Introduction Examination Techniques Equipment chapter 3

standard precautions
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standard precautions
_____ _____ are for all pts and in any setting where health care is delivered
blood borne pathogens
standard precautions are designed to prevent transmission of _____ _____ _____
-blood

-body fluids

-secretions

-excretions except sweat

-non-intact skin

-mucous membranes

(all of the above may contain transmissible infectious agents)
although standard precautions were originally designed for blood borne pathogens what does it now include (give some examples)
personal protective equipment
what does PPE stand for?
visibly soiled (e.g. blood, body fluids)
use soap and water the hands are _____ _____ or after caring for pts with known or suspected Cllostridum difficile or norovirus during an outbreak
alcohol-based hand rub (ABHR)
the preferred method of hand hygiene in clinical situations is an _____ _____ _____
before
use hand hygiene:

_____ contact with a pt
aseptic task (e.g. insertion of IV, preparing an injection)
use hand hygiene:

before performing an _____ task
after
use hand hygiene:

_____ contacts with the pt or objects in the immediate vicinity of the pt
contaminated
use hand hygiene:

after contact with blood, body fluids or _____ surfaces
cleanuse hand hygiene: if hands will be moving from a contained body site to a _____ body site during pt careafteruse hand hygiene: _____ removal of PPEremoved and discardedPPE, other than respirators, should be _____ and _____ prior to leaving the pts room or care areleavingif a respirator is used it should be removed and discarded (or reprocessed if reusable) after _____ the pts room or care area and closing the doorimmediatelyhand hygiene is performed _____ after removal of PPEgloves_____ are used for potential contact with blood, body fluids, mucous membranes, non-intact skin, or contaminated equipmentNO! -do not wear the same pair of gloves for the care of more than on ptis it permissible to wear the same pair of gloves with multiple different pts?NO! -do not wash gloves for the purpose of reuseis it permissible to wash gloves for later use?gownwear a _____ to protect skin and clothing during procedures or activities where contact with blood or body fluids is anticipated -do not wear the same _____ for the care of more than one ptmouth, nose, and eyewear _____, _____, and _____ protection during procedures that are likely to generate splashes or sprays of blood or other body fluids especially during suctioning, endotracheal intubation, or lumbar punctureaseptic techniquessafe injection practices: use _____ _____ when preparing and administrating medicationsdiaphragmsafe injection practices: cleanse the access _____ of medication vials with alcohol before inserting a device into he vialsyringesafe injection practices: never administered medications from the same _____ to multiple pts, even if the needle is changes or the injection is administered through an intervening length of intravenous tubingmedications vialsafe injection practices: do not reuse a syringe to enter a _____ _____ or containeradministersafe injection practices: do not _____ medications from single dose or single use vials, ampoules, or bags or bottles of intravenous solution to more than on ptintravenous tubingsafe injection practices: do not use fluid infusion or administration sets such as _____ _____ for more than one ptmultidose vialsdedicate _____ _____ to a single pt whenever possible; if the _____ _____ will be used for more than one pt, they should be restricted to a centralized medication area and should not enter the immediate ot treatment areasharpssafe injection practices: dispose of used _____ ag the point of use in a sharp's container that is closable, puncture resistant, and leak prooffacemasksafe injection practices: wear a _____ when placing a catheter or injecting material into the epidermal or subdural spacecleaning and disinfectantestablish policies and procedures for routine _____ and _____ of environmental surfaces in the facilityspillspolicies and procedures should also address prompt and appropriate cleaning and decontamination of _____ of blood or other potential infectious materialEPA-registeredselect _____ disinfectants or detergents/disinfectants with bale chains for use in healthcare; follow the manufacture recommendations for amount, dilution, contact time, safe use, and disposalcoverinstruct symptomatic persons to _____ mouth/nose when sneezing/coughing; use tissues and dispose un no touch receptacle; observe hand hygiene after soiling hands with respiratory secretions; wear surgical mask if tolerated or maintain spatial separation of >3 feet if possiblesigns and symptomsimplement measures to contain respiratory secretions and accompanying individuals who have _____ and _____ of a respiratory infection, beginning at the point of entry to the facility and containing throughout the duration of the visitlatex allergya _____ _____ is when the body's immune system reacts to *proteins* found in natural rubber latex*gloves* and other *equipment*health care providers are at an increased risk of a latex allergy do to use of _____ and other _____ that contain latexairbornelatex proteins can be _____ or acquired by direct skin or mucous membrane contactcontact dermatitislatex allergy reactions