Tuesday, November 29, 2005
UNIT Z12 - CONTRIBUTE TO THE MANAGEMENT OF CLIENT CONTINENCE1. Describe the function and appearance of normal body waste: -(a) Urine.This is the product of ultrafiltration undertaken by the kidneys. It consists of waist products from the blood such as urea.It is normally described as being straw coloured and odourless. However, there are many variations of this.(b) Faeces.This is the unused remains of food after it has been digested. It contains the insoluble parts of food and fibre.It is normally formed and mid brown in colour. It must be noted that some individual's waste may differ from what may be considered normal and this not be a problem for that individual.2. List the observations you would make of the client’s body waste.Colour?Smell?Consistency ?Was there pain on passing?Any evidence of blood?Frequency of micturitions/defections
3. How and where do you record your observations?Observations need to be recorded in an objective manner that is clear to understand. They need to be made in the client's care plan and any abnormalities need to pass on to the Registered Practitioner in question.4. Why do we need to know the client’s normal pattern of elimination?As a benchmark if there are any deviations that may be important.5. What are the effects of an individual’s personal beliefs and preferences on toileting and cleansing?One commonly held view is that bowel actions need to be a daily occurrence. This is not so. Some individuals defecate more than once a day and some individual can no have their bowels open for three days. With age, the frequency of bowel actions can be longer. This is a normal process of ageing. Usually, intervention is made after three days or if the problem persists, then regular intervention, such as aperients, can be used to maintain regularity. If an individual believes that bowel actions should be daily, she/he may abuse laxatives to "rectify" this but may cause more harm, such as megacolon, may result.Some individuals may believe that they need to use disinfectant on the groin/rectal area every time they go to the toilet. This can cause many problems as the skin area can become excoriated and sore due to the corrosive effect of disinfectant and also, the natural flora on the skin can be disturbed or destroyed, increasing the chances of opportunistic infection to set in.6. Briefly explain the effect that each of the following can have on a client’s elimination pattern.(a) Diet.UrineThis may become discoloured by some foods such as beetroot. Also, some food may encourage fluid retention or act as a diuretic.BowelsFaeces is highly dependent of diet, as it is the waste products of food that constitute faeces. For example, if an individual has a low fibre diet, then they may have very constipated stools, or, conversely, if a high fibre diet, then well formed stools.(b) Fluid.Urine.Insufficient fluid can cause client's urine to be dark in colour and difficult to pass. Due to the increased acidity due to the increased concentration of the urine, the number of micturitions may be greater and lower volumes of urine may be passed as the bladder is more likely to be irritated by the increased acidity. High fluid volumes tend to result in very pale urine with large amounts passed at each micturition.Faeces.Insufficient fluid can cause and exacerbate constipation and excess fluids can cause faeces to be looser.(c) Medication.UrineDiuretics increase micturition volume. Some drugs may cause colour changesFaecesSome painkillers can cause constipation. Others may cause loose faeces such as antibiotics as, as well as killing off the required pathogen, can also kill off the helpful bacterial flora in the gut.(d) Mobility.7. What may cause the client pain on: -(a) Micturition?
Infection
Trauma
Kidney stones
(b) Defecation?
Constipation
Diarrhoea
Trauma
Infection
8. List the legislation/policies that affect the disposal of body waste.
Heath and Safety at work Act
Care of substances hazardous to health (COSHH)
9. Describe the correct procedure for: -(a) Disposing of a client’s body waste and equipment used.
Where waste has been passed into a bedpan, this should be placed into a bedpan washer (if the bed pan is not disposable) or a masserater (if the bed pan is designed to be disposed of in this way).
Where incontinence has occurred, all laundry should be sent for washing in a dissolvable red bag then placed in an outer red bag.
If incontinence has occurred on a hard surface, such as the floor or table. The excess should be disposed of
Latex glove and disposable aprons should be worn at al times during the procedure
(b) Cleaning up a spillage of urine/faeces.10. Describe how you would explain the following terminology to clients: -(a) Micturition.Passing urine(b) Defecation.Having bowels open(c) MSU.The taking of a specimen of urine
11. What do you understand the term ‘continence’ to mean?The ability to fully manage one's toileting. There are varying degrees of continence. An individual can have a catheter and manage it and still be regarded as continent. There are a chain of events that are involved with continence: -Having the sensation of requiring to use bowels or empty bladderBeing able to access toilet facilities safelyBeing able to adjust clothingThe use of toilet facilities without spillageBeing able to clean oneself afterwardsBeing able to return to a comfortable position afterwards.If any link in this chain is broken, then it could be argued that an individual could be said to be incontinent.1. Briefly explain the effect that hospitalisation may have on a client’s continence.Describe the actions you take to promote the continence of clients in your care.Hospitalisation is notorious for causing incontinence. One of the major factors is that of time. Workers tend to have many tasks to undertake and toileting can be low on the list of priorities. Individuals being embarrassed about asking for toilet facilities so they wait until they are desperate to use facilities before asking can exacerbate this. Add this to busy worker who say "in a minute" and the chances of incontience occurring are highly increased.Time is not only a big factor. Another factor is that of mobility. Individuals tend to not mobilise at their premorbid level. This is due to the fact that they may be ill so mobilisation may be compromised. Also if a client is slow to mobilise, then workers may take short cuts such as inappropriately use continence aids such as commodes, bedpans or incontinence pads which encourage clients to be incontinence.Some medication can effect continence. Diuretics greatly increase urine output and also the urge to micturate. Antibiotics can kill gut flora and cause diarrhoea.Continence can be encouraged with pre-thought and giving clients time. A full understanding is also very important. Getting to know one's clients is quintessential to fully promote continence. The promotion of a good client-worker relationship is also good as the client then feels less embarrassed to ask for help with continence.2. How would you recognise that a client was embarrassed about toileting or incontinence?Being in hospital can be very frightening for clients. They not only have the fear of what may or is wrong with them but also the fear of if they are incontinent then workers being cross with them for being "dirty". If clients ask for the toilet when they are absolutely desperate. They may also try to hide incontinence by, for example, refusing help with toileting and hiding soiled linen and clothing. Their manner may be abrupt3. Describe how you maintain confidentiality, privacy and dignity when assisting the client with toileting or incontinence?
Maximise discretion when dealing with toileting such as not shouting across the room.
Endeavour to build a constructive trusting professional relationship with clients so that they do not feel intimidated when discussing matters of continence.
Listen to client as to what works for them and try to involve this when dealing with the constraints that may be incurred by hospitalisation.
Do not uncover clients unnecessarily during procedures.
4. How do you ensure that communication with the client concerning toileting is not a problem?
Let them know this verbally.
Do not use unconstructive verbal and non-verbal cues when dealing with issues of continence
Ensure that clients have optimum access to the appropriate toileting facilities.
Ensure they have the bell to hand
5. Identify and explain the 5 different types of urinary incontinence, giving possible causes for each.
Stress
Bladder weakness, possibly caused by trauma or atrophy can cause urine to leak out on exertion or sneezing
Urge
If an individual has no real warning before micturition, then micturition can occur before toilet facilities are accessed
Neurological
If there are impaired neurological pathways between the brain and the bladder, then there may be no message received by the client that they need to go to the toilet
Orientation
If a client is disorientated or had dementia, then they may not be able to express the desire to micturate or even interpret it as thus. Sometimes, they know that something is wrong but do not know what it is. Also, there may be a problem expressing the fact that they are wet, even if they realise the fact at all
Iatragenic (medically induced)
Certain medication can cause urinary incontinence. Diuretics can cause vast volumes of urine to be produced over a relatively short time. There is a sudden, strong urge to micturate and toilet facilities may not be able to be accessed at an appropriate speed. Diuretics tend to be given to individuals who are compromised in other ways so the affects of these can compound the problem, especially if the client is not very mobile.
6. Give 3 reasons why ladies are more likely to suffer from incontinence than men do.
they tend to have shorter urethras
they have children which causes weakening of the pelvic floor muscles
7. What are the main causes of faecal incontinence?
constipation
diarrhoea
functional
orientations
8. List the aids and support available for incontinent clients in hospital.
Incontinence pads
Incontinence pads
Stoma bags
Urostomy bags
Catheters
Penile sheaths
9. Why is it important to allow the client choice when selecting incontinence aids and clothing?
At the end of the day, it is the client's right to choose what product or even lack of product or clothing.
The client may be the best arbiter of their own needs
10. What exercises and methods of bladder/habit training can be used to promote continence?
Regular toileting
After a while, the bladder become used to emptying at regular times thus reducing incontinence episodes
Pelvic floor exercises
Educating clients to perform pelvic floor exercises can help to make bladder control better and thus reduce such things as stress incontinence.
11. Describe the potential effects of incontinence on the client and the impact this may have on different aspects of their life?
Physiological
Both primary and secondary incontinence can cause a threat to skin integrity as they can cause burning of the dermis. This can cause skin to break and, if the waste products are not removed, then these will get worse
Although urine is sterile, under normal circumstances, when it leaves the body, as soon as it hits the air, it starts to decompose and airborne bacteria use it for a multiplication medium. Thus it becomes a source of infection. Faeces is already incubation bacteria. Thus, both types of waste pose a possible infection risk.
Psychological
Some individuals find the concept of incontinence degrading and feel awful about having it as a problem. They can feel dirty.
Urine is odourless, under normal circumstance, on leaving the body, until it hits the air when the bacteria mentioned earlier can cause it to smell. Faeces smells already. clients can become isolated due to the smell that they have
Social.
Due to the smell and not wanting to be labelled as being incontinent, then some individuals who are incontinent remove themselves from social situations. They tend not to go out as much as they are frightened that they might need a toilet in a hurry, which then can have an affect on their mobility. This can make incontinence worse.
12. Draw a spider chart showing the services and support available in the community for the incontinent client when they are discharged home.
District Nurse ¬® Other Agencies (Pad services, Physiotherapy, Occupational Therapy …..)
¯ ¯
Client ¨GP
¯ ¯
3. How and where do you record your observations?Observations need to be recorded in an objective manner that is clear to understand. They need to be made in the client's care plan and any abnormalities need to pass on to the Registered Practitioner in question.4. Why do we need to know the client’s normal pattern of elimination?As a benchmark if there are any deviations that may be important.5. What are the effects of an individual’s personal beliefs and preferences on toileting and cleansing?One commonly held view is that bowel actions need to be a daily occurrence. This is not so. Some individuals defecate more than once a day and some individual can no have their bowels open for three days. With age, the frequency of bowel actions can be longer. This is a normal process of ageing. Usually, intervention is made after three days or if the problem persists, then regular intervention, such as aperients, can be used to maintain regularity. If an individual believes that bowel actions should be daily, she/he may abuse laxatives to "rectify" this but may cause more harm, such as megacolon, may result.Some individuals may believe that they need to use disinfectant on the groin/rectal area every time they go to the toilet. This can cause many problems as the skin area can become excoriated and sore due to the corrosive effect of disinfectant and also, the natural flora on the skin can be disturbed or destroyed, increasing the chances of opportunistic infection to set in.6. Briefly explain the effect that each of the following can have on a client’s elimination pattern.(a) Diet.UrineThis may become discoloured by some foods such as beetroot. Also, some food may encourage fluid retention or act as a diuretic.BowelsFaeces is highly dependent of diet, as it is the waste products of food that constitute faeces. For example, if an individual has a low fibre diet, then they may have very constipated stools, or, conversely, if a high fibre diet, then well formed stools.(b) Fluid.Urine.Insufficient fluid can cause client's urine to be dark in colour and difficult to pass. Due to the increased acidity due to the increased concentration of the urine, the number of micturitions may be greater and lower volumes of urine may be passed as the bladder is more likely to be irritated by the increased acidity. High fluid volumes tend to result in very pale urine with large amounts passed at each micturition.Faeces.Insufficient fluid can cause and exacerbate constipation and excess fluids can cause faeces to be looser.(c) Medication.UrineDiuretics increase micturition volume. Some drugs may cause colour changesFaecesSome painkillers can cause constipation. Others may cause loose faeces such as antibiotics as, as well as killing off the required pathogen, can also kill off the helpful bacterial flora in the gut.(d) Mobility.7. What may cause the client pain on: -(a) Micturition?
