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
BP elevated range
120-129/<80
Hypertension stage one
130-139/80-89
Hypertension stage two
140/90
Hypotensive = Sbp _____/ Dbp ______; can be normal in healthy people.
<90/<60
PQRST
P
Provokes (precipitating and palliative factors): How did it come about? What might be
the causes for the symptom? What makes it better or worse? Are there activities (e.g.,
exercise, sleep) that affect it?
PQRST- Q
Quality What does the symptom feel like? (Have the patient explain in his or her own
words.) If the patient has difficulty in describing symptoms, offer probes (e.g., "Is the
pain sharp? Dull?" or "Do you feel light-headed, dizzy, off balance?"). What does the
illness or symptom mean to the patient?
PQRST-
R
Radiate/Region: Where is the symptom located? Is it in one place? Does it go anywhere
else? Have the patient be as precise as possible.
PQRST-
S
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
BP elevated range
120-129/<80
Hypertension stage one
130-139/80-89
Hypertension stage two
140/90
Hypotensive = Sbp _____/ Dbp ______; can be normal in healthy people.
<90/<60
PQRST
P
Provokes (precipitating and palliative factors): How did it come about? What might be
the causes for the symptom? What makes it better or worse? Are there activities (e.g.,
exercise, sleep) that affect it?
PQRST- Q
Quality What does the symptom feel like? (Have the patient explain in his or her own
words.) If the patient has difficulty in describing symptoms, offer probes (e.g., "Is the
pain sharp? Dull?" or "Do you feel light-headed, dizzy, off balance?"). What does the
illness or symptom mean to the patient?
PQRST-
R
Radiate/Region: Where is the symptom located? Is it in one place? Does it go anywhere
else? Have the patient be as precise as possible.
PQRST-
S
