cvt exam room med 250 daymar college lisa h. young, rn,bsn, med
TRANSCRIPT
![Page 1: CVT Exam Room MED 250 Daymar College Lisa H. Young, RN,BSN, Med](https://reader035.vdocuments.us/reader035/viewer/2022062805/5697bfd21a28abf838cabe31/html5/thumbnails/1.jpg)
CVT Exam RoomMED 250
Daymar CollegeLisa H. Young, RN,BSN, Med.
![Page 2: CVT Exam Room MED 250 Daymar College Lisa H. Young, RN,BSN, Med](https://reader035.vdocuments.us/reader035/viewer/2022062805/5697bfd21a28abf838cabe31/html5/thumbnails/2.jpg)
Interpersonal Communication
• Verbal Communication• Written Communication• Symbolic Language• English as a second language• Nonverbal Communication• Listening
![Page 3: CVT Exam Room MED 250 Daymar College Lisa H. Young, RN,BSN, Med](https://reader035.vdocuments.us/reader035/viewer/2022062805/5697bfd21a28abf838cabe31/html5/thumbnails/3.jpg)
Pain
• Acute or Chronic
• Types of pain
• Pain Assessment (Pain Scale)
![Page 4: CVT Exam Room MED 250 Daymar College Lisa H. Young, RN,BSN, Med](https://reader035.vdocuments.us/reader035/viewer/2022062805/5697bfd21a28abf838cabe31/html5/thumbnails/4.jpg)
Clinical Environment and Safety
• Occupational Safety and Health Administration (OSHA)
• Emergency Plan– Hepatitis B Vaccinations– TB Skin test (PPD test)
![Page 5: CVT Exam Room MED 250 Daymar College Lisa H. Young, RN,BSN, Med](https://reader035.vdocuments.us/reader035/viewer/2022062805/5697bfd21a28abf838cabe31/html5/thumbnails/5.jpg)
Medical Records & Documentation
• Consent to Release Information
• Medical Forms
• Charting (SOAP)
• Patient History
![Page 6: CVT Exam Room MED 250 Daymar College Lisa H. Young, RN,BSN, Med](https://reader035.vdocuments.us/reader035/viewer/2022062805/5697bfd21a28abf838cabe31/html5/thumbnails/6.jpg)
Vital Signs
• Temperature (Oral / Aural / Axillary / Rectal)
![Page 7: CVT Exam Room MED 250 Daymar College Lisa H. Young, RN,BSN, Med](https://reader035.vdocuments.us/reader035/viewer/2022062805/5697bfd21a28abf838cabe31/html5/thumbnails/7.jpg)
Vital Signs
• Pulse– Apical– Radial
![Page 8: CVT Exam Room MED 250 Daymar College Lisa H. Young, RN,BSN, Med](https://reader035.vdocuments.us/reader035/viewer/2022062805/5697bfd21a28abf838cabe31/html5/thumbnails/8.jpg)
Vital Signs
• Respirations• Oxygen Saturation
![Page 9: CVT Exam Room MED 250 Daymar College Lisa H. Young, RN,BSN, Med](https://reader035.vdocuments.us/reader035/viewer/2022062805/5697bfd21a28abf838cabe31/html5/thumbnails/9.jpg)
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
![Page 10: CVT Exam Room MED 250 Daymar College Lisa H. Young, RN,BSN, Med](https://reader035.vdocuments.us/reader035/viewer/2022062805/5697bfd21a28abf838cabe31/html5/thumbnails/10.jpg)
• 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
![Page 11: CVT Exam Room MED 250 Daymar College Lisa H. Young, RN,BSN, Med](https://reader035.vdocuments.us/reader035/viewer/2022062805/5697bfd21a28abf838cabe31/html5/thumbnails/11.jpg)
Normal Vital Signs
![Page 12: CVT Exam Room MED 250 Daymar College Lisa H. Young, RN,BSN, Med](https://reader035.vdocuments.us/reader035/viewer/2022062805/5697bfd21a28abf838cabe31/html5/thumbnails/12.jpg)
Height and Weight Measurement
• Height
• Weight
![Page 13: CVT Exam Room MED 250 Daymar College Lisa H. Young, RN,BSN, Med](https://reader035.vdocuments.us/reader035/viewer/2022062805/5697bfd21a28abf838cabe31/html5/thumbnails/13.jpg)
Physical Examination
• Review of systems
• Palpation / Percussion / Auscultation/ Inspection/Mensuration/Manipulation
• Glasgow Coma Scale
![Page 14: CVT Exam Room MED 250 Daymar College Lisa H. Young, RN,BSN, Med](https://reader035.vdocuments.us/reader035/viewer/2022062805/5697bfd21a28abf838cabe31/html5/thumbnails/14.jpg)