Infection
Trauma
Kidney stones
(b) Defecation?
Constipation
Diarrhoea
Trauma
Infection
8. List the legislation/policies that affect the disposal of body waste.
Heath and Safety at work Act
Care of substances hazardous to health (COSHH)
9. Describe the correct procedure for: -(a) Disposing of a client’s body waste and equipment used.
Where waste has been passed into a bedpan, this should be placed into a bedpan washer (if the bed pan is not disposable) or a masserater (if the bed pan is designed to be disposed of in this way).
Where incontinence has occurred, all laundry should be sent for washing in a dissolvable red bag then placed in an outer red bag.
If incontinence has occurred on a hard surface, such as the floor or table. The excess should be disposed of
Latex glove and disposable aprons should be worn at al times during the procedure
(b) Cleaning up a spillage of urine/faeces.10. Describe how you would explain the following terminology to clients: -(a) Micturition.Passing urine(b) Defecation.Having bowels open(c) MSU.The taking of a specimen of urine
11. What do you understand the term ‘continence’ to mean?The ability to fully manage one's toileting. There are varying degrees of continence. An individual can have a catheter and manage it and still be regarded as continent. There are a chain of events that are involved with continence: -Having the sensation of requiring to use bowels or empty bladderBeing able to access toilet facilities safelyBeing able to adjust clothingThe use of toilet facilities without spillageBeing able to clean oneself afterwardsBeing able to return to a comfortable position afterwards.If any link in this chain is broken, then it could be argued that an individual could be said to be incontinent.1. Briefly explain the effect that hospitalisation may have on a client’s continence.Describe the actions you take to promote the continence of clients in your care.Hospitalisation is notorious for causing incontinence. One of the major factors is that of time. Workers tend to have many tasks to undertake and toileting can be low on the list of priorities. Individuals being embarrassed about asking for toilet facilities so they wait until they are desperate to use facilities before asking can exacerbate this. Add this to busy worker who say "in a minute" and the chances of incontience occurring are highly increased.Time is not only a big factor. Another factor is that of mobility. Individuals tend to not mobilise at their premorbid level. This is due to the fact that they may be ill so mobilisation may be compromised. Also if a client is slow to mobilise, then workers may take short cuts such as inappropriately use continence aids such as commodes, bedpans or incontinence pads which encourage clients to be incontinence.Some medication can effect continence. Diuretics greatly increase urine output and also the urge to micturate. Antibiotics can kill gut flora and cause diarrhoea.Continence can be encouraged with pre-thought and giving clients time. A full understanding is also very important. Getting to know one's clients is quintessential to fully promote continence. The promotion of a good client-worker relationship is also good as the client then feels less embarrassed to ask for help with continence.2. How would you recognise that a client was embarrassed about toileting or incontinence?Being in hospital can be very frightening for clients. They not only have the fear of what may or is wrong with them but also the fear of if they are incontinent then workers being cross with them for being "dirty". If clients ask for the toilet when they are absolutely desperate. They may also try to hide incontinence by, for example, refusing help with toileting and hiding soiled linen and clothing. Their manner may be abrupt3. Describe how you maintain confidentiality, privacy and dignity when assisting the client with toileting or incontinence?
Maximise discretion when dealing with toileting such as not shouting across the room.
Endeavour to build a constructive trusting professional relationship with clients so that they do not feel intimidated when discussing matters of continence.
Listen to client as to what works for them and try to involve this when dealing with the constraints that may be incurred by hospitalisation.
Do not uncover clients unnecessarily during procedures.
4. How do you ensure that communication with the client concerning toileting is not a problem?
Let them know this verbally.
Do not use unconstructive verbal and non-verbal cues when dealing with issues of continence
Ensure that clients have optimum access to the appropriate toileting facilities.
Ensure they have the bell to hand
5. Identify and explain the 5 different types of urinary incontinence, giving possible causes for each.
Stress
Bladder weakness, possibly caused by trauma or atrophy can cause urine to leak out on exertion or sneezing
Urge
If an individual has no real warning before micturition, then micturition can occur before toilet facilities are accessed
Neurological
If there are impaired neurological pathways between the brain and the bladder, then there may be no message received by the client that they need to go to the toilet
Orientation
If a client is disorientated or had dementia, then they may not be able to express the desire to micturate or even interpret it as thus. Sometimes, they know that something is wrong but do not know what it is. Also, there may be a problem expressing the fact that they are wet, even if they realise the fact at all
Iatragenic (medically induced)
Certain medication can cause urinary incontinence. Diuretics can cause vast volumes of urine to be produced over a relatively short time. There is a sudden, strong urge to micturate and toilet facilities may not be able to be accessed at an appropriate speed. Diuretics tend to be given to individuals who are compromised in other ways so the affects of these can compound the problem, especially if the client is not very mobile.
6. Give 3 reasons why ladies are more likely to suffer from incontinence than men do.
they tend to have shorter urethras
they have children which causes weakening of the pelvic floor muscles
7. What are the main causes of faecal incontinence?
constipation
diarrhoea
functional
orientations
8. List the aids and support available for incontinent clients in hospital.
Incontinence pads
Incontinence pads
Stoma bags
Urostomy bags
Catheters
Penile sheaths
9. Why is it important to allow the client choice when selecting incontinence aids and clothing?
At the end of the day, it is the client's right to choose what product or even lack of product or clothing.
The client may be the best arbiter of their own needs
10. What exercises and methods of bladder/habit training can be used to promote continence?
Regular toileting
After a while, the bladder become used to emptying at regular times thus reducing incontinence episodes
Pelvic floor exercises
Educating clients to perform pelvic floor exercises can help to make bladder control better and thus reduce such things as stress incontinence.
11. Describe the potential effects of incontinence on the client and the impact this may have on different aspects of their life?
Physiological
Both primary and secondary incontinence can cause a threat to skin integrity as they can cause burning of the dermis. This can cause skin to break and, if the waste products are not removed, then these will get worse
Although urine is sterile, under normal circumstances, when it leaves the body, as soon as it hits the air, it starts to decompose and airborne bacteria use it for a multiplication medium. Thus it becomes a source of infection. Faeces is already incubation bacteria. Thus, both types of waste pose a possible infection risk.
Psychological
Some individuals find the concept of incontinence degrading and feel awful about having it as a problem. They can feel dirty.
Urine is odourless, under normal circumstance, on leaving the body, until it hits the air when the bacteria mentioned earlier can cause it to smell. Faeces smells already. clients can become isolated due to the smell that they have
Social.
Due to the smell and not wanting to be labelled as being incontinent, then some individuals who are incontinent remove themselves from social situations. They tend not to go out as much as they are frightened that they might need a toilet in a hurry, which then can have an affect on their mobility. This can make incontinence worse.
12. Draw a spider chart showing the services and support available in the community for the incontinent client when they are discharged home.
District Nurse ¬® Other Agencies (Pad services, Physiotherapy, Occupational Therapy …..)
¯ ¯
Client ¨GP
¯ ¯
Sunday, July 24, 2005
b3 vewnepuncture
Skills Training Pack
VENEPUNCTURE
Practice Development
June 2004
DEVELOPING PRACTICE
EDUCATION
Name:
Designation:
Area of Work:
Venepuncture
PDD/Reviewed June04
Review: June06
1
SKILLS TRAINING PACK
CONTENTS
Page No.
• Aim 2
• Definition 2
• Standard 2
• Self-Directed Learning Method 3
• Training Summary Sheet 4
• Responsibilities of an Assessor 5
• Child Health Directorate Criteria 6
• Learning Outcomes 7
• Theory Assessment 8
• Supervised Practice 15
• Reading List 16
• Evaluation 17
The concept of the Self Directed Learning Packs has resulted from funding from the
Cornwall and South Devon Education Purchasing Consortium and the subsequent joint
project work of the Consortium Project Team, consisting of a representative from Royal
Cornwall Hospitals NHS Trust, Plymouth Hospital NHS Trust and South Devon Healthcare
NHS Trust.
The Core Competency Skills Modules were developed as part of the Critical Care Project at
RCHT (2000 – 2001) in response to the Department of Health’s modernisation programme to
develop consistent and comprehensive critical care services throughout the NHS
(Comprehensive Critical Care, A Review of Adult Critical Care Services, DoH 2000).
All rights reserved. Should you need to copy, record, store in a retrieval system or transmit
electronically or otherwise, permission must be sought from the Practice Development
Department, Royal Cornwall Hospitals Trust, Royal Cornwall Hospital.
Venepuncture
PDD/Reviewed June04
Review: June06
2
AIM
To educate and train Health Care Professionals/Designated Support Workers to perform the
skill / competency safely and competently, in accordance with Trust procedures, with
underpinning theoretical knowledge to ensure evidence based practice.
DEFINITION
The insertion of a needle into a vein in order to obtain a blood specimen/s
STANDARD
• The skill is performed in accordance with RCHT policies, procedures, guidelines and
protocols.
• Staff have access to RCHT policies, procedures, guidelines and protocols available in all
clinical areas and the document library.
• Relevant policies, procedures guidelines and protocols are listed for each skill in the
specific skills training pack.
• There is validated education and training in place to enable staff to attain competency in
the skill.
• There is written evidence of attained competence.
Venepuncture
PDD/Reviewed June04
Review: June06
3
SELF DIRECTED LEARNING METHOD
This training pack is for use by Health Care Professionals/Designated Support Workers for
initial training, continual updating and self assessment.
• It is designed for you to direct your own learning to achieve the competence level
and Trust standard required for this skill.
• The flexibility of self directed learning will allow you to utilise your time for
study to obtain both theoretical knowledge and practical skills.
• You will be able to work at your own pace and decide for yourself when you are
ready for assessment. You will then be able to initiate your own updating to
maintain your competence of this skill.
• You must successfully complete the theory preparations and assessments before
your practical training, where indicated, followed by supervised practice.
• You must successfully complete the theory assessment and undertake a period of
supervised practice, where indicated, before undertaking this skill unsupervised.
It is expected that you direct yourself to gain competence in the theoretical assessment using
your Trust's resources. These may include:
Practice Development Resource Room.
Practice Development Website
Library
Pharmacy
Document Library
Clinical Practice Educators
Clinical Experts
Risk and Safety Department
Pathology Department
It is essential that you make full use of your Supervisor/Assessor to help with both the
learning and assessment stages of this skill.
Venepuncture
PDD/Reviewed June04
Review: June06
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TRAINING SUMMARY SHEET
Training Entry Criteria
• Health Care Professionals/Designated Support Workers, with line manager’s approval.
• Health Care Professionals who show a clear understanding of their Governing Body's
directives regarding the procedure.
Criteria for Supervisors and Assessors
• Practice Educator.
• Competent Health Care Professional who has been assessed as having reached the
Trust's Standard for venepuncture.
