Introduction Examination Techniques Equipment chapter 3

standard precautions
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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