Dr. Rodney Martinez

1

Hand washing is the single most important procedure for preventing the spread of infections.

Alcohol handrub should also be regularly used when entering or leaving a ward and before and after examining patients.

2

This is an important and routine procedure which is often carried out by nursing staff, although doctors may be asked to administer medication at times.

Good injection technique can make the experience for the patient relatively painless.

Three commonly used routes of administration are: ◦ subcutaneous (S/C), ◦ intramuscular (IM) and ◦ intradermal (ID).

3

Peripheral IV cannulation is a generic skill that the medical student should learn early.

A thin tube line is inserted into a vein allowing easy venous access which is used in many situations, including the administration of fluids and iv medication.

4

Plastic tube is inserted through the nose, down the back of the throat, oesophagus and into the stomach.

5

A needle is inserted through the abdominal wall allowing the withdrawal of a small amount of fluid for diagnostic purposes.

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A urinary catheter has a balloon near the tip which is inflated via a sidearm near the other end.

Once inside the bladder, the inflated balloon prevents it fallingor being pulled out.

7

Basic suturing, or stitching, has many practical applications outside the field of surgery.

Whether you are called upon to suture a central line in place or are stitching up a laceration,

It's a skill you should practise before you need to use it.

8

In the context of a swollen joint, a joint aspiration is performed for both:

Diagnostic (to identify infectious and crystal arthropathies) and

Therapeutic (to relieve tense effusions and haemarthroses) purposes.

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Insertion of a spinal needle through the L3-L4 interspace into the lumbar subarachnoid

space to obtain cerebrospinal fluid,

measure CSF fluid or pressure, or instill air, dye, or medications.

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DIAGNOSTIC Suspected meningitis Subarachnoid hemorrhage Hydrocephalus Benign Intracranial hypertension

THERAPEUTIC Spinal anesthesia Chemotherapy

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CONTRAINDICATIONS

-coliosis -CP unidentified -oagulopathy -yphosis

S I C K

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PRETEST orm of informed consent ree of urine bladder etal position

F F F

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INTRATEST

hrimp or Fetal position

pecimens to be collected

terile vials- 4

trict asepsis

S S S S

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POSTTEST lat 12-24 hrs or vital signs and LOC

monitoring orce fluid unless

contraindicated uncture site for bleeding,

CSF leakage erform CMS assessment

F F F p p

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COMPLICATION

Spinal Headache

-lat

-luids

-ain Management

F F P

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-valuates heart rate and the regularity of heartbeats.

-ardiac dysrhythmias, MI, and cardiac hypertrophy

- raph of the electrical impulses moving through the heart.

E C G

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Consideration: -lectrical shock will not occur

-ardiac medications of the patient should be documented

-ive instructions to lie still, breathe normally, and refrain from talking during the test

E C G

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PRECORDIAL LEADS

White: Right Arm Black: Left Arm Green: Right Leg Red: Left Leg

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LIMBS LEADS

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P WAVE: Atrial depolarization PR INTERVAL: AV conduction

time QRS COMPLEX: Ventricular

depolarization ST SEGMENT: Time interval

between complete depolarization of ventricles and repolarization of ventricles

T WAVE: Ventricular repolarization

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NORMAL SINUS RHYTHM: 60 TO 100 bpm

SINUS BRADYCARDIA: <60 bpm

SINUS TACHYCARDIA: >100 bpm

QRS WIDTH: 0.08 to 0.12 sec PR INTERVAL: 0.12 to 0.20

sec QT INTERVAL: 0.30 to 0.40

sec

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-atheter is attached to an IV infusion and H2O manometer by a three way stopcock

-eins external jugular, antecubital, or femoral

- ressure within the superior vena cava

C V P

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Normal Value: 3 to 8 mmHg Position: Cardiac Disease: Semi

Fowler’s Dressing or Tubing Change:

Flat or Trendelenburg CVP Reading and Monitoring:

Flat, Supine, or Dorsal Recumbent

Air Embolism: Left Side Lying

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Ericardial

effusion

uncture

ericardial sac

ericardial fluid

P P P P

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PREPROCEDURE erform blood analysis CG estriction of food and water is recommended for six hours before the test.