• A competent Health Care Professional who performs venepuncture a minimum of twice
a week.
• The supervisor will supervise practice on a one to one basis.
• A supervisor is not necessarily required to be an assessor.
Policies, Procedures and Standards Associated with Venepuncture
• Trust Procedure for Venepuncture.
• Trust Risk and Safety Policy.
• Trust Infection Control Policy.
• Trust Standard for Venepuncture.
• Trust Standard for Records and Record Keeping.
• Health Care Professionals' Governing Body's directives on best practice.
• Trust Disposal of Waste Policy.
Teaching resources
• Equipment required for venepuncture as per Trust procedure.
• Model arms available.
Training Content/Presentation/Timetable
• Theoretical knowledge will be obtained and demonstrated using a self directed study
method.
• Practical training will take place in the clinical and/or study areas. Models will be used
followed by supervised practice
• Training sessions should be completed in one hour.
Venepuncture
PDD/Reviewed June04
Review: June06
5
Assessments
• It is advised that training should be completed within a period of one month.
• Each Health Care Professional will take responsibility for their own level of competence and
exercise their professional clinical judgement before undertaking this procedure unsupervised.
• Each Health Care Professional will be responsible for maintaining their knowledge base on
venepuncture by analysing the latest research and recommended changes in practice.
• Designated Support Workers will seek guidance from appropriate clinical supervisor regarding
their own competence and current research.
• Self directed theoretical study.
• Self assessment must be continuous once the individual is competent.
• The period of supervised practice to be negotiated on an individual basis, until the learner is
confident to undertake a practical assessment, where indicated, and ultimately perform the
procedure unsupervised.
Responsibilities of an Assessor
• Act always in such a manner as to promote and safeguard the interests and well-being of
patients and clients.
• Assist professional colleagues in the context of your own knowledge, expertise and sphere of
responsibility, to develop their professional competence.
• Must honestly acknowledge any limit of personal knowledge and skill and take steps to remedy
any relevant deficits.
• Recognise and honour the personal accountability borne for all aspects of professional practice.
• Enhance trust and confidence within a health care team and promote collaborative work
between other health care professionals.
• To assist health care professionals in their role as clinical assessors it is expected that all
experienced clinically competent health care professionals complete the theoretical self directed
learning section of the skills training packages.
• By completing the theoretical training the clinically competent health care professional will
maintain their knowledge base and ensure that they are equipped to assess other health care
workers.
• The Practice Educators will evaluate the assessors completed theoretical section. By monitoring
the assessor in this fashion the Practice Educators will be able to promote a high standard of
subsequent assessments.
• Health care professionals who decline to complete the theoretical section of the training
package may not have sufficient expertise or knowledge required to complete the theoretical
section and thus would not make suitable assessors.
• Health care professionals who do not follow this process may compromise trainees.
Venepuncture
PDD/Reviewed June04
Review: June06
6
CHILD HEALTH DIRECTORATE CRITERIA
To comply with the recommendations in the "Clothier Report"(1994), the following advice
should be adhered to when caring for children under the age of sixteen.
Children are cared for in areas other than the Child Health Directorate. When this occurs
the skills contained in these packs should only be performed by Registered Sick Children
nurses, experienced doctors or experienced paediatric therapists.
Personnel wishing to train in these skills who are Registered Sick Children nurse trained,
experienced doctors or experienced paediatric therapists, must seek the approval of the
Senior Nurse for the Child Health Directorate, Consultant Paediatrician or Therapies
Manager.
For personnel working in Accident and Emergency, Intensive Therapy Unit and in
theatres, approval must be sought from the appropriate Line Manager and Consultant.
Venepuncture
PDD/Reviewed June04
Review: June06
7
LEARNING OUTCOMES
At the conclusion of the theory assessment and supervised practice for venepuncture training
you will be able to:
• Demonstrate knowledge of national, local and professional policies, procedures and
standards in relation to venepuncture.
• Demonstrate knowledge of your governing body's directives if applicable, pertaining to
responsibilities and accountability regarding clinical skills.
• Demonstrate the correct procedure for patient identification and obtaining informed
consent.
• Demonstrate knowledge of the normal anatomy of the arm, having a clear
understanding of the location of nerves, arteries and veins.
• Explain the rationale behind correct vein choice and the concept of vein preservation.
• Prepare and use the equipment required.
• Demonstrate the principles of the correct venepuncture technique following the Trust's
procedure and standard.
• Demonstrate the ability to assess and identify practical problems associated with
venepuncture and state how to deal with these.
• Demonstrate knowledge of psychological problems patients may have in preparation
for and when venepuncture is performed.
• Demonstrate knowledge of how to identify the resources available for up-to-date
information and practical advice.
• Demonstrate knowledge of the rationale behind self assessment and a clear
understanding of how to use the Trust's assessment tool.
(Refer to descriptors for this skill in the Practice Development Prospectus / Website –
these can be downloaded for use).
Venepuncture
PDD/Reviewed June04
Review: June06
8
THEORY ASSESSMENT 1
Policies, procedures and standards
a) In accordance with the Health and Safety Policy what is your duty when caring for
patients?
b) How does the 'Control of Substances Hazardous to Health' legislation impact upon
venepuncture?
c) What is the Trust's Standard for venepuncture?
d) Where is the Trust's venepuncture procedure located?
e) Why is it important to have a Trust ratified procedure for clinical skills?
f) What is the Trust's Standard on record keeping by Health Care Professionals and how
are the principles applied in relation to the sample request forms and labelling the
specimens?
Venepuncture
PDD/Reviewed June04
Review: June06
9
THEORY ASSESSMENT 2
a) How will you assess your continual competence to perform this skill and maintain best
practice?
b) What resources are available to you in your Trust to facilitate theoretical knowledge and
practical skills?
Venepuncture
PDD/Reviewed June04
Review: June06
10
THEORY ASSESSMENT 3
Infection Control
a) Explain the importance of maintaining asepsis during the venepuncture procedure.
b) Explain why it is important to adhere to the 'Universal Precautions' policy during
venepuncture procedure and the patient's after care.
c) What is the single most important process in preventing nosocomial infections?
d) What should you do if you sustain a needlestick injury?
Venepuncture
PDD/Reviewed June04
Review: June06
11
THEORY ASSESSMENT 4
Knowledge required for venepuncture
a) How can you ensure the patient gives valid consent?
b) What should you do to ensure that the patient is correctly identified?
c) How do you clinically differentiate between a vein and an artery:
d) How would you describe veins which are:
i) Tortuous
ii) Thin walled
iii) Thrombosed
iv) Inflamed
Venepuncture
PDD/Reviewed June04
Review: June06
12
e) Explain which vein should ideally be used for venepuncture and the accompanying
rationale.
f) Where should you apply the tourniquet in relation to the proposed venepuncture site?
g) What is the rationale for palpating the radial pulse after applying the tourniquet?
h) Where would you find the information about which sample tubes to use and the order in
which to draw them?
i) List at least 3 situations / conditions when it may be inappropriate to take a blood sample:
(i)
(ii)
(iii)
Venepuncture
PDD/Reviewed June04
Review: June06
13
THEORY ASSESSMENT 5
The Risks
a) What are the three possible problems associated with venepuncture?
i)
ii)
iii)
b) What are the three possible causes?
i)
ii)
iii)
c) What are the three possible solutions?
i)
ii)
iii)
Venepuncture
PDD/Reviewed June04
Review: June06
14
d) Give three examples of blood borne viruses to which you may be at risk if you are
exposed to infected blood.
i)
ii)
iii)
e) Define 'needle phobia'
f) Explain how needle phobia may complicate the therapy/investigations which need to be
carried out on the patient.
Completed satisfactorily: Yes No
Signed: (Assessor)
Date:
Comments:
Venepuncture
PDD/Reviewed June04
Review: June06
15
SUPERVISED PRACTICE
SELF DIRECTED LEARNING PACK
You must successfully complete the theory assessments before attempting any practical
learning of this skill.
You must successfully complete the theory and supervised practice before undertaking this
skill unsupervised.
Supervisor:
Date Supervised Practice Completed:
Signature:
Comments:
Learners Signature:
Comments:
Venepuncture
PDD/Reviewed June04
Review: June06
16
READING LIST
Clothier Report (1994) Independent Enquiry Relative to Deaths and Injuries on the Childrens
Ward at Grantham & Kesteven General Hospital. London HMSO
Royal Cornwall Hospitals NHS Trust's Health and Safety Policy
Royal Cornwall Hospitals NHS Trust's Control of Substances Hazardous to Health
Royal Cornwall Hospitals NHS Trust's Infection Control Policy
Royal Cornwall Hospitals NHS Trust's Disposal of Waste Policy
The Royal Marsden Manual of Clinical Nursing Procedures (6th Edition)
Black. F. (1997) Venepuncture. Nursing Standard, Vol 11, No 41, pp 49-55
McConnell. A A. Mackay. G M. (1996) Venepuncture – the medicolegal hazards.
Postgraduate Medical Journal, No 72, pp 23-24
Stevenson. B. (1997) Venepuncture. Community Nurse, October, pp 21-22
Nursing Times Practice (2000) Tourniquets pose infection risk. Nursing Times, Vol 96, No 2.
Venepuncture
PDD/Reviewed June04
Review: June06
17
EVALUATION OF TRAINING PACK
Title of training package: …………………………………………………………………..
Duration of training: …………………………………………………………………………..
Final assessment date: …………………………………………………………………..
Successful assessment: Yes No
Please complete the following evaluations:
Very user friendly
5
4
3
2
1
Very difficult to use
Instructions were clear
5
4
3
2
1
Instructions were
unclear
Information was easily
resourced
5
4
3
2
1
Information was
difficult to resource
Knowledge about skill has
increased
5
4
3
2
1
Knowledge has not
increased
Able to reflect on your
training and its benefits
5
4
3
2
1
Difficult to reflect on
your training and its
benefits.
Please detach this page and return to:
Practice Development Department, Royal Cornwall Hospital.
VENEPUNCTURE
Practice Development
June 2004
DEVELOPING PRACTICE
EDUCATION
Name:
Designation:
Area of Work:
Venepuncture
PDD/Reviewed June04
Review: June06
1
SKILLS TRAINING PACK
CONTENTS
Page No.
• Aim 2
• Definition 2
• Standard 2
• Self-Directed Learning Method 3
• Training Summary Sheet 4
• Responsibilities of an Assessor 5
• Child Health Directorate Criteria 6
• Learning Outcomes 7
• Theory Assessment 8
• Supervised Practice 15
• Reading List 16
• Evaluation 17
The concept of the Self Directed Learning Packs has resulted from funding from the
Cornwall and South Devon Education Purchasing Consortium and the subsequent joint
project work of the Consortium Project Team, consisting of a representative from Royal
Cornwall Hospitals NHS Trust, Plymouth Hospital NHS Trust and South Devon Healthcare
NHS Trust.
The Core Competency Skills Modules were developed as part of the Critical Care Project at
RCHT (2000 – 2001) in response to the Department of Health’s modernisation programme to
develop consistent and comprehensive critical care services throughout the NHS
(Comprehensive Critical Care, A Review of Adult Critical Care Services, DoH 2000).
All rights reserved. Should you need to copy, record, store in a retrieval system or transmit
electronically or otherwise, permission must be sought from the Practice Development
Department, Royal Cornwall Hospitals Trust, Royal Cornwall Hospital.
Venepuncture
PDD/Reviewed June04
Review: June06
2
AIM
To educate and train Health Care Professionals/Designated Support Workers to perform the
skill / competency safely and competently, in accordance with Trust procedures, with
underpinning theoretical knowledge to ensure evidence based practice.