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
![Page 15: CVT Exam Room MED 250 Daymar College Lisa H. Young, RN,BSN, Med](https://reader035.vdocuments.us/reader035/viewer/2022062805/5697bfd21a28abf838cabe31/html5/thumbnails/15.jpg)
Review of Systems• Hematologic• Endocrine• Psychiatric• Neurological• Eyes• Cardiovascular• Respiratory• HEENT• Gastrointestinal• Integumentary• Musculoskeletal• Urinary• Genital
![Page 16: CVT Exam Room MED 250 Daymar College Lisa H. Young, RN,BSN, Med](https://reader035.vdocuments.us/reader035/viewer/2022062805/5697bfd21a28abf838cabe31/html5/thumbnails/16.jpg)
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
![Page 17: CVT Exam Room MED 250 Daymar College Lisa H. Young, RN,BSN, Med](https://reader035.vdocuments.us/reader035/viewer/2022062805/5697bfd21a28abf838cabe31/html5/thumbnails/17.jpg)
Physical Examination • Positioning the patientSitting positionFowler’s position / Semi-Fowler’s positionDorsal recumbent positionProne positionTrendelenburg positionKnee-chest position Jackknife position (proctologic)Lithotomy positionSims’ position
![Page 18: CVT Exam Room MED 250 Daymar College Lisa H. Young, RN,BSN, Med](https://reader035.vdocuments.us/reader035/viewer/2022062805/5697bfd21a28abf838cabe31/html5/thumbnails/18.jpg)
Aseptic Hand Washing
![Page 19: CVT Exam Room MED 250 Daymar College Lisa H. Young, RN,BSN, Med](https://reader035.vdocuments.us/reader035/viewer/2022062805/5697bfd21a28abf838cabe31/html5/thumbnails/19.jpg)
Non-Sterile Gloving
![Page 20: CVT Exam Room MED 250 Daymar College Lisa H. Young, RN,BSN, Med](https://reader035.vdocuments.us/reader035/viewer/2022062805/5697bfd21a28abf838cabe31/html5/thumbnails/20.jpg)
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
![Page 21: CVT Exam Room MED 250 Daymar College Lisa H. Young, RN,BSN, Med](https://reader035.vdocuments.us/reader035/viewer/2022062805/5697bfd21a28abf838cabe31/html5/thumbnails/21.jpg)
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
![Page 22: CVT Exam Room MED 250 Daymar College Lisa H. Young, RN,BSN, Med](https://reader035.vdocuments.us/reader035/viewer/2022062805/5697bfd21a28abf838cabe31/html5/thumbnails/22.jpg)
Injection Administrations
![Page 23: CVT Exam Room MED 250 Daymar College Lisa H. Young, RN,BSN, Med](https://reader035.vdocuments.us/reader035/viewer/2022062805/5697bfd21a28abf838cabe31/html5/thumbnails/23.jpg)
Injections
![Page 24: CVT Exam Room MED 250 Daymar College Lisa H. Young, RN,BSN, Med](https://reader035.vdocuments.us/reader035/viewer/2022062805/5697bfd21a28abf838cabe31/html5/thumbnails/24.jpg)
Subcutaneous Injection
![Page 25: CVT Exam Room MED 250 Daymar College Lisa H. Young, RN,BSN, Med](https://reader035.vdocuments.us/reader035/viewer/2022062805/5697bfd21a28abf838cabe31/html5/thumbnails/25.jpg)
Intradermal Injections
![Page 26: CVT Exam Room MED 250 Daymar College Lisa H. Young, RN,BSN, Med](https://reader035.vdocuments.us/reader035/viewer/2022062805/5697bfd21a28abf838cabe31/html5/thumbnails/26.jpg)
Intramuscular Injections
![Page 27: CVT Exam Room MED 250 Daymar College Lisa H. Young, RN,BSN, Med](https://reader035.vdocuments.us/reader035/viewer/2022062805/5697bfd21a28abf838cabe31/html5/thumbnails/27.jpg)
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
![Page 28: CVT Exam Room MED 250 Daymar College Lisa H. Young, RN,BSN, Med](https://reader035.vdocuments.us/reader035/viewer/2022062805/5697bfd21a28abf838cabe31/html5/thumbnails/28.jpg)
Capillary Stick
![Page 29: CVT Exam Room MED 250 Daymar College Lisa H. Young, RN,BSN, Med](https://reader035.vdocuments.us/reader035/viewer/2022062805/5697bfd21a28abf838cabe31/html5/thumbnails/29.jpg)
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
