Clinical Skills

Question 1 of 1

Time Left

Put the steps in order for when doing venepuncture

Match the text (click and drag)

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Match the Text
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Ask if patient has preferred arm
Thank patient
Insert needle at 15-30', and take blood
Apply tournique, ask patient to clench fist, and palpate vein
Explain procedure, common risks (bruising, bleeding), check allergies/needle phobias
Wash hands and put on gloves
Check site for bleeding and offer and plaster if patient is not allergic
Assemble need without unsheething needle
Put blood into sample bottles
Introduce self, identify patient (name, DOB)
Clean tray, sharp bin. Collect: needle and syringe or vacutainer, clean tourniquet, non-sterile gloves, alcohol wipe, cotton wool, plaster
Remove needle, apply cotton wool, and put needle into sharps bin
Unsheet needle and stabilise vein (do not palpate)
Wash hands
Clean skin with alcohol wipe for 30 seconds and allow to dry
Remove gloves and wash hands
Label specimen tubes at bedside: patient's name, DOB and hospital number

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Carotid pulses
Face - eyes for xanthalosma, lips, tongue, teeth for dental caries
Palpate apex beat - 5th ICS, mid clavicular
Collapsing pulse
Hands - clubbing, Janeway lesions, Osler's nodes, splinter haemorrhages, colour, tar
Inspect chest - scars, asymmetries
Brachial pulse, mention BP
Ask about pain/tenderness
Auscultate lung bases
Feel carotid and ausculate valves with bell and diaphragm. Listen to axilla with diaphragm (mitral regurg)
Wash hands, introduce yourself, ask patient's name and DOB
JVP
Pre-warn patient of possible discomfort, gain consent, adequate exposure
Cap refill (hold for 5, less than 2 seconds refill)
Listen to carotids with diaphragm/bell whilst patient holds breath
Explain reason for exam. and outline what it will consist of
Check for sacral and peripheral oedema
Feel for thrills (over valves) and heaves (left sternal edge)
Feel carotids and ask patient to roll on to left side - listen to apex
Sit patient forward and listen over lower left sternal edge with diaphragm in expiration
Thank patient and wash hands
Radial pulse, radio-radial delay
End of bed inspection - GTN, monitors etc, breathless, sweating

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Family history
Past medical history
Presenting complain
Systemic enquiry - not in a focused history
Social history
Allergies
Summary
Drug history
ICE
History of PC

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Listen with diaphragm above umbilicus for aortic bruit
End of bed inspection: environment (drips, vomit bowl, urine/faeces sample)
Percuss liver: RIF and then down from 5th ICS
Radial pulse - rate and rhythm
Pre-warm the patient of possible discomfort
JVP
Palpate aorta: halfway between xiphoid and umbilicus. Press fingers posteriorly and medially. Pulsatile/expansile
Lie patient down
Percuss spleen: RIF to left costal margin
Palpate for liver from RIF to costal margin, taking deep breath in and out
Ask if patient has abdominal pain
Palpate for spleen from RIF to left costal margin
Deep palpation: note voluntary (pain) or non-voluntary guarding (peritonitis)
End of bed inspection: colour (jaundice, pallor, grey)
Ankle oedema
Right of umbilicus with diaphragm for 2 minutes. No bowel sounds = paralysis, tinkling = obstruction
Thank patient and wash hands
Ascites: percuss from midline to left flank (dull for fluid). Ask patient to roll onto right and percuss spot again after 10 seconds
End of bed inspection: body habitus (malnourished, overweight, cachexia), gynaecomastia
Ballot both kidneys: left hand on back and right hand on front. Push together on exhalation then ballot
Gain consent and explain reason for examination. Outline what it will consist of
Inspect hands: white nails (leukonychia), spoon nails (kolionychia), Dupytren's contracture (thickening of palm), clubbing, palmar erythema (red palms), hepatic flap
Wash hands, introduce self, obtain patient's name and DOB
Mention BP
Listen with diaphragm 2-3 cm above and lateral to the umbilicus for renal bruit. Repeat on other side
Expose chest: spider naevia, scars, distension, caput medusae, gynaecomastia, masses
Lightly palpate all 9 areas
Lymph nodes - sit up and swing lefts round
Mentions examination of hernial orifices, external genitalia, digital rectal exam, urinary dipstick, pregnancy test
Inspect face: pallor (conjunctiva, face), jaundice, angular stomatitis (cracked skin at corner of mouth), glossitis (red, enlarged tongue), aphthous ulcers (mouth ulcers)

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Check patient doesn't have should pain - collapsing pulse
Palpate brachial pulse and assess character and volume - more reliable here
Explain to patient what you are going to do - palpate carotid pulses
Radio-radial delay (causes can be coartctation of aorta proximal to subclavian artery)
Explain procedure, gain consent
Feel 2cm below and 2cm behind the bony part on the side of the ankle for the posterior tibial pulses. Assess both
Count pulse over 15s and multiply by 4 unless irregular, then you must assess for 1 minute
Assess both dorsalis pedis pulses - high up foot between big toe and the next tow
Place pads of two fingers over the right radial artery and assess rate and rhythm and volume
Correct exposure and end of bed inspection
Thank patient and wash hands
Listen for carotid bruits with diaphragm of stethoscope while patient holds their breath
Flex patient's knee to 30'. Put thumbs in front of knee and fingers behind and palpate BOTH popliteals
Wash hands, introduce yourself, patient's name and DOB
Say you would do radio-femoral delay (causes can be coarctation of the aorta distal to the subclavian artery)

Clinical Skills

Question 1 of 1

Time Left

Put the steps in order for when doing venepuncture

Match the text (click and drag)

(0/0)

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

Ask if patient has preferred arm

Thank patient

Insert needle at 15-30', and take blood

Apply tournique, ask patient to clench fist, and palpate vein

Explain procedure, common risks (bruising, bleeding), check allergies/needle phobias

Wash hands and put on gloves

Check site for bleeding and offer and plaster if patient is not allergic

Assemble need without unsheething needle

Put blood into sample bottles

Introduce self, identify patient (name, DOB)

Clean tray, sharp bin. Collect: needle and syringe or vacutainer, clean tourniquet, non-sterile gloves, alcohol wipe, cotton wool, plaster

Remove needle, apply cotton wool, and put needle into sharps bin

Unsheet needle and stabilise vein (do not palpate)

Wash hands

Clean skin with alcohol wipe for 30 seconds and allow to dry

Remove gloves and wash hands

Label specimen tubes at bedside: patient's name, DOB and hospital number

Put the steps in order for when doing a CVS examination

Match the text (click and drag)

(0/0)

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

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Carotid pulses

Face - eyes for xanthalosma, lips, tongue, teeth for dental caries

Palpate apex beat - 5th ICS, mid clavicular

Collapsing pulse

Hands - clubbing, Janeway lesions, Osler's nodes, splinter haemorrhages, colour, tar

Inspect chest - scars, asymmetries

Brachial pulse, mention BP

Ask about pain/tenderness

Auscultate lung bases

Feel carotid and ausculate valves with bell and diaphragm. Listen to axilla with diaphragm (mitral regurg)

Wash hands, introduce yourself, ask patient's name and DOB

JVP

Pre-warn patient of possible discomfort, gain consent, adequate exposure

Cap refill (hold for 5, less than 2 seconds refill)