DEFINITION
The insertion of a needle into a vein in order to obtain a blood specimen/s
STANDARD
• The skill is performed in accordance with RCHT policies, procedures, guidelines and
protocols.
• Staff have access to RCHT policies, procedures, guidelines and protocols available in all
clinical areas and the document library.
• Relevant policies, procedures guidelines and protocols are listed for each skill in the
specific skills training pack.
• There is validated education and training in place to enable staff to attain competency in
the skill.
• There is written evidence of attained competence.
Venepuncture
PDD/Reviewed June04
Review: June06
3
SELF DIRECTED LEARNING METHOD
This training pack is for use by Health Care Professionals/Designated Support Workers for
initial training, continual updating and self assessment.
• It is designed for you to direct your own learning to achieve the competence level
and Trust standard required for this skill.
• The flexibility of self directed learning will allow you to utilise your time for
study to obtain both theoretical knowledge and practical skills.
• You will be able to work at your own pace and decide for yourself when you are
ready for assessment. You will then be able to initiate your own updating to
maintain your competence of this skill.
• You must successfully complete the theory preparations and assessments before
your practical training, where indicated, followed by supervised practice.
• You must successfully complete the theory assessment and undertake a period of
supervised practice, where indicated, before undertaking this skill unsupervised.
It is expected that you direct yourself to gain competence in the theoretical assessment using
your Trust's resources. These may include:
Practice Development Resource Room.
Practice Development Website
Library
Pharmacy
Document Library
Clinical Practice Educators
Clinical Experts
Risk and Safety Department
Pathology Department
It is essential that you make full use of your Supervisor/Assessor to help with both the
learning and assessment stages of this skill.
Venepuncture
PDD/Reviewed June04
Review: June06
4
TRAINING SUMMARY SHEET
Training Entry Criteria
• Health Care Professionals/Designated Support Workers, with line manager’s approval.
• Health Care Professionals who show a clear understanding of their Governing Body's
directives regarding the procedure.
Criteria for Supervisors and Assessors
• Practice Educator.
• Competent Health Care Professional who has been assessed as having reached the
Trust's Standard for venepuncture.
• A competent Health Care Professional who performs venepuncture a minimum of twice
a week.
• The supervisor will supervise practice on a one to one basis.
• A supervisor is not necessarily required to be an assessor.
Policies, Procedures and Standards Associated with Venepuncture
• Trust Procedure for Venepuncture.
• Trust Risk and Safety Policy.
• Trust Infection Control Policy.
• Trust Standard for Venepuncture.
• Trust Standard for Records and Record Keeping.
• Health Care Professionals' Governing Body's directives on best practice.
• Trust Disposal of Waste Policy.
Teaching resources
• Equipment required for venepuncture as per Trust procedure.
• Model arms available.
Training Content/Presentation/Timetable
• Theoretical knowledge will be obtained and demonstrated using a self directed study
method.
• Practical training will take place in the clinical and/or study areas. Models will be used
followed by supervised practice
• Training sessions should be completed in one hour.
Venepuncture
PDD/Reviewed June04
Review: June06
5
Assessments
• It is advised that training should be completed within a period of one month.
• Each Health Care Professional will take responsibility for their own level of competence and
exercise their professional clinical judgement before undertaking this procedure unsupervised.
• Each Health Care Professional will be responsible for maintaining their knowledge base on
venepuncture by analysing the latest research and recommended changes in practice.
• Designated Support Workers will seek guidance from appropriate clinical supervisor regarding
their own competence and current research.
• Self directed theoretical study.
• Self assessment must be continuous once the individual is competent.
• The period of supervised practice to be negotiated on an individual basis, until the learner is
confident to undertake a practical assessment, where indicated, and ultimately perform the
procedure unsupervised.
Responsibilities of an Assessor
• Act always in such a manner as to promote and safeguard the interests and well-being of
patients and clients.
• Assist professional colleagues in the context of your own knowledge, expertise and sphere of
responsibility, to develop their professional competence.
• Must honestly acknowledge any limit of personal knowledge and skill and take steps to remedy
any relevant deficits.
• Recognise and honour the personal accountability borne for all aspects of professional practice.
• Enhance trust and confidence within a health care team and promote collaborative work
between other health care professionals.
• To assist health care professionals in their role as clinical assessors it is expected that all
experienced clinically competent health care professionals complete the theoretical self directed
learning section of the skills training packages.
• By completing the theoretical training the clinically competent health care professional will
maintain their knowledge base and ensure that they are equipped to assess other health care
workers.
• The Practice Educators will evaluate the assessors completed theoretical section. By monitoring
the assessor in this fashion the Practice Educators will be able to promote a high standard of
subsequent assessments.
• Health care professionals who decline to complete the theoretical section of the training
package may not have sufficient expertise or knowledge required to complete the theoretical
section and thus would not make suitable assessors.
• Health care professionals who do not follow this process may compromise trainees.
Venepuncture
PDD/Reviewed June04
Review: June06
6
CHILD HEALTH DIRECTORATE CRITERIA
To comply with the recommendations in the "Clothier Report"(1994), the following advice
should be adhered to when caring for children under the age of sixteen.
Children are cared for in areas other than the Child Health Directorate. When this occurs
the skills contained in these packs should only be performed by Registered Sick Children
nurses, experienced doctors or experienced paediatric therapists.
Personnel wishing to train in these skills who are Registered Sick Children nurse trained,
experienced doctors or experienced paediatric therapists, must seek the approval of the
Senior Nurse for the Child Health Directorate, Consultant Paediatrician or Therapies
Manager.
For personnel working in Accident and Emergency, Intensive Therapy Unit and in
theatres, approval must be sought from the appropriate Line Manager and Consultant.
Venepuncture
PDD/Reviewed June04
Review: June06
7
LEARNING OUTCOMES
At the conclusion of the theory assessment and supervised practice for venepuncture training
you will be able to:
• Demonstrate knowledge of national, local and professional policies, procedures and
standards in relation to venepuncture.
• Demonstrate knowledge of your governing body's directives if applicable, pertaining to
responsibilities and accountability regarding clinical skills.
• Demonstrate the correct procedure for patient identification and obtaining informed
consent.
• Demonstrate knowledge of the normal anatomy of the arm, having a clear
understanding of the location of nerves, arteries and veins.
• Explain the rationale behind correct vein choice and the concept of vein preservation.
• Prepare and use the equipment required.
• Demonstrate the principles of the correct venepuncture technique following the Trust's
procedure and standard.
• Demonstrate the ability to assess and identify practical problems associated with
venepuncture and state how to deal with these.
• Demonstrate knowledge of psychological problems patients may have in preparation
for and when venepuncture is performed.
• Demonstrate knowledge of how to identify the resources available for up-to-date
information and practical advice.
• Demonstrate knowledge of the rationale behind self assessment and a clear
understanding of how to use the Trust's assessment tool.
(Refer to descriptors for this skill in the Practice Development Prospectus / Website –
these can be downloaded for use).
Venepuncture
PDD/Reviewed June04
Review: June06
8
THEORY ASSESSMENT 1
Policies, procedures and standards
a) In accordance with the Health and Safety Policy what is your duty when caring for
patients?
b) How does the 'Control of Substances Hazardous to Health' legislation impact upon
venepuncture?
c) What is the Trust's Standard for venepuncture?
d) Where is the Trust's venepuncture procedure located?
e) Why is it important to have a Trust ratified procedure for clinical skills?
f) What is the Trust's Standard on record keeping by Health Care Professionals and how
are the principles applied in relation to the sample request forms and labelling the
specimens?
Venepuncture
PDD/Reviewed June04
Review: June06
9
THEORY ASSESSMENT 2
a) How will you assess your continual competence to perform this skill and maintain best
practice?
b) What resources are available to you in your Trust to facilitate theoretical knowledge and
practical skills?
Venepuncture
PDD/Reviewed June04
Review: June06
10
THEORY ASSESSMENT 3
Infection Control
a) Explain the importance of maintaining asepsis during the venepuncture procedure.
b) Explain why it is important to adhere to the 'Universal Precautions' policy during
venepuncture procedure and the patient's after care.
c) What is the single most important process in preventing nosocomial infections?
d) What should you do if you sustain a needlestick injury?
Venepuncture
PDD/Reviewed June04
Review: June06
11
THEORY ASSESSMENT 4
Knowledge required for venepuncture
a) How can you ensure the patient gives valid consent?
b) What should you do to ensure that the patient is correctly identified?
c) How do you clinically differentiate between a vein and an artery:
d) How would you describe veins which are:
i) Tortuous
ii) Thin walled
iii) Thrombosed
iv) Inflamed
Venepuncture
PDD/Reviewed June04
Review: June06
12
e) Explain which vein should ideally be used for venepuncture and the accompanying
rationale.
f) Where should you apply the tourniquet in relation to the proposed venepuncture site?
g) What is the rationale for palpating the radial pulse after applying the tourniquet?
h) Where would you find the information about which sample tubes to use and the order in
which to draw them?
i) List at least 3 situations / conditions when it may be inappropriate to take a blood sample:
(i)
(ii)
(iii)
Venepuncture
PDD/Reviewed June04
Review: June06
13
THEORY ASSESSMENT 5
The Risks
a) What are the three possible problems associated with venepuncture?
i)
ii)
iii)
b) What are the three possible causes?
i)
ii)
iii)
c) What are the three possible solutions?
i)
ii)
iii)
Venepuncture
PDD/Reviewed June04
Review: June06
14
d) Give three examples of blood borne viruses to which you may be at risk if you are
exposed to infected blood.
i)
ii)
iii)
e) Define 'needle phobia'
f) Explain how needle phobia may complicate the therapy/investigations which need to be
carried out on the patient.
Completed satisfactorily: Yes No
Signed: (Assessor)
Date:
Comments:
Venepuncture
PDD/Reviewed June04
Review: June06
15
SUPERVISED PRACTICE
SELF DIRECTED LEARNING PACK
You must successfully complete the theory assessments before attempting any practical
learning of this skill.
You must successfully complete the theory and supervised practice before undertaking this
skill unsupervised.
Supervisor:
Date Supervised Practice Completed:
Signature:
Comments:
Learners Signature:
Comments:
Venepuncture
PDD/Reviewed June04
Review: June06
16
READING LIST
Clothier Report (1994) Independent Enquiry Relative to Deaths and Injuries on the Childrens
Ward at Grantham & Kesteven General Hospital. London HMSO
Royal Cornwall Hospitals NHS Trust's Health and Safety Policy
Royal Cornwall Hospitals NHS Trust's Control of Substances Hazardous to Health
Royal Cornwall Hospitals NHS Trust's Infection Control Policy
Royal Cornwall Hospitals NHS Trust's Disposal of Waste Policy
The Royal Marsden Manual of Clinical Nursing Procedures (6th Edition)
Black. F. (1997) Venepuncture. Nursing Standard, Vol 11, No 41, pp 49-55
McConnell. A A. Mackay. G M. (1996) Venepuncture – the medicolegal hazards.
Postgraduate Medical Journal, No 72, pp 23-24
Stevenson. B. (1997) Venepuncture. Community Nurse, October, pp 21-22
Nursing Times Practice (2000) Tourniquets pose infection risk. Nursing Times, Vol 96, No 2.
Venepuncture
PDD/Reviewed June04
Review: June06
17
EVALUATION OF TRAINING PACK
Title of training package: …………………………………………………………………..
