CVT Exam Room MED 250

1. CVT Exam RoomMED 250 Daymar College Lisa H. Young, RN,BSN, Med.

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

3. Pain • Acute or Chronic • Types of pain • Pain Assessment (Pain Scale)

4. Clinical Environment and Safety • Occupational Safety and Health Administration (OSHA) • Emergency Plan • Hepatitis B Vaccinations • TB Skin test (PPD test)

5. Medical Records & Documentation • Consent to Release Information • Medical Forms • Charting (SOAP) • Patient History

6. Vital Signs • Temperature (Oral / Aural / Axillary / Rectal)

7. Vital Signs • Pulse • Apical • Radial

8. Vital Signs • Respirations • Oxygen Saturation

9. 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

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

11. Normal Vital Signs

12. Height and Weight Measurement • Height • Weight

13. Physical Examination • Review of systems • Palpation / Percussion / Auscultation/ Inspection/Mensuration/Manipulation • Glasgow Coma Scale

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

16. 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

17. Physical Examination • Positioning the patient • Sitting position • Fowler’s position / Semi-Fowler’s position • Dorsal recumbent position • Prone position • Trendelenburg position • Knee-chest position • Jackknife position (proctologic) • Lithotomy position • Sims’ position

18. Aseptic Hand Washing

19. Non-Sterile Gloving

20. 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

21. 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

22. Injection Administrations

23. Injections

24. Subcutaneous Injection

25. Intradermal Injections

26. Intramuscular Injections

27. Z-Track Injections • Medication is sealed deeply within the muscle and allows no exit path back into the subcutaneous tissue and skin • Used when giving dark-colored medication solutions or irritating to the tissue

28. Capillary Stick

29. 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

30. Venipuncture

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

32. Blood Chemistry Testing • Glucose • Electrolytes (sodium, potassium, chloride, CO2) • Creatinine • BUN • Total protein • Albumin • Bilirubin levels

33. Blood Tube Collection • Vacutainer Collection • Red • Blue • Green • Purple • Reversed order if from an IV site

34. Blood Tubes

35. Labeling Blood Sample • Patient’s surname, first and middle • Patient’s ID number • Date, time and initials of the collector

36. 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.

37. 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

38. Butterfly Venipuncture

39. Venipuncture with Vacutainer

40. Suture and Staple Removal

41. Clean Catch Urine Specimen

42. Urine Dipstick Analysis

43. Culture Testing • Wound • Throat • Bacteria • Fecal

44. Ordered Tests • Blood chemistry test • Hematology and coagulation • Microbiology • Blood serum • Centrifuge