CVT Exam RoomMED 250

Daymar CollegeLisa H. Young, RN,BSN, Med.

Interpersonal Communication

• Verbal Communication• Written Communication• Symbolic Language• English as a second language• Nonverbal Communication• Listening

Pain

• Acute or Chronic

• Types of pain

• Pain Assessment (Pain Scale)

Clinical Environment and Safety

• Occupational Safety and Health Administration (OSHA)

• Emergency Plan– Hepatitis B Vaccinations– TB Skin test (PPD test)

Medical Records & Documentation

• Consent to Release Information

• Medical Forms

• Charting (SOAP)

• Patient History

Vital Signs

• Temperature (Oral / Aural / Axillary / Rectal)

Vital Signs

• Pulse– Apical– Radial

Vital Signs

• Respirations• Oxygen Saturation

Vital Signs• Blood pressure– Sphygmomanometer (cuff widths)– Stethoscope– Brachial artery– Kortikoff sound

• Average blood pressure readings– Newborn: 80/50 mmHg– Infant: 90/60 mmHg– Child 3 – 6 yrs.: 100/60 mmHg – Child 10 yrs.: 110/60 mmHg– Child 14 yrs.: 130/60 mmHg– Adult: 120/80 mmHg– Elderly > 60 yrs. : 155/95 mmHg

• Systolic pressure: highest pressure• Diastolic pressure: lowest pressure• Pulse pressure• Hypertension• Malignant Hypertension• Hypotension• Classifications

BP Classification Normal Pre-Hypertensive

Hypertension

SBP (mmHg) 119 or below

120 to 139 140 or above

DBP (mmHg) 79 or below

80 to 89 90 or above

Normal Vital Signs

Height and Weight Measurement

• Height

• Weight

Physical Examination

• Review of systems

• Palpation / Percussion / Auscultation/ Inspection/Mensuration/Manipulation

• Glasgow Coma Scale

Eyes Opening Response

Spontaneous-open with blinking at baselineOpens to verbal command, speech, or shoutOpens to pain, not applied to faceNone

4 points

3 points

2 points

1 point

Verbal Response

OrientedConfused conversation, but able to answer questionsInappropriate responses, words discernibleIncomprehensible speechNone

5 points4 points

3 points

2 points1 point

Motor Response

Obeys commands for movementPurposeful movement to painful stimulusWithdraws from painAbnormal (spastic) flexion, decorticate postureExtensor (rigid) response, decerebrate postureNone

5 points4 points

3 points

2 points

1 point

Review of Systems• Hematologic• Endocrine• Psychiatric• Neurological• Eyes• Cardiovascular• Respiratory• HEENT• Gastrointestinal• Integumentary• Musculoskeletal• Urinary• Genital

Procedures / Diagnostic Test for the Cardiovascular System

• Aneurysmectomy• Angiography• Angioplasty• Arterial blood gases• Artery graft• Artificial pacemaker• Cardiac catheterization• Cardiac enzymes

• Cardiac MRI• Cardiolysis• Cardiorrhaphy• Cardioversion• Commissurotomy• CABG• Doppler

ultrasonography• Electrocardiogram

Physical Examination • Positioning the patientSitting positionFowler’s position / Semi-Fowler’s positionDorsal recumbent positionProne positionTrendelenburg positionKnee-chest position Jackknife position (proctologic)Lithotomy positionSims’ position

Aseptic Hand Washing

Non-Sterile Gloving

Medication Administration

• Conversions– Move the decimal point 3 places to the left or right– Large to smaller: move to the right (L > S)– Small to large: move to the left (S >L)– Change 200 mg to mcg = 200, 000 mcg– Metric scale: kg-hg-dag-g-dg-cg-mg X X mcg

Medication Administration

• Apothecary & Metric Equivalencies– 1000 ml = 1 liter– 1cc = 1 ml– 1 ounce = 30 cc or 30 ml– 1 dram = 4 ml– 1 grain = 60 mg– 1 tablespoon = 15 ml– 1 teaspoon = 5 ml

Injection Administrations

Injections

Subcutaneous Injection

Intradermal Injections

Intramuscular Injections

Z-Track Injections

• Medication is sealed deeply within the muscleand allows no exit path back into the subcutaneous tissue and skin

• Used when giving dark-colored medication solutions or irritating to the tissue

Capillary Stick

Clinical Laboratory Improvement Amendments (CLIA)

• Federal act• Quality standards • Health Care Financing Administration (HFCA)• Certification by Secretary of Health and

Human Services• Center of Disease (CDC)• Category of testing

Venipuncture

Basics of Hematology Testing• WBC count• RBC counts • Hemoglobin• Hematocrit• Platelet counts• MCV, MCHC, and MCH• ESR or sed rate• Blood typing

Blood Chemistry Testing

• Glucose• Electrolytes (sodium, potassium, chloride,

CO2)• Creatinine• BUN• Total protein • Albumin• Bilirubin levels

Blood Tube Collection

• Vacutainer Collection– Red– Blue– Green – Purple

– Reversed order if from an IV site

Blood Tubes

Labeling Blood Sample

• Patient’s surname, first and middle• Patient’s ID number• Date, time and initials of the collector

Venipuncture Procedure

• Assemble equipment• Approach patient in a friendly, calm manner. Gain the patient’s cooperation• Identify the patient correctly• Properly fill out appropriate requisition forms, indicating the test(s) ordered• Verify the patient’s condition.• Check for allergies• Position patient• Wash hands• Place tourniquet (2 inches above)• Locate desired vein and clean puncture site• Apply gloves• Insert needle, bevel up, at a 15 degree angle• Aspiration of the blood into syringe• Remove tourniquet.• Remove needle. Apply pressure (3 min.) Dressing app;lied.• Dispose of contaminated materials/supplies• Mix and label tubes• Deliver specimen(s) to laboratory.

Complications with Blood Collection

• Fainting• Hematomas• Petechiae• Edema• Obesity• IV therapy• Damaged, Sclerosed, or occulded Veins• Hemoconcentration• Hemolysis• Collapsed Veins• Allergies• Thrombosis• Burned or Scarred Areas• Infections• Upper extremity on the side of a previous mastectomy• Superficial veins

Butterfly Venipuncture

Venipuncture with Vacutainer

Suture and Staple Removal

Clean Catch Urine Specimen

Urine Dipstick Analysis

Culture Testing

• Wound• Throat• Bacteria• Fecal

Ordered Tests

• Blood chemistry test• Hematology and coagulation• Microbiology• Blood serum• Centrifuge