Clinical Skills

Front 1

Conventional

Back 1

blade is on the inside

Front 2

reverse needle

Back 2

blade is on the outside

Front 3

order of veins you want to hit first

Back 3

1. median cubital

2. cephalic

3. basiclic

Front 4

What does FACTS stand for?

Back 4

Feeling, arterial pulse, capillary refill, temperature, sensation

Front 5

Where does IM go?

Back 5

deltoid, ventrogluteal, vastus lateralis

Front 6

gauge of needle for IM

Back 6

18 - 22

Front 7

gauge of needle for SQ

Back 7

26 - 29??

Front 8

gauge of needle for Indradermal

Back 8

25 - 27

Front 9

angle of needle for Intra dermal inj

Back 9

15 degrees

Front 10

angle of needle for SQ

Back 10

45 degrees

Front 11

angle of needle for IM

Back 11

90 degrees

Front 12

examples of SQ inj

Back 12

insulin, MMR, varicella

Front 13

examples of IM inj

Back 13

TDAP, PPV, HPV

Front 14

far far near near

Back 14

vertical mattress

Front 15

three things needed for a microbials

Back 15

1. kills microbes

2. accumulation effect

3. sustained effect

Front 16

wound closure indications

Back 16

reduce infection

cosmetic

decrease healing time

repair structure or function

decrease scar tissue

Front 17

contraindications for wound closure

Back 17

high likelihood of contamination

greater than 8 hours

only ok 24 hours after to close if its a highly vascularized

Front 18

what are tetanus prone wounds?

Back 18

over 6 hours

greater than 1 cm

contaminated with soil, feces, or salivia

from a puncture, missle, gunshot wound, burn, or frostbate

Front 19

primary classification

Back 19

all layers closed

minimal healing

ex: suturing

Front 20

secondary classification

Back 20

deep layers closed

superficial layers

leaves scars

Front 21

areas to inj insulin

Back 21

abdomen

thigh

Front 22

do not aspirate or rub

Back 22

heparin

Front 23

who has delayed wound healing

Back 23

diabetic

immunocomprised

smoker

Front 24

when to remove the sutures?

Back 24

eyelids - day 3

neck - day 3 - 4

face - day 5

scalp - 7 - 10

Front 25

Venipuncture indications

Back 25

a

Front 26

Venipuncture contraindications

Back 26

a

Front 27

Inserting IV Catheters indicating

Back 27

· Fluid administration ·

Administration of abx, chemo, or blood products·

Administration of diagnostic substances such as dyesor contrast ·

Administration of some nutritional components

Front 28

Inserting IV Catheters contraindication

Back 28

· Extremities with significant burns, edema, injury; aninfection or cellulitis · Insertion should not be performed distal to priorfailed IV catheter insertion attempt · Avoid insertion in areas of preexisting phlebitis,extremities with impaired circulation (mastectomy, axillary lymph node dissection,lymphedema, clot, peripheral vascular dz, venous insufficiency), areas ofindwelling fistulas · Care should be taken with a pt with known bleedingdiathesis · Consideration should be given to placing aperipherally inserted central cath if medication being infused is too caustic,is hypertonic, or is being given for longer than 6 days

Front 29

Injections indications

Back 29

a

Front 30

Injections contraindications

Back 30

a

Front 31

NG Tube Placement indications

Back 31

· Both therapeutic and diagnostic·

Used to evaluate CNS infections such as:o Bacterial meningitis (MC reason) --> CSF sample with an elevated WBC count, elevated PMNcount, and low glucose level; gram staining may tentatively identify organismswhile waiting for culture o Viral meningitis --> typically causes CSF mononuclear pleocytosis, normalglucose level, negative gram stain, and elevated protein level · also used to distinguish SAH from other causes of CNSsymptoms o SAH is characterized by CSF with a xanthochromic colorat the time of LP and elevated erythrocute in the fluid · Traumatic LP is characterized by initially red CSFwith subsequent clearing of fluid as collection progresses · Guillain-Barre --> isolated, very high protein concentration· CSF analysis may be useful in evaluating pts withsuspected MS, ALS, Alzheimer dz· Therapeutically used in the following instances:o Intraventricular pressure from hydrocephalus isrelived by LPo LP is used to administer intrathecal pharmacologicagents (abx, antiviral, antineoplastic)

Front 32

NG Tube Placement contraindications

Back 32

· Increasedintracranial pressure o S/sx: progressive HA, focal neurologic s/sx,papilledema, progressive deterioration of mental status over hours to weeks o These pts should have a CT before a LP· Known or suspected coagulopathies are a relative CI o Includes hemophilia, leukemia, liver dz, oranticoagulant therapy· Local infection overlying the site of the LP risksdirect inoculation · Surface abnormalities such as nevi, hair tufts, andsinuses or palpable bony abnormalities · Critical illness or medical instability is a relativeCI

Front 33

NG tube placement potential complications

Back 33

· Postural puncture HA is the mc complicationo s/sx: bilateral, generally occipital, throbbing orpressure pain, intensity is increased in the upright position and my movement;pain is relieved by lying supine · back discomfort from local trauma · infection may be introduced by improperly preparingskin, contaminating the needle, or introducing blood into subarachnoid space· Nerve damage · Herniation into foramen magnum may occur when LP isperformed in the presence of increased ICP· Significant bleeding locally or into the CNS is rareand occurs almost exclusively in pts with coagulopathies or other risk factors

Front 34

Urinary Bladder Catheterization indications

Back 34

a

Front 35

Urinary Bladder Catheterization contraindications

Back 35

a

Front 36

Joint and bursal aspiration indications

Back 36

a

Front 37

Joint and bursal aspiration contra indications

Back 37

a

Front 38

Casting and Splinting indications

Back 38

a

Front 39

Casting and Splinting contraindications

Back 39

a

Front 40

plaster

Back 40

o Easier to mold to an extremity than fiberglass givingit an advantage when a snug and form fitting case is needed on an area withchallenging contours (such as a chubby cone-shaped arm or leg of a toddler)o Also absorbs underlying wound drainage, making itdesirable splinting material in trauma and post OP settings o Messy to apply but easily washed off with soap andwater o Heavier than fiberglass but not as durable o If sufficiently stressed à it cracks o Once hardened, if will get soft and break down à requiring enforcemento Begins to harden in 10 – 15 minutes but takes 6 – 8hours to fully dry and harden o Emits quite a bit of heat as it cures (exothermicreaction) à causes potential burn risk in pts with sensorydeficits and in those who are unable to communicate their pain § To reduce the amount of heat generated, cool water isused to wet the plaster but this increases the time needed to harden

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a

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a

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a

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a

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a

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Front 48

a

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a

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a

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a