Duration of training: …………………………………………………………………………..
Final assessment date: …………………………………………………………………..
Successful assessment: Yes No
Please complete the following evaluations:
Very user friendly
5
4
3
2
1
Very difficult to use
Instructions were clear
5
4
3
2
1
Instructions were
unclear
Information was easily
resourced
5
4
3
2
1
Information was
difficult to resource
Knowledge about skill has
increased
5
4
3
2
1
Knowledge has not
increased
Able to reflect on your
training and its benefits
5
4
3
2
1
Difficult to reflect on
your training and its
benefits.
Please detach this page and return to:
Practice Development Department, Royal Cornwall Hospital.
b3 venepuncture procedure
G28
PROCEDURE FOR VENEPUNCTURE
Equipment:
Tourniquet
Clean tray
Vacutainer needle and holder (Refer to Becton Dickinson Vacutainer Systems Venous Access
Guide for needle size and alternative equipment.)
Sharps container
Cotton wool balls
Blood specimen tubes (refer to Vacutainer tube guide, the request form or phone the laboratory
to ensure correct specimen tubes are used, and specific storage conditions fulfilled).
Specimen request forms
Non sterile low protein powder free latex gloves
Procedure:
Action Rationale
1 Wash hands using a bactericidal soap and
water and dry hands, or use bactericidal
alcohol hand rub.
To minimise the risk of infection.
2 Appropriate identification must be
obtained wherever possible by the patient
verbally confirming their full name,
address and date of birth. Information on
in-patient identification wrist bands must
correspond to this. Check hospital number
on request form with in-patient notes
and/or identification wrist band. If the
patient is not wearing an identification
wristband, or it is illegible or contains
insufficient detail, the blood sample must
not be taken.
If the request form is not fully completed
to include clinical details the blood sample
must not be taken.
Explain the procedure.
To ensure patient safety and valid
consent
Ensures high risk specimens are
identified and processed correctly.
Page 1 of 4
M Pearce / PDD / August 2004
Review: August 2006
3 Ensure the patient is comfortable and
support the chosen limb on a pillow or
cushion. Raise the bed to a comfortable
working height.
To ensure the patient's comfort. To aid
venepuncture.
4 Place tourniquet around upper arm, making
sure it does not obstruct arterial flow, by
palpating radial pulse.
To dilate the veins by obstructing
venous return.
5 In good light, inspect the veins of the ante
cubital fossa. Observe for large
superficial, full veins in a site that is not
inflamed. Palpate the vein and ensure it is
soft and unscarred.
To ensure the most appropriate,
accessible vein is chosen.
If veins not prominent ask the patient to
hang their arm down and open and close
the fist. The area may be rubbed lightly.
Never hit the vein, it is extremely painful.
To increase the prominence of the veins.
If a vein cannot be located, remove the
tourniquet and apply moist heat, eg, a hot
compress or soak the arm in hot water.
To promote blood flow and therefore
distend the veins.
6. Apply gloves. To comply with universal precautions.
7. Holding the coloured section of the needle
with one hand, twist and remove the white
section. Screw needle into holder.
Carefully remove sheath.
To ensure correct assembly of
equipment.
8. Holding skin taut with one hand, insert
needle a short distance into vein, with
bevel uppermost, at an angle of
approximately 15 degrees from the skin.
If the first attempt fails and the needle is
completely withdrawn, the procedure must
be restarted using a new needle.
If you are unable to obtain the correct
amount of blood after a maximum of two
attempts, you should refer the request back
to the nurse or doctor responsible.
To immobilise the vein. To provide
countertension which will facilitate a
smoother needle entry.
Page 2 of 4
M Pearce / PDD / August 2004
Review: August 2006
Keeping needle holder steady in this
position with one hand, push specimen
tube onto needle inside the holder with the
other. Adjust position of needle gently as
necessary. Do not withdraw needle from
underneath the skin or vacuum in the tube
is lost. (Refer to Vacutainer Guide for tube
draw order)
To ensure blood sample is obtained
safely.
When specimen tube has filled to required
amount, remove and fill other tubes as
necessary. The vacuum in the tube will
ensure that the correct volume is taken.
Take last tube out of holder.
9. Release tourniquet. Apply dry cotton ball
to puncture site, as needle is removed from
vein. Apply pressure for a minimum of
two minutes, using tape as required. Do
not bend elbow.
To prevent bruising after needle is
removed.
10 While still with the patient, label all tubes
of blood with patient's full name, hospital
number, date of birth, ward and signature.
Also the date and time of collection.
Blood Transfusion specimens must be hand
written to include gender and must be
signed. Blood Transfusion request forms
are to be signed by the person taking blood
and the requesting doctor. (Refer to
Pathology Request Form and Sample
Labelling Policy RCHT 2004)
DO NOT LABEL THE BOTTLES
BEFORE TAKING BLOOD.
To prevent mis-labelling of specimen
tubes.
11 Dispose of needle safely. DO NOT RESHEATH
NEEDLES BY HAND.
To ensure safe disposal and to avoid
laceration or other injury to
staff/public.
12 Follow local procedure for transportation
of specimens to laboratory.
When veins are small or fragile, use of a 23g blood collection set (butterfly with adaptor and
needle holder) must be used.
Page 3 of 4
M Pearce / PDD / August 2004
Review: August 2006
References:
Infection Control Department, Royal Cornwall Hospitals NHS Trust
B-D Vacutainer Systems, Venous Access Guide.
Becton Disckinson. A Guide to the withdrawl of blood for laboratory testing.
Page 4 of 4
M Pearce / PDD / August 2004
Review: August 2006
PROCEDURE FOR VENEPUNCTURE
Equipment:
Tourniquet
Clean tray
Vacutainer needle and holder (Refer to Becton Dickinson Vacutainer Systems Venous Access
Guide for needle size and alternative equipment.)
Sharps container
Cotton wool balls
Blood specimen tubes (refer to Vacutainer tube guide, the request form or phone the laboratory
to ensure correct specimen tubes are used, and specific storage conditions fulfilled).
Specimen request forms
Non sterile low protein powder free latex gloves
Procedure:
Action Rationale
1 Wash hands using a bactericidal soap and
water and dry hands, or use bactericidal
alcohol hand rub.
To minimise the risk of infection.
2 Appropriate identification must be
obtained wherever possible by the patient
verbally confirming their full name,
address and date of birth. Information on
in-patient identification wrist bands must
correspond to this. Check hospital number
on request form with in-patient notes
and/or identification wrist band. If the
patient is not wearing an identification
wristband, or it is illegible or contains
insufficient detail, the blood sample must
not be taken.
If the request form is not fully completed
to include clinical details the blood sample
must not be taken.
Explain the procedure.
To ensure patient safety and valid
consent
Ensures high risk specimens are
identified and processed correctly.
Page 1 of 4
M Pearce / PDD / August 2004
Review: August 2006
3 Ensure the patient is comfortable and
support the chosen limb on a pillow or
cushion. Raise the bed to a comfortable
working height.
To ensure the patient's comfort. To aid
venepuncture.
4 Place tourniquet around upper arm, making
sure it does not obstruct arterial flow, by
palpating radial pulse.
To dilate the veins by obstructing
venous return.
5 In good light, inspect the veins of the ante
cubital fossa. Observe for large
superficial, full veins in a site that is not
inflamed. Palpate the vein and ensure it is
soft and unscarred.
To ensure the most appropriate,
accessible vein is chosen.
If veins not prominent ask the patient to
hang their arm down and open and close
the fist. The area may be rubbed lightly.
Never hit the vein, it is extremely painful.
To increase the prominence of the veins.
If a vein cannot be located, remove the
tourniquet and apply moist heat, eg, a hot
compress or soak the arm in hot water.
To promote blood flow and therefore
distend the veins.
6. Apply gloves. To comply with universal precautions.
7. Holding the coloured section of the needle
with one hand, twist and remove the white
section. Screw needle into holder.
Carefully remove sheath.
To ensure correct assembly of
equipment.
8. Holding skin taut with one hand, insert
needle a short distance into vein, with
bevel uppermost, at an angle of
approximately 15 degrees from the skin.
If the first attempt fails and the needle is
completely withdrawn, the procedure must
be restarted using a new needle.
If you are unable to obtain the correct
amount of blood after a maximum of two
attempts, you should refer the request back
to the nurse or doctor responsible.
To immobilise the vein. To provide
countertension which will facilitate a
smoother needle entry.
Page 2 of 4
M Pearce / PDD / August 2004
Review: August 2006
Keeping needle holder steady in this
position with one hand, push specimen
tube onto needle inside the holder with the
other. Adjust position of needle gently as
necessary. Do not withdraw needle from
underneath the skin or vacuum in the tube
is lost. (Refer to Vacutainer Guide for tube
draw order)
To ensure blood sample is obtained
safely.
When specimen tube has filled to required
amount, remove and fill other tubes as
necessary. The vacuum in the tube will
ensure that the correct volume is taken.
Take last tube out of holder.
9. Release tourniquet. Apply dry cotton ball
to puncture site, as needle is removed from
vein. Apply pressure for a minimum of
two minutes, using tape as required. Do
not bend elbow.
To prevent bruising after needle is
removed.
10 While still with the patient, label all tubes
of blood with patient's full name, hospital
number, date of birth, ward and signature.
Also the date and time of collection.
Blood Transfusion specimens must be hand
written to include gender and must be
signed. Blood Transfusion request forms
are to be signed by the person taking blood
and the requesting doctor. (Refer to
Pathology Request Form and Sample
Labelling Policy RCHT 2004)
DO NOT LABEL THE BOTTLES
BEFORE TAKING BLOOD.
To prevent mis-labelling of specimen
tubes.
11 Dispose of needle safely. DO NOT RESHEATH
NEEDLES BY HAND.
To ensure safe disposal and to avoid
laceration or other injury to
staff/public.
12 Follow local procedure for transportation
of specimens to laboratory.
When veins are small or fragile, use of a 23g blood collection set (butterfly with adaptor and
needle holder) must be used.
Page 3 of 4
M Pearce / PDD / August 2004
Review: August 2006
References:
Infection Control Department, Royal Cornwall Hospitals NHS Trust
B-D Vacutainer Systems, Venous Access Guide.
Becton Disckinson. A Guide to the withdrawl of blood for laboratory testing.
Page 4 of 4
M Pearce / PDD / August 2004
Review: August 2006
Wednesday, July 06, 2005
b3
KNOWLEDGE EVIDENCE QUESTIONS
UNIT B3 – OBTAIN VENOUS BLOOD SAMPLES USING INVASIVE TECHNIQUES
1
KE3
Discuss why a doctor may refer a patient for Venepuncture
Levels of certain chemical in blood can be used not only to diagnose clients but also, changes in chemial levels in blood can also show if conditions are either worsening or getting better. Phylbotomy can provide vital information about clients.
2
Describe how infection is spread
For infection to spread, there needs to be a source of that infection, a vector (some way of transfering it), a portal (a way into a new living ground) and nutritions when it gets there, be that air, water or a food source. If one of these is ilimated, then the chain of infection will be broken.
3
KE1
How may its spread be limited?
Not washing hands before and after procedure.
Dirty equipment
Not using gloves
Tourniquet used should not be used between patients
Using the same
Gloves should not be worn between two patients
each individual patient should have completely new equipment each time. deviously
4
KE4
Why is it important to clean Venepuncture sites effectively, how and when should this be carried out?