![Page 30: CVT Exam Room MED 250 Daymar College Lisa H. Young, RN,BSN, Med](https://reader035.vdocuments.us/reader035/viewer/2022062805/5697bfd21a28abf838cabe31/html5/thumbnails/30.jpg)
Venipuncture
![Page 31: CVT Exam Room MED 250 Daymar College Lisa H. Young, RN,BSN, Med](https://reader035.vdocuments.us/reader035/viewer/2022062805/5697bfd21a28abf838cabe31/html5/thumbnails/31.jpg)
Basics of Hematology Testing• WBC count• RBC counts • Hemoglobin• Hematocrit• Platelet counts• MCV, MCHC, and MCH• ESR or sed rate• Blood typing
![Page 32: CVT Exam Room MED 250 Daymar College Lisa H. Young, RN,BSN, Med](https://reader035.vdocuments.us/reader035/viewer/2022062805/5697bfd21a28abf838cabe31/html5/thumbnails/32.jpg)
Blood Chemistry Testing
• Glucose• Electrolytes (sodium, potassium, chloride,
CO2)• Creatinine• BUN• Total protein • Albumin• Bilirubin levels
![Page 33: CVT Exam Room MED 250 Daymar College Lisa H. Young, RN,BSN, Med](https://reader035.vdocuments.us/reader035/viewer/2022062805/5697bfd21a28abf838cabe31/html5/thumbnails/33.jpg)
Blood Tube Collection
• Vacutainer Collection– Red– Blue– Green – Purple
– Reversed order if from an IV site
![Page 34: CVT Exam Room MED 250 Daymar College Lisa H. Young, RN,BSN, Med](https://reader035.vdocuments.us/reader035/viewer/2022062805/5697bfd21a28abf838cabe31/html5/thumbnails/34.jpg)
Blood Tubes
![Page 35: CVT Exam Room MED 250 Daymar College Lisa H. Young, RN,BSN, Med](https://reader035.vdocuments.us/reader035/viewer/2022062805/5697bfd21a28abf838cabe31/html5/thumbnails/35.jpg)
Labeling Blood Sample
• Patient’s surname, first and middle• Patient’s ID number• Date, time and initials of the collector
![Page 36: CVT Exam Room MED 250 Daymar College Lisa H. Young, RN,BSN, Med](https://reader035.vdocuments.us/reader035/viewer/2022062805/5697bfd21a28abf838cabe31/html5/thumbnails/36.jpg)
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.
![Page 37: CVT Exam Room MED 250 Daymar College Lisa H. Young, RN,BSN, Med](https://reader035.vdocuments.us/reader035/viewer/2022062805/5697bfd21a28abf838cabe31/html5/thumbnails/37.jpg)
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
![Page 38: CVT Exam Room MED 250 Daymar College Lisa H. Young, RN,BSN, Med](https://reader035.vdocuments.us/reader035/viewer/2022062805/5697bfd21a28abf838cabe31/html5/thumbnails/38.jpg)
Butterfly Venipuncture
![Page 39: CVT Exam Room MED 250 Daymar College Lisa H. Young, RN,BSN, Med](https://reader035.vdocuments.us/reader035/viewer/2022062805/5697bfd21a28abf838cabe31/html5/thumbnails/39.jpg)
Venipuncture with Vacutainer
![Page 40: CVT Exam Room MED 250 Daymar College Lisa H. Young, RN,BSN, Med](https://reader035.vdocuments.us/reader035/viewer/2022062805/5697bfd21a28abf838cabe31/html5/thumbnails/40.jpg)
Suture and Staple Removal
![Page 41: CVT Exam Room MED 250 Daymar College Lisa H. Young, RN,BSN, Med](https://reader035.vdocuments.us/reader035/viewer/2022062805/5697bfd21a28abf838cabe31/html5/thumbnails/41.jpg)
Clean Catch Urine Specimen
![Page 42: CVT Exam Room MED 250 Daymar College Lisa H. Young, RN,BSN, Med](https://reader035.vdocuments.us/reader035/viewer/2022062805/5697bfd21a28abf838cabe31/html5/thumbnails/42.jpg)
Urine Dipstick Analysis
![Page 43: CVT Exam Room MED 250 Daymar College Lisa H. Young, RN,BSN, Med](https://reader035.vdocuments.us/reader035/viewer/2022062805/5697bfd21a28abf838cabe31/html5/thumbnails/43.jpg)
Culture Testing
• Wound• Throat• Bacteria• Fecal
![Page 44: CVT Exam Room MED 250 Daymar College Lisa H. Young, RN,BSN, Med](https://reader035.vdocuments.us/reader035/viewer/2022062805/5697bfd21a28abf838cabe31/html5/thumbnails/44.jpg)
Ordered Tests
• Blood chemistry test• Hematology and coagulation• Microbiology• Blood serum• Centrifuge