)

    • Above 450 mg/dL

• Steps for Testing Blood Glucose:

  • Insert a test strip into the glucometer.

  • Perform a dermal puncture and discard the first drop of blood.

  • Apply the second drop to the test strip.

  • Read and document the result.

Vital Signs - Normal Ranges & Critical Values:

• Temperature:

  • Oral: 97.6° to 99.6°F

  • Rectal: 99.6°F (most accurate core temp)

• Heart Rate:

  • Adults: 60-100 bpm

  • Newborns: 120-160 bpm

• Respiratory Rate:

  • Adults: 12-20 breaths per minute

  • Newborns: 30-50 breaths per minute

• Blood Pressure:

  • Normal: Less than 120/80 mmHg

  • Hypotension: Systolic below 90 mmHg

  • Hypertension: Systolic above 140 mmHg

• Pulse Oximetry:

  • Normal: 95% or higher

  • Patients with respiratory disease may have lower baseline levels.

3. Removing Peripheral IV Catheters

• Confirm provider's order before removing an IV.

• Steps for Removal:

  • Close the roller clamp to stop fluid flow.

  • Carefully remove tape and dressing while stabilizing the catheter.

  • Apply pressure with sterile gauze for 2-3 minutes.

  • Inspect the catheter tip (if broken, notify the nurse immediately).

  • Check for signs of infection: redness, swelling, pain, or drainage.

4. Wound Care and Infection Control

Wounds include surgical incisions, pressure ulcers, and diabetic ulcers. The technician’s role is to monitor for infection and assist with dressing changes.

Signs of Wound Infection:

• Redness, warmth, and swelling.

• Foul-smelling or purulent (pus-filled) drainage.

• Fever or increased pain.

Dressing Changes:

• Sterile dressings: Applied by nurses.

• Aseptic (clean) dressings: May be changed by technicians following facility guidelines.

• Steps:

  • Perform hand hygiene.

  • Remove the old dressing with gloves.

  • Observe and document drainage.

  • Clean the wound with sterile water or saline.

  • Apply a fresh sterile dressing.

5. Adaptive Devices for Mobility and ADLs

Patients with physical limitations require assistive devices for daily activities.

• Common Adaptive Devices:

  • Walkers and canes (for stability).

  • Adaptive utensils (for arthritis/tremors).

  • Reachers/grabbers (to extend reach).

  • Prosthetics (monitor fit and cleanliness).

6. Preventing Blood Clots – Sequential Compression Devices (SCDs)

• SCDs help prevent deep vein thrombosis (DVT) by compressing the legs to improve circulation.

• Proper Fit:

  • The sleeve should allow two fingers’ space to prevent restricted blood flow.

  • Remove the sleeves at least once every 8 hours to check skin integrity.

7. Safe Equipment Use & Patient Restraints

• Restraints require a provider’s order and must be:

  • Checked every 15 minutes for circulation.

  • Removed every 2 hours to provide skin care and movement.

• Side Rails & Fall Risk:

  • Use rails properly to prevent patient entrapment.

  • Bed must be in lowest position to reduce fall risk.

8. Workplace Safety – OSHA Guidelines

• Biological Hazards: Proper handling of needles, blood, and bodily fluids prevents exposure.

• Hazardous Chemicals: Follow Safety Data Sheets (SDS) for handling.

• Electrical Safety: Avoid overloading outlets or using damaged cords.

• Radiation Safety: Use lead aprons and dosimeters for protection.

9. Patient Safety & Fall Prevention

• High-Risk Patients:

  • Those with dizziness, cognitive impairment, or previous falls.

• Preventative Measures:

  • Keep hallways clear, provide non-slip footwear, and respond to call lights promptly.

10. Infection Control – Medical & Surgical Asepsis

• Medical Asepsis (Clean Technique):

  • Hand hygiene, disinfecting surfaces, and using gloves.

• Surgical Asepsis (Sterile Technique):

  • Used for catheter insertion, sterile dressings, and surgeries.

Hand Hygiene - When to Wash Hands

• Before and after patient contact.

• After touching body fluids, even with gloves.

• After removing gloves.

11. Communication & Documentation

• Electronic Medical Records (EMRs)

  • Always document immediately after care.

  • Do not document actions performed by others.

  • Use medical terminology, not personal opinions.

Common Medical Abbreviations

• BP (blood pressure)

• CPR (cardiopulmonary resuscitation)

• NPO (nothing by mouth)

12. Venipuncture & Phlebotomy

• Site Selection:

  • Median cubital vein is the first choice.

• Steps for Blood Collection:

  • Identify the patient properly.

  • Use a tourniquet and select the correct needle gauge.

  • Invert tubes as required to prevent clotting.

• Errors to Avoid:

  • Hemolysis (caused by shaking tubes).

  • Contaminated samples (caused by improper cleaning).

  • Using expired collection tubes.

Low-Scoring Areas – Key Improvements

• Venipuncture: Avoiding contaminated samples and hemolysis.

• Medical Terminology: Understanding roots, prefixes, and suffixes.

• Equipment Use: Proper handling of restraints and fall-risk precautions.

• Postmortem Care: Ensuring compliance with family and cultural preferences.