Vein are being puntured. Infection on the skin can be transferred from here to the blood stream that can be very dangerous. Inadequate use of alcohol wipes can meerly disturb the skin flora. They are only effective if they are vigourously used for 30 seconds.
5
KE5
In relation to Venepuncture, what is hazardous and non-hazardous waste? How would you dispose of each?
Hazardous
Blood stained items such as cotton wool, etcetera, should be disposed of in yellow clinical waste bins.
Non-hazardous
Packaging, etcetera, should be placed in a non-clinical waste bag - black.
6
KE6
Why is correct labelling important and what are the possible consequences of muddling samples?
It is important that correct labelling occurs because then the right sample relates to the right client and then the right treatment happens to the correct client. If encorerect labelling occurs the so can death!!!
7
KE2
Describe the legal and organisational requirements regarding health and safety and infection control when working with blood (e.g. COSHH, DoH guidelines and local policies
Protective equipment such as gloves and aprons should be worn as they have been provided by the employer for the safety of the worker.
All sharps should be disposed of in a sharps bin
All clinical waste should be disposed of in a yellow clinical waste bag
No needle should be resheathed for fear of needle stick injury.
All blood bottles should be labled by hand. Even were a sticker has been stuck on to a bottle and removed the sample will be rejected. Where hand labelling and a sticker are present, the sample will be rejected
All relevent material should be indate and in intact packaging
8
KE7
Which types of sample have particular storage and transfer requirements (e.g. temperature dependant tests) and what are the requirements?
Cold agglutinins
Must be kept at body temperature
Haematoloty: INR, APTT
Coagualtion screen
Factor Assays and Thrombophilia
Screen by arrangement (3x tubes required)
fill to the line and mix well
Attp and coag Screen must be tesed the same day.
Pediatric 1ml size from lab
Haematoloty ERS
Mix well
Chemistry Profiles: Enzymes, TFT. Lipids, CRP, rheumatolid factors, Immunoglobulins, B12, feritin, Tumour markers, Tyroid function, other hormones, PSA , Theraputic Drugs, TPI,
1 tube
Haematology: fbc, flim, Reticulocytes, Viscoscitym, Hb electrophoresis, Sickle Test IM Screen Malaria parasites
folate HbA1C, Lead porphytrin, PCR Assays
Mix well. separet tube for viscosity kept at room temperature. Paediactric tobes from lab.
Blood transfution: Crosmatch, Group and Save< Ante-nateal Group and Screen, DAG, Kleihauer
Mix well.
Chemistry: Sample requieing rapid preservation, eg, insulin
Obtain from laboratorty after consulation. Mix well
lactate
keep in the dark and and be processed within ten minutes. Prewarn the lab.
9
Why is it important to get positive confirmation of individuals identity and consent before starting the procedure?
To insure correct client is being tested
To ensure that the client is not having the consent of a client constitutes assault.
10
KE8
Describe effective ways of getting positive identification.
Appropriate identification must be
obtained wherever possible by the patient
verbally confirming their full name,
address and date of birth. Information on
in-patient identification wrist bands must
correspond to this. Check hospital number
on request form with in-patient notes
and/or identification wrist band. If the
patient is not wearing an identification
wristband, or it is illegible or contains
insufficient detail, the blood sample must
not be taken.
If the request form is not fully completed
to include clinical details the blood sample
must not be taken.
11
KE10
Describe the contra-indications and changes in behaviour and condition, which indicate that the procedure should be stopped, and advice sought. (e.g. allergies, skin problems, incorrect presentation such as non – fasting.)
The client may consent verbally and then, by behavieour imply they they do not want the proecure done. this could invodlve moving an amr just before the needle is incernted. if this persists, then the client should be asked if they want the test in the first place.
Allergies,
Any allergies should be discovered prior to commencement of the procedure. An which directly effect the procedure should be identified and any remedial action taken. For example, if a client is alergic to latex, then non-latex glove should be worn for the procedure. Client is alergic to micropore tape then another type of tape should be used.
Skin problems,
If the client has skin problems at a prospective venepuncture site, then an alternative stie should be investigated and adivice sort.
Incorrect presentation such as non – fasting
The procedure should be postonted until the correct condtions are implace.
12
KE12
What sites may you choose for Venepuncture and why.
the veian cubital veins
the cephalic vein
basilic vein
the metacarpal veins )only used when other sites are not accessible
13
KE13
What factors would you consider when choosing the best site to use (including the individuals own preference)
Previous experience of client
Accessiblity
Degree of tortuousness of veins
client contsent and ability to co-operate
lack of infection
14
KE14
What factors can affect the quality of the sample (e.g. prolonged use of a tourniquet)
Type of needle used. If the lumen is too small, then this can affect the sample. Also, the cells can be affected if a "butterfly" needle is used
15
KE15
Describe how you would prepare individuals for Venepuncture; include how their personal preferences may effect their preparation.
Check client identity and confirm by checking name band and asking for verbal verificaion if possible
Explain procdure and gain an informed conscent.
ensue the cleitn is comfotable.
Assess veins and determ which to use
Supprot lim comfortable invovling clinet to maximise comfoft here.
16
KE16
Describe the steps you would take to detect suitable veins
Appy a bouniquet above the site for inspection and visually inpsect the vein
palpate the vein
17
KE17
Describe the possible concerns individuals may have in relation to Venepuncture and blood sampling.
Is is going to hurt?
yes it is. Clients have the right to be told that this is the case. It is important that they are tol that the pain should be transitarty. If a particular needl phobia is in place, then skin-numbing cream can be prescribed.
How do they know if is my sample?
All samples are labed and placed in a labled form. this reduced the risk of mixing up samples.
18
KE18
What is likely to cause discomfort to individuals during and after the collection of blood samples? Describe how such discomforts can minimised. E.g. applying correct pressure to tourniquet and puncture site to avoid bruising)
Applying the tourniquet too hard can restrict arterial blood flow. To test if this has not occured, palpation of the radial pulse should be carried out.
Insertion of the needle will cause pain. In needle phobia or minors, skin numbing cream can be applied prior to procedure.
19
KE19
What remedial action can be taken if there are problems in obtaining blood?
If a client's veins collapse or are not very prominent, soaking the site in warm water can cause vasodilation thus fascilitating the procedure.
Aterial puncture
If this occurs:-
remove needle
apply pressure to site unit bleeding ceases.
explain what has happened
if there is contieneued pain, increase swelling or bruising, seek medical advice.
20
KE20
Why are anticoagulants added to blood samples and why is it important to collect the right volume of blood when it is to be mixed with anti-coagulant?
When blood leaves the body, the clotting proecess is initisated. Anticoagulent in the bottom of sample bottles help to stop this from happening. There is a specific vacumm in each tube which, in theory, attracts a specific volume of blood. Thus, there needs to be a speicif ammount of anticoagulanant in the bottom of the tube as to not excessively anticoagulate or allow haemolysation to occur.
21
Describe the dressings needed for the different types of puncture sites.
For younger clients, an ordinary sticking plaster may suffice. However, where skin is more friable such as in elderly clients, the lint free dressing secured with tape may be the dressing of choice.
22
Describe how you would apply dressings.
A lint free dressing should be held in place for two minutes then secured with tape once bleeding has ceased. The elbow should be kept straight as this helps to reduce bruising.
23
KE21
What advice would you give individuals on caring for the site? (Ke21)
keep the dressing on for 24 hours at least. keep dry and clean.
24
KE23
How would you recognise the common adverse reactions which individuals may have (e.g. fainting, bruising) What action would you take if they occurred.
Bruising and /or haematoma
This can occur when the needle has venetrated the posterier wall of the vein possibly due to the insertion angle being lower than 30 degrees. the needlw shoud be reomved and pressure applied and until the cessation of bleeding. The limb should be elevated, an ice pack should be applied then a pressure dressing should be applied.
Fainting
Place client's head between legs if feeling faint. encouage client to lie down. The use of a butterfly may be helpful. this should be secured if the client should need medication. Assistance should be summoned.
25
Describe how you would recognise an arterial puncture
Excessive pain on needle insertion. The punctured vessel has a pulse.
26
KE24
What action would you take if the above occurs.
The needle shoud be at once removed. Bleeding, which can be perfuse, should be stemmed by the application of pressure until it's cessation
27
KE25
What equipment and materials are needed for venous sampling, and how would you check and prepare them (including protective clothing for the worker and/or the individual.
Please note that all equipment must be checked that it has not been used before, is clean, within intact packaging, where appropriate and is within date, where appropriate.
Tourniquet
Clean tray
Vacutainer needle and holder (Refer to Becton Dickinson Vacutainer Systems Venous Access
Guide for needle size and alternative equipment.)
Sharps container (
This needs to be assembled at correctly, the relevant information (date assembled, location, the name of the person who assembled the bin) needs to be displayed on the bin. The bin must not be excessively full. If the bin is more than three-quarters full, it should be sealed, signed that it has been sealed and placed in the designated area where it will be collected for incineration.)
Cotton wool balls
Blood specimen tubes (refer to Vacutainer tube guide, the request form or phone the laboratory
to ensure correct specimen tubes are used, and specific storage conditions fulfilled).
Specimen request forms
Non sterile low protein powder free latex gloves
Pillow to support limb
Plastic apron (for the Worker and optional for the client)
a bowl of warm water to aid the vasodilation of limb is necessary
28
How would you maintain confidentiality whilst transporting blood samples (i.e. from patients home to the surgery)
Confidentiality is very important at all times. Blood samples I used for testing for certain diseases such as HIV and hepatitis as well as many sexually transmitted diseases. The client may not wish all and sundry to know that they are being tested for such conditions. It is therefore important that all blood samples have their names and any tests that pertain to covered. The forms used within the trust fall back on themselves, hiding the identity and reason for the tests required. When taking Blood, it is important that the accompanying form is stuck down as to not allow the name of the patient to be read nor what tests have been taken.
29
How would you deal with any spillages of blood?
the excess is soaked up using disposable paper towles. neat milton solution is then poured on the top of these.
30
Describe the procedure you would follow if you sustain a needlestick injury
Immediately a needle stick injury is incurred, the site should be encouraged to bleed over a sink so that the workers own bloodstream helps to flush away the blood of the individual who had the needle used upon them. Once the needle stick site has been bled like this, it should then be covered by waterproofed plaster. If required, the individual who has been stuck can request to have blood taken and stored for future reference should the client who hadn't even used upon them have any blood borne diseases.
An incident report form should be completed. Occupational health should be informed also.
UNIT B3 – OBTAIN VENOUS BLOOD SAMPLES USING INVASIVE TECHNIQUES
1
KE3
Discuss why a doctor may refer a patient for Venepuncture
Levels of certain chemical in blood can be used not only to diagnose clients but also, changes in chemial levels in blood can also show if conditions are either worsening or getting better. Phylbotomy can provide vital information about clients.
2
Describe how infection is spread
For infection to spread, there needs to be a source of that infection, a vector (some way of transfering it), a portal (a way into a new living ground) and nutritions when it gets there, be that air, water or a food source. If one of these is ilimated, then the chain of infection will be broken.
3
KE1
How may its spread be limited?
Not washing hands before and after procedure.
Dirty equipment
Not using gloves
Tourniquet used should not be used between patients
Using the same
Gloves should not be worn between two patients
each individual patient should have completely new equipment each time. deviously
4
KE4
Why is it important to clean Venepuncture sites effectively, how and when should this be carried out?
Vein are being puntured. Infection on the skin can be transferred from here to the blood stream that can be very dangerous. Inadequate use of alcohol wipes can meerly disturb the skin flora. They are only effective if they are vigourously used for 30 seconds.
