Clinical Skills Exam|Complete and A+ Graded
Nails should be trimmed to no longer than
1/4 in
Handwashing should be performed:
· Before and after every patient encounter.
· After contact with bodily fluid (i.e. blood, excretions, secretions).
· After contact with equipment contaminated with bodily fluid.
After removing gloves
Traditional handwashing must be used when:
· Hands are visibly soiled.
· Infections with spore-forming organisms are present (Clostridium difficile, noroviruses).
Temp range
96.8 - 100.4 (average 98 - 98.6)
Afebrile
without fever
Hyperthermia
Fever caused by pyrogens secreted by toxic bacteria during infections or from tissue breakdown
Hypothermia
abnormally low body temperature
Oral- Average oral/tympanic temp
37C (98.6F)
Axillary- add 1*F to reading / Average
36.5C (97.7F)
Rectal temp- reflective of core temp / Average
37.5C (99.5F)
When not to use electronic temp.
no rectal temps on newborns.
no rectal temps on cardiac patients in ICU
Adult normal___________ beats/min, strong and regular
60-100 beats/min
Bradycardia
slow heart rate (less than 60 bpm)
, Tachycardia
> 100 beats/min
Tachycardia occurs with
infection, sepsis, pneumonia, MI, anxiety, increased exercise
Force (strength of pulse) grading
4+ - bounding
3+ - full and strong
2+ - normal and expected
1+ - diminished or barely palpable
0 - absent
Normal respiration rate
12-20 breaths per minute
Eupnea
Respiration rate (normal) = 12-20/min
Bradypnea
Respiration rate <12/min - regular rate but abnormally slow.
Tachypnea
Respiration rate >20/min - regular rate but abnormally rapid.
without breathing
Apnea
SpO2 Normal range
> 95%
hypoxic drive problem would expect values to be between
88 to 94 percent
Pulse procedure
· Position patient forearm across chest, elbow flexed 90 degree.
· Obliterate pulse, then relax pressure until palpable.
· Assess rate, rhythm & force (strength) (State as RRR 70 2+).
· Count for 30 sec if regular and 60 sec if irregular.
BP normal range
120/80
Nails should be trimmed to no longer than
1/4 in
Handwashing should be performed:
· Before and after every patient encounter.
· After contact with bodily fluid (i.e. blood, excretions, secretions).
· After contact with equipment contaminated with bodily fluid.
After removing gloves
Traditional handwashing must be used when:
· Hands are visibly soiled.
· Infections with spore-forming organisms are present (Clostridium difficile, noroviruses).
Temp range
96.8 - 100.4 (average 98 - 98.6)
Afebrile
without fever
Hyperthermia
Fever caused by pyrogens secreted by toxic bacteria during infections or from tissue breakdown
Hypothermia
abnormally low body temperature
Oral- Average oral/tympanic temp
37C (98.6F)
Axillary- add 1*F to reading / Average
36.5C (97.7F)
Rectal temp- reflective of core temp / Average
37.5C (99.5F)
When not to use electronic temp.
no rectal temps on newborns.
no rectal temps on cardiac patients in ICU
Adult normal___________ beats/min, strong and regular
60-100 beats/min
Bradycardia
slow heart rate (less than 60 bpm)
, Tachycardia
> 100 beats/min
Tachycardia occurs with
infection, sepsis, pneumonia, MI, anxiety, increased exercise
Force (strength of pulse) grading
4+ - bounding
3+ - full and strong
2+ - normal and expected
1+ - diminished or barely palpable
0 - absent
Normal respiration rate
12-20 breaths per minute
Eupnea
Respiration rate (normal) = 12-20/min
Bradypnea
Respiration rate <12/min - regular rate but abnormally slow.
Tachypnea
Respiration rate >20/min - regular rate but abnormally rapid.
without breathing
Apnea
SpO2 Normal range
> 95%
hypoxic drive problem would expect values to be between
88 to 94 percent
Pulse procedure
· Position patient forearm across chest, elbow flexed 90 degree.
· Obliterate pulse, then relax pressure until palpable.
· Assess rate, rhythm & force (strength) (State as RRR 70 2+).
· Count for 30 sec if regular and 60 sec if irregular.
BP normal range
120/80