V line for sedation

P E R I

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INTRAPROCEDURE vail emergency resuscitative equipment at bedside

ed is elevated to 45 to 60 degrees

ardiac activity monitoring one in emergency room, ICU, or at the bedside

A B C D

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POSTPROCEDURE

pical pulse monitoring lood pressure VP etect complications:

Ventricular or coronary artery puncture, dysrhythmias, pleural laceration, gastric puncture, myocardial trauma

A B C D

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Purposes: -pply medications

-rush biopsy

-arefully remove foreign objects

-irect visualization

A B C D

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PREPROCEDURE: tain informed consent emove dentures or eyeglasses btain vital signs PO postmidnight oagulation studies result must be

checked ave emergency resuscitation

equipment readily vailable give IVF and medication for

sedation uction equipment at bedside

B

O N

C

H

U

S

R

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POSTPROCEDURE: ag reflex return ssess for bloody sputum ive instruction that sore throat is

common espiratory status must be monitored mesis basin at bedside owler’s semi position ook out for complications like

bronchospasm or bronchial perforation

levated temperature and DOB- Notify! amine vital signs

G A G R E F L E X

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Insertion of a needle through the chest wall:

Obtain specimen

Remove pleural fluid accumulation

Instill medication

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PREPROCEDURE: o obtain informed consent ealth teaching: not cough, breathe

deeply, or move during the test n doctor's office, in the X-ray

department, ER, OR or at bedside idden on bed: Sidelying towards the

unaffected side with HOB elevated mbulatory: Sit upright with arms and

shoulders supported by a table -ray or ultrasound before the

procedure

T H O R A X

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POSTPROCEDURE: Monitor vital signs

Monitor respiratory status

Apply a pressure dressing

Assess the puncture site for bleeding and crepitus

Monitor for signs of pneumothorax, air embolism, and pulmonary edema

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C-ulture

C-ytological

exam

P-ulmonary

lesion

P-leural

effusion

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PREPROCEDURE: -et the patient signs informed consent

-se of local anesthesia, pressure during insertion of needle

-PO -ive analgesics and sedatives as prescribed

L U N G

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POSTPROCEDURE: -ital signs must be monitored -nspect biopsy site for drainage

or bleeding -n biopsy site dressing must be

applied -neumothorax and air embolism -igns of respiratory distress must

be monitored -ou prepare the patient for chest

x-ray

B I

O P S Y

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Measuremet Oxygen Carbon dioxide

Arterial blood

Acid base state

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PREPROCEDURE: -llen’s test before drawing radial artery specimens

-efore specimen collection, client to rest for 30 minutes

-iving suction before drawing ABG sample is avoided

A B G

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POSTPROCEDURE:

Place the specimen on ice

Note the client’s temperature on the laboratory form

Note the oxygen and type of ventilation that the client is receiving on the laboratory form

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POSTPROCEDURE: Apply pressure to the puncture site for 5 to 10 minutes or longer if the client is taking anticoagulant therapy or has a bleeding disorder

Transport the specimen to the laboratory within 15 minutes

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Normal Arterial Blood Gas Values:

pH 7.35 to 7.45

PCO2 35 to 45 mmHg

HCO3 22 to 26 mmHg

PO2 80 to 100 mmHg

O2 sat 96% to 100 %

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R-espiratory

O-pposite

M-etabolic

E-qual

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Sustained

Maximal

Inspiration

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INDICATIONS:

Upper-abdominal surgery

Thoracic surgery

Surgery in patients with chronic obstructive pulmonary disease

Pulmonary atelectasis

Presence of a restrictive lung defect associated with quadraplegia and/or dysfunctional diaphragm.

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Considerations PREPROCEDURE -void smoking or eating heavy meal

for 4 to 6 hours before the test -e sure to remove dentures -onsult with the physician regarding

holding bronchodilators before testing

-etermine whether analgesic that may depress the respiratory function is being administered

-ncourage to void and wear loose clothing

A B C D E

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Considerations

POSTPROCEDURE

Resume:

Diet

Bronchodilators

Respiratory treatments

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determines the effectivity of bronchodilator for asthmatic patients

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Management: 1. Diary 2. Weeks period that the child

is well 3. Blows Results: GREEN: 80 to 100%... Very

Good YELLOW: 50 to 80%...

Beginning Attack RED: <50%... Bring to ER

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