5
KE5
In relation to Venepuncture, what is hazardous and non-hazardous waste? How would you dispose of each?
Hazardous
Blood stained items such as cotton wool, etcetera, should be disposed of in yellow clinical waste bins.
Non-hazardous
Packaging, etcetera, should be placed in a non-clinical waste bag - black.
6
KE6
Why is correct labelling important and what are the possible consequences of muddling samples?
It is important that correct labelling occurs because then the right sample relates to the right client and then the right treatment happens to the correct client. If encorerect labelling occurs the so can death!!!
7
KE2
Describe the legal and organisational requirements regarding health and safety and infection control when working with blood (e.g. COSHH, DoH guidelines and local policies
Protective equipment such as gloves and aprons should be worn as they have been provided by the employer for the safety of the worker.
All sharps should be disposed of in a sharps bin
All clinical waste should be disposed of in a yellow clinical waste bag
No needle should be resheathed for fear of needle stick injury.
All blood bottles should be labled by hand. Even were a sticker has been stuck on to a bottle and removed the sample will be rejected. Where hand labelling and a sticker are present, the sample will be rejected
All relevent material should be indate and in intact packaging
8
KE7
Which types of sample have particular storage and transfer requirements (e.g. temperature dependant tests) and what are the requirements?
Cold agglutinins
Must be kept at body temperature
Haematoloty: INR, APTT
Coagualtion screen
Factor Assays and Thrombophilia
Screen by arrangement (3x tubes required)
fill to the line and mix well
Attp and coag Screen must be tesed the same day.
Pediatric 1ml size from lab
Haematoloty ERS
Mix well
Chemistry Profiles: Enzymes, TFT. Lipids, CRP, rheumatolid factors, Immunoglobulins, B12, feritin, Tumour markers, Tyroid function, other hormones, PSA , Theraputic Drugs, TPI,
1 tube
Haematology: fbc, flim, Reticulocytes, Viscoscitym, Hb electrophoresis, Sickle Test IM Screen Malaria parasites
folate HbA1C, Lead porphytrin, PCR Assays
Mix well. separet tube for viscosity kept at room temperature. Paediactric tobes from lab.
Blood transfution: Crosmatch, Group and Save< Ante-nateal Group and Screen, DAG, Kleihauer
Mix well.
Chemistry: Sample requieing rapid preservation, eg, insulin
Obtain from laboratorty after consulation. Mix well
lactate
keep in the dark and and be processed within ten minutes. Prewarn the lab.
9
Why is it important to get positive confirmation of individuals identity and consent before starting the procedure?
To insure correct client is being tested
To ensure that the client is not having the consent of a client constitutes assault.
10
KE8
Describe effective ways of getting positive identification.
Appropriate identification must be
obtained wherever possible by the patient
verbally confirming their full name,
address and date of birth. Information on
in-patient identification wrist bands must
correspond to this. Check hospital number
on request form with in-patient notes
and/or identification wrist band. If the
patient is not wearing an identification
wristband, or it is illegible or contains
insufficient detail, the blood sample must
not be taken.
If the request form is not fully completed
to include clinical details the blood sample
must not be taken.
11
KE10
Describe the contra-indications and changes in behaviour and condition, which indicate that the procedure should be stopped, and advice sought. (e.g. allergies, skin problems, incorrect presentation such as non – fasting.)
The client may consent verbally and then, by behavieour imply they they do not want the proecure done. this could invodlve moving an amr just before the needle is incernted. if this persists, then the client should be asked if they want the test in the first place.
Allergies,
Any allergies should be discovered prior to commencement of the procedure. An which directly effect the procedure should be identified and any remedial action taken. For example, if a client is alergic to latex, then non-latex glove should be worn for the procedure. Client is alergic to micropore tape then another type of tape should be used.
Skin problems,
If the client has skin problems at a prospective venepuncture site, then an alternative stie should be investigated and adivice sort.
Incorrect presentation such as non – fasting
The procedure should be postonted until the correct condtions are implace.
12
KE12
What sites may you choose for Venepuncture and why.
the veian cubital veins
the cephalic vein
basilic vein
the metacarpal veins )only used when other sites are not accessible
13
KE13
What factors would you consider when choosing the best site to use (including the individuals own preference)
Previous experience of client
Accessiblity
Degree of tortuousness of veins
client contsent and ability to co-operate
lack of infection
14
KE14
What factors can affect the quality of the sample (e.g. prolonged use of a tourniquet)
Type of needle used. If the lumen is too small, then this can affect the sample. Also, the cells can be affected if a "butterfly" needle is used
15
KE15
Describe how you would prepare individuals for Venepuncture; include how their personal preferences may effect their preparation.
Check client identity and confirm by checking name band and asking for verbal verificaion if possible
Explain procdure and gain an informed conscent.
ensue the cleitn is comfotable.
Assess veins and determ which to use
Supprot lim comfortable invovling clinet to maximise comfoft here.
16
KE16
Describe the steps you would take to detect suitable veins
Appy a bouniquet above the site for inspection and visually inpsect the vein
palpate the vein
17
KE17
Describe the possible concerns individuals may have in relation to Venepuncture and blood sampling.
Is is going to hurt?
yes it is. Clients have the right to be told that this is the case. It is important that they are tol that the pain should be transitarty. If a particular needl phobia is in place, then skin-numbing cream can be prescribed.
How do they know if is my sample?
All samples are labed and placed in a labled form. this reduced the risk of mixing up samples.
18
KE18
What is likely to cause discomfort to individuals during and after the collection of blood samples? Describe how such discomforts can minimised. E.g. applying correct pressure to tourniquet and puncture site to avoid bruising)
Applying the tourniquet too hard can restrict arterial blood flow. To test if this has not occured, palpation of the radial pulse should be carried out.
Insertion of the needle will cause pain. In needle phobia or minors, skin numbing cream can be applied prior to procedure.
19
KE19
What remedial action can be taken if there are problems in obtaining blood?
If a client's veins collapse or are not very prominent, soaking the site in warm water can cause vasodilation thus fascilitating the procedure.
Aterial puncture
If this occurs:-
remove needle
apply pressure to site unit bleeding ceases.
explain what has happened
if there is contieneued pain, increase swelling or bruising, seek medical advice.
20
KE20
Why are anticoagulants added to blood samples and why is it important to collect the right volume of blood when it is to be mixed with anti-coagulant?
When blood leaves the body, the clotting proecess is initisated. Anticoagulent in the bottom of sample bottles help to stop this from happening. There is a specific vacumm in each tube which, in theory, attracts a specific volume of blood. Thus, there needs to be a speicif ammount of anticoagulanant in the bottom of the tube as to not excessively anticoagulate or allow haemolysation to occur.
21
Describe the dressings needed for the different types of puncture sites.
For younger clients, an ordinary sticking plaster may suffice. However, where skin is more friable such as in elderly clients, the lint free dressing secured with tape may be the dressing of choice.
22
Describe how you would apply dressings.
A lint free dressing should be held in place for two minutes then secured with tape once bleeding has ceased. The elbow should be kept straight as this helps to reduce bruising.
23
KE21
What advice would you give individuals on caring for the site? (Ke21)
keep the dressing on for 24 hours at least. keep dry and clean.
24
KE23
How would you recognise the common adverse reactions which individuals may have (e.g. fainting, bruising) What action would you take if they occurred.
Bruising and /or haematoma
This can occur when the needle has venetrated the posterier wall of the vein possibly due to the insertion angle being lower than 30 degrees. the needlw shoud be reomved and pressure applied and until the cessation of bleeding. The limb should be elevated, an ice pack should be applied then a pressure dressing should be applied.
Fainting
Place client's head between legs if feeling faint. encouage client to lie down. The use of a butterfly may be helpful. this should be secured if the client should need medication. Assistance should be summoned.
25
Describe how you would recognise an arterial puncture
Excessive pain on needle insertion. The punctured vessel has a pulse.
26
KE24
What action would you take if the above occurs.
The needle shoud be at once removed. Bleeding, which can be perfuse, should be stemmed by the application of pressure until it's cessation
27
KE25
What equipment and materials are needed for venous sampling, and how would you check and prepare them (including protective clothing for the worker and/or the individual.
Please note that all equipment must be checked that it has not been used before, is clean, within intact packaging, where appropriate and is within date, where appropriate.
Tourniquet
Clean tray
Vacutainer needle and holder (Refer to Becton Dickinson Vacutainer Systems Venous Access
Guide for needle size and alternative equipment.)
Sharps container (
This needs to be assembled at correctly, the relevant information (date assembled, location, the name of the person who assembled the bin) needs to be displayed on the bin. The bin must not be excessively full. If the bin is more than three-quarters full, it should be sealed, signed that it has been sealed and placed in the designated area where it will be collected for incineration.)
Cotton wool balls
Blood specimen tubes (refer to Vacutainer tube guide, the request form or phone the laboratory
to ensure correct specimen tubes are used, and specific storage conditions fulfilled).
Specimen request forms
Non sterile low protein powder free latex gloves
Pillow to support limb
Plastic apron (for the Worker and optional for the client)
a bowl of warm water to aid the vasodilation of limb is necessary
28
How would you maintain confidentiality whilst transporting blood samples (i.e. from patients home to the surgery)
Confidentiality is very important at all times. Blood samples I used for testing for certain diseases such as HIV and hepatitis as well as many sexually transmitted diseases. The client may not wish all and sundry to know that they are being tested for such conditions. It is therefore important that all blood samples have their names and any tests that pertain to covered. The forms used within the trust fall back on themselves, hiding the identity and reason for the tests required. When taking Blood, it is important that the accompanying form is stuck down as to not allow the name of the patient to be read nor what tests have been taken.
29
How would you deal with any spillages of blood?
the excess is soaked up using disposable paper towles. neat milton solution is then poured on the top of these.
30
Describe the procedure you would follow if you sustain a needlestick injury
Immediately a needle stick injury is incurred, the site should be encouraged to bleed over a sink so that the workers own bloodstream helps to flush away the blood of the individual who had the needle used upon them. Once the needle stick site has been bled like this, it should then be covered by waterproofed plaster. If required, the individual who has been stuck can request to have blood taken and stored for future reference should the client who hadn't even used upon them have any blood borne diseases.
An incident report form should be completed. Occupational health should be informed also.
Tuesday, July 05, 2005
CU5
KNOWLEDGE EVIDENCE QUESTIONS
UNIT CU5 - RECEIVE, TRANSMIT, STORE AND RETRIEVE INFORMATION
1List the regulations/hospital policies that affect the gaining of information?
the Data Protection Act
The Freedom Information Act
2Briefly describe your responsibility in relation to the above regulations/hospital policies.
Individuals have the right to confidentiality of their care and medical history so my role is to reduce their risk of information being transferred to the wrong person and facilitating the relevant information being passed to the correct person.
3Through what sources can you obtain information about patient care?
The client themselves
The clients' friends
the clients' relatives (it must be noted that these are three sources may be subject to bias and may not be totally valid sources. Also, individuals can make mistakes, so care must be made when using these sources)
The client care plan
The client's medical notes
4How do you ensure that the information gained is relevant and correct?
objective information he's the most desired as it is without bias. However, 100 per cent objective information is really impossible to obtain because, at some level, subjective feelings come into play. It is therefore important to eliminate subjective feelings as much as possible when trying to gain information. If, for example, a client is confused, a relative or friend maybe a more suitable source of information than the client themselves.
it would be hoped that if a source is a another professional, that them this information would be more valid than a more subjective one. However, professionals, themselves been human, are subject to bias themselves.