range from mild _____ _____ to anaphylaxis with cardiovascular collapseirritant contact dermatitisname the type of latex reaction: -chemical irritation of the skin -does NOT involve the immune system -appears dry and erythematous; itchy -typically appears on the hands; very commondelayed hypersensitivity (Type IV Dermatitis)name the type of latex reaction: -involves the immune system -allergic contact dermatitis due to chemicals in latex products -occurs 24-48hrs after exposure -appears as red, raised, itchy patches often with blisters -resembles poison ivy -may progress to oozing skin and blisterssystemic reaction (Type I Systemic Reaction)name the type of latex reaction: -true immune allergic reaction ranging from local itching to anaphylaxis -actual antigen-antibody reaction -due to IgE antibodies -results in release of histamine, leukotrienes (can close up throat), prostaglandins, and kinins -result from a foreign protein and the bodys immune system reactions include... -local urticaria (skin wheals) -generalized urticaria with angioedema (tissue swelling) -asthma -eye/nose itching -gastrointestinal symptoms -anaphylaxis (cardiovascular collapse) -chronic asthma -permanent kung damagesafetydo not attempt to place a pt in any examination position that may compromise _____; always modify if needed---keep in mind the age, disabilities, mobility, impairments, sensory impairments of the ptseatedname the position -pt on stretcher or table -examiner faces pt and moves from side to side or behind the pt as needed -drape covers lap and legs; moved to uncover areas of the body as neededseatedname the position for the following examinations -general inspection -vital signs -skin -HEENT, thyroid -chest exam -cardiac exam -breast examseatedname the positionsupinename the position -pt lies face up with arms at sides and legs extended -pt on laying down on their back (looking at the ceiling) -examiner may be standing on the right side of the pt -drape covers from chest to knees or toes; uncover areas of the body as needed -make sure the bed is fully extendedsupinename the position for the following examinations -cardiovascular system -JVD -posterior pulses -abdominal exam including inguinal nodes and femoral pulses -breast exam / palpation -musculoskeletal examsupinename the positionpronename the position -pt lies on their stomach -pt is laying faced down looking at the floor -drape covers back from torso to back of knees or toes; uncover parts of body as needed -a more dangerous position to use; make sure to modify as needed -ideally used with babies to check their neck strengthpronename the position for the following examinations -special manuvers -parts of musculoskeletal examspronename the positiondorsal recumbentname the position -pt supine with knees bent and flat on table -drape in "diamond" shape from chest to toes; wrap legs with corners of "diamond"; turn back distal corner from examinationdorsal recumbentname the position for the following examinations -genital exam -rectal exam in childrendorsal recumbentname the positionlateral recumbentname the position -pt lies on side with legs extended or flexed -can be left or right -drape from chest to lower legslateral recumbentname the position for the following examinations -cardiac auscultation (left)lateral recumbentname the positionlithotomyname the position -pt in dorsal recumbent position with feet at corners of table more in stirrups; buttocks slide to edge of table -drape as in dorsal recumbent; diamond drapelithotomyname the position for the following examinations -pelvic examinationlithotomyname the positionsimsname the position -pt in lateral recumbent position; torso rolled prone; top leg flexed at hip and knee; bottom leg slightly bent -drape from shoulders to toessimsname the position for the following examinations -rectal exam -rectal temperaturesimsname the positionpronename the positionlateral recumbentname the positionsimsname the positionsupinename the positionlithotomyname the positiondorsal recumbentname the positionLEFT lateral recumbent for listening to the apex of the heartname the position-inspection -palpation -percussion -auscultationwhat are the 4 examination techniques?inspection_____ is the process of observation beginning with first exposure to pt and continuing throughout history and PE *involves the eyes and nose* -need to remember cultural differences -adequate lighting -unhurried and careful inspection -adequate exposure -validate finings with pt -remove clothing if necessary bur remember to drape the ptdiabetic ketoacidosis (DKA)a fruity breathe odor can be a sign of what?the 44 y/o male pt shows muscle movement in the eyebrow, mouth, and forehead on the right side of his face while the left side of his face has no movement assessment: left hemiparesiswhat would the inspection be for this pt?the 36 y/o male shows erythema/redness in his left leg; this redness does not touch the foot but it does extend upward to above the kneecap region; the left leg also shows edema/swelling in comparison to the other leg assessment: possible clot or infectionwhat would the inspection be for this pt?palpation_____ is the use of hands and finger to gather information through touch -keep fingernails short -have warm hands -be gentle in approach -use appropriate hand surface -use correct depthpalmer surfacethe _____ _____ of fingers and finger pads is the most commonly used palpation method; often used to feel the liver, abdomen, spleenulnar surfacethe _____ _____ of the hand and finger is the pinky side; this is used for vibrationsdorsal surfacethe _____ _____ of the hand is the back of the hand and the skin is very thin; great for taking temperatureslight palpation1cm or < palpationdeep palpation4cm or > palpation-position -texture -size -consistency -fluid -crepitus -form of mass -structurewith the palmer surface e of the fingers what are some things that are important to be feeling for?percussions_____ are sound waves that arise from vibrations and produce tonestappingduring the PE, _____ the finger or fist on the body causes vibrationsdensitypercussion tone is related to _____ of underlying tissuetympany_____ is loud, high pitched, drumlike -gastric bubbleresonance_____ is loud, low pitch, hollow -health lung tissuehyperresonance_____ is very loud, low pitch, booming -emphysematous lungs -an ABNORMAL SOUNDdull_____ is quiet, moderate pitch, thudlike -over the liverflat_____ is quiet, high pitch, brief, very dull -over muscleimmediate / directname the percussion technique -finger striking directly abasing bodymediate / indirectname the percussion technique -middle finger of dominant hand functions as hammer, middle finger of non-dominant hand placed on body and struckfistname the percussion technique -fist of dominant hand hand as hammer, non-dominant hand placed on body and struck (usually performed to assess for pain and NOT a percussion tone)interphalangeal joint or distal joint (must be consistent in whichever you chose)for the percussion technique, which area of the finger should be hit?auscultation_____ is listening to sounds produced by the bodystethoscopemost commonly auscultation sounds must be augmented/enhanced by using a _____lastauscultation guidlines -auscultation is usually _____ in the examination sequence -stethoscope is placed on naked skin -listen for presence/characteristics of sound -listen to one sound at a time -take time to identify characteristics of sound -don't anticipate next soundignorepts with disabilities: -dont _____ and obvious disability -speak directly to the pt, not those with the ptassistmobility impairments: -ask the pt how they should be moved -_____ the pt as per their instructionsidentifypts with visual impairments: -_____ yourself when entering and exiting the room -ask pt what type of assistance they need when moving/transferringfacingpts with hearing impairments: -may involve sign language, interpreter, lipreading or writing -if interpreter is used, speak to the pt -if lipreading is used, speak only when _____ the pt-diaphragm -Bellathere are 2 sides of a stethoscope. what are they called?diaphragmwhich side of the stethoscope: -screens out low pitched sounds -best transmits high pitched sounds -requires firm pressure -larger sidebellwhich side of the stethoscope: -screens out high pitched sounds -best transmits low pitched sounds -requires light pressure -smaller sidedopplera _____ is used to hear sounds too difficult to hear with a stethoscope such as pulses, fetal heart etcultrasonic stethoscopean _____ _____ detects blood flow rather than amplifying soundstransmission gelwhen using a doppler, you must place _____ _____ over the area you will be listening toarterial_____ flow sounds like a pulsatile pumping soundveinous_____ flow sounds like a rushing soundotoscopean _____ which is also called an auriscope, is used to view the inside of the earsophthalmoscopean _____ is a medical instrument used to view the eye; it has different light settingsSnellen and Sloanthe _____ and _____ visual acuity charts are for *far vision* testingE or "Tumbling E"the _____ or _____ visual acuity charts are a *modification eye test* often used for young children or illiterate adultsRosenbaum and Jaegerthe _____ and _____ visual acuity charts are used for *near vision* testingAmsler Gridthe _____ _____ visual acuity test is used for *macular degeneration*; its a series of grids and the pt tries to focus on the lines if the lines appear wavy this is a sign of macular degenerationtransilluminatora _____ is a strong light source with a narrow beam; aids in differentiating between air, fluid, tissuehydrocele_____ is when there is swelling and fluid in the scrotum; benign, but light will pass through it due to the fluid being clearnowill light from a transilluminator be able to pass through a large mass?nowill light from a transilluminator be able to pass through the sinuses if they are filled with mucous?vaginal speculaa _____ _____ is a metal or plastic medical instrument used for vaginal exams128 hrtz; used to assess vibrations in neuro examswhich tuning fork is this? and what is it used for?510 hrtz; used to assess hearingwhich tuning fork is this? and what is it used for?reflex hammera _____ _____ is used to test deep tendon reflexesthey have a pin/needle that screws into the bottom and if it pricks a pt and draws blood it may accidental be reused in between other pt visitswhat is the main issue with using older versions of reflux hammers?goniometera _____ is used to measure degree of joint flexion and extensionmonofilamenta _____ is used to test for loss of protective sensations on plantar surfaces of the foot; bends 10g of linear pressure; often used on diabetic pts