5Briefly describe the different purposes for which information may be required in your work area and the degree of detail necessary for each purpose.
Handover
Handover information needs to be succinct and relevant to the client. It needs to be free from bias and, because it is verbalised, a suitable venue needs to be found for its delivery. Care needs to be taken when giving goal handover in front of the patient because do so she/he the main not want to here that they have cancer or they may not wish everyone in the bay to here when they last had their bowels open.
Clare plans
Again, information is to be six into relevant. Been succinct still need to be maintained, however, there is more room for morning depth information to berecorded . as clients have access to their care plans, care must be taken when recording in them and his reach its to be taken into consideration when recording anything in a care plan. Care plans need to be kept in the appropriate place, in an hour case, in the trolley pertaining to the baby in which the client is situated, when the care plan is not being used. Clients have access to their own care plan. Because an individual is a relative of a client, this does not guarantee that they have access by right to the information recorded in the care plan.
Medical notes
These are far more in depth tomes that clients do not have direct access to. A client does have access to their medical notes under certain circumstances. These arc, when the client requests in writing to see only a certain portion of the notes over which are the relevant consultant has veto. Once these have been accessed, they must be returned to the relevant notes trolley.
6How are patients’ records obtained on admission and transfer?
On admission
Clients are usually accompanied by a letter from their general practitioner or, if they have been admitted via ambulance, documentation from that service. From this information, a temporary medical notes are raised. If a relevant doctor sees fit, clients' medical modes I'll are located.
When a climb need to be transferred, then notes, if they are in the same location as the client, do with the client to the new location. It is essential that any confidential notes, such as medical notes, remain confidential. Also, as the client has not requested to see the medical notes at that point, the client themselves must not read the medical merits or any other confidential information. The database of the location of all medical notes is then updated so, at any point, though it can be traced if necessary.
7Where are the client’s medical and nursing notes stored in your work area?
In the relevant rate trolley pertaining to the Bay in which they are located.
8Who has the right to access these notes?
see Question 5
Also further to this, only relevant members of the multi-disciplinary team should have access to clients of nodes are who they are directly looking after. If as a professional is not looking after her a a patient, then they should not be accessing their notes.
9How should the notes be transferred between wards, departments and hospitals?
they should be transferred in specifically designed nodes bags ideally. The client to whom they pertain should not have access to them.
10Where are they stored when the patient has been discharged home?
Usually, notes her are stored at the Medical Records store.
11What is your responsibility with regards to patients’ notes?
Information the in them should be correct and accurate
Information should be legible and be a bias free
They should be stored in a manner appropriate to the type of notes
Actions to should be taken as to reduce risks of breaches in confidentiality
12A patient asks you if they can see their notes or a parent asks to see their childs notes. What should be your reply?
I would say that this shy and not in a position to allow any individual to look at the Medical notes belonging to others and would refer them to the registered practitioner.
13To whom do the notes belong?
medical notes belong to the health authority
Care plans belong to the client they pertain to
14What is the procedure for the notes in the event of a fire?
the although medical notes are very important, human life is far more important so it is far more important stat human life is preserved over that of medical notes.
15A relative on the ‘phone asks you what is wrong with their mother/daughter. How would you deal with this call?
as a health care support worker, a I am responsible for my actions. I am not accountable for them in the way in which a qualified what nurse is. Therefore, it is not my responsibility to discuss client diagnosis with a are either the client or their significant others. In this instance it, therefore, I would I get suggest that I'd take a telephone to the client in question, if they were unable and capable of talking on the telephone, or I would pass them over to be qualified nurse in question.
16What do you need to consider when speaking to people on the telephone?
Who are you talking to?
Who is listening where you areand where the individual this was on the phone?
What are they asking?
Are they who they say they are?
Do I need to pass a the call onto a more relevant person or am I able to answer this call within my role?
17When writing down a message, how do you ensure relevancy, accuracy and currency of information?
Be brief
Only record that which is necessary
Check for accuracy with others such as client themselves, significant others, or other healthcare professionals
18Why is it important to take messages accurately?
to facilitate beneficence
to reduce maleficence
19What actions need to be taken after obtaining this information?
Only the person for whom the information is intended accesses it
Others who do not need to access the information should be denied from doing so
The information should be placed/ recorded in the relevant place
20What do you need to consider when passing information to colleagues/relatives?
do these individuals specifically need to know?
Is it in their best interest?
Is it in the best interest of the client ?
As the client given consent?
Is it within the role of the information to giver to impart this information ?
21List the different types of charts used in your work area.
Observation charts
Fluid charts
Bowel charts
Weight charts
Food charts
Peak flow charts
Insulin sliding scale charts
Standard blood glucose level charts
22Who is responsible for maintaining these charts?
The registered practitioner that is accountable for the filling in of these charts. However, if a health care support worker has been designated to fill in any specific chart that is within their role then it is the responsibility of that said worker
23Why are these charts necessary?
It they show what has happened to a client
They provide a benchmark on admission against which any change maybe measured
The show if any changes in climate condition have occurred or are likely to occur
24Briefly describe the kind of problems that can arise during the maintenance and storage of these charts and the action you should take.
There is not enough room to fit in at a certain piece of information within the chart . Get a new chart
There is a chart without a name on in a patient's nodes. All paperwork should have Client name and number on it before it is written on.
UNIT CU5 - RECEIVE, TRANSMIT, STORE AND RETRIEVE INFORMATION
1List the regulations/hospital policies that affect the gaining of information?
the Data Protection Act
The Freedom Information Act
2Briefly describe your responsibility in relation to the above regulations/hospital policies.
Individuals have the right to confidentiality of their care and medical history so my role is to reduce their risk of information being transferred to the wrong person and facilitating the relevant information being passed to the correct person.
3Through what sources can you obtain information about patient care?
The client themselves
The clients' friends
the clients' relatives (it must be noted that these are three sources may be subject to bias and may not be totally valid sources. Also, individuals can make mistakes, so care must be made when using these sources)
The client care plan
The client's medical notes
4How do you ensure that the information gained is relevant and correct?
objective information he's the most desired as it is without bias. However, 100 per cent objective information is really impossible to obtain because, at some level, subjective feelings come into play. It is therefore important to eliminate subjective feelings as much as possible when trying to gain information. If, for example, a client is confused, a relative or friend maybe a more suitable source of information than the client themselves.
it would be hoped that if a source is a another professional, that them this information would be more valid than a more subjective one. However, professionals, themselves been human, are subject to bias themselves.
5Briefly describe the different purposes for which information may be required in your work area and the degree of detail necessary for each purpose.
Handover
Handover information needs to be succinct and relevant to the client. It needs to be free from bias and, because it is verbalised, a suitable venue needs to be found for its delivery. Care needs to be taken when giving goal handover in front of the patient because do so she/he the main not want to here that they have cancer or they may not wish everyone in the bay to here when they last had their bowels open.
Clare plans
Again, information is to be six into relevant. Been succinct still need to be maintained, however, there is more room for morning depth information to berecorded . as clients have access to their care plans, care must be taken when recording in them and his reach its to be taken into consideration when recording anything in a care plan. Care plans need to be kept in the appropriate place, in an hour case, in the trolley pertaining to the baby in which the client is situated, when the care plan is not being used. Clients have access to their own care plan. Because an individual is a relative of a client, this does not guarantee that they have access by right to the information recorded in the care plan.
Medical notes
These are far more in depth tomes that clients do not have direct access to. A client does have access to their medical notes under certain circumstances. These arc, when the client requests in writing to see only a certain portion of the notes over which are the relevant consultant has veto. Once these have been accessed, they must be returned to the relevant notes trolley.
6How are patients’ records obtained on admission and transfer?
On admission
Clients are usually accompanied by a letter from their general practitioner or, if they have been admitted via ambulance, documentation from that service. From this information, a temporary medical notes are raised. If a relevant doctor sees fit, clients' medical modes I'll are located.
When a climb need to be transferred, then notes, if they are in the same location as the client, do with the client to the new location. It is essential that any confidential notes, such as medical notes, remain confidential. Also, as the client has not requested to see the medical notes at that point, the client themselves must not read the medical merits or any other confidential information. The database of the location of all medical notes is then updated so, at any point, though it can be traced if necessary.
7Where are the client’s medical and nursing notes stored in your work area?
In the relevant rate trolley pertaining to the Bay in which they are located.
8Who has the right to access these notes?
see Question 5
Also further to this, only relevant members of the multi-disciplinary team should have access to clients of nodes are who they are directly looking after. If as a professional is not looking after her a a patient, then they should not be accessing their notes.
9How should the notes be transferred between wards, departments and hospitals?
they should be transferred in specifically designed nodes bags ideally. The client to whom they pertain should not have access to them.
10Where are they stored when the patient has been discharged home?
Usually, notes her are stored at the Medical Records store.
11What is your responsibility with regards to patients’ notes?
Information the in them should be correct and accurate
Information should be legible and be a bias free
They should be stored in a manner appropriate to the type of notes
Actions to should be taken as to reduce risks of breaches in confidentiality
12A patient asks you if they can see their notes or a parent asks to see their childs notes. What should be your reply?
I would say that this shy and not in a position to allow any individual to look at the Medical notes belonging to others and would refer them to the registered practitioner.
13To whom do the notes belong?
medical notes belong to the health authority
Care plans belong to the client they pertain to
14What is the procedure for the notes in the event of a fire?
the although medical notes are very important, human life is far more important so it is far more important stat human life is preserved over that of medical notes.
15A relative on the ‘phone asks you what is wrong with their mother/daughter. How would you deal with this call?
as a health care support worker, a I am responsible for my actions. I am not accountable for them in the way in which a qualified what nurse is. Therefore, it is not my responsibility to discuss client diagnosis with a are either the client or their significant others. In this instance it, therefore, I would I get suggest that I'd take a telephone to the client in question, if they were unable and capable of talking on the telephone, or I would pass them over to be qualified nurse in question.
16What do you need to consider when speaking to people on the telephone?
Who are you talking to?
Who is listening where you areand where the individual this was on the phone?
What are they asking?
Are they who they say they are?
Do I need to pass a the call onto a more relevant person or am I able to answer this call within my role?
17When writing down a message, how do you ensure relevancy, accuracy and currency of information?
Be brief
Only record that which is necessary
Check for accuracy with others such as client themselves, significant others, or other healthcare professionals
18Why is it important to take messages accurately?
to facilitate beneficence
to reduce maleficence
19What actions need to be taken after obtaining this information?
Only the person for whom the information is intended accesses it
Others who do not need to access the information should be denied from doing so
The information should be placed/ recorded in the relevant place
20What do you need to consider when passing information to colleagues/relatives?
do these individuals specifically need to know?
Is it in their best interest?
Is it in the best interest of the client ?
As the client given consent?
Is it within the role of the information to giver to impart this information ?
21List the different types of charts used in your work area.
Observation charts
Fluid charts
Bowel charts
Weight charts
Food charts
Peak flow charts
Insulin sliding scale charts
Standard blood glucose level charts
22Who is responsible for maintaining these charts?
The registered practitioner that is accountable for the filling in of these charts. However, if a health care support worker has been designated to fill in any specific chart that is within their role then it is the responsibility of that said worker
23Why are these charts necessary?
It they show what has happened to a client
They provide a benchmark on admission against which any change maybe measured
The show if any changes in climate condition have occurred or are likely to occur
24Briefly describe the kind of problems that can arise during the maintenance and storage of these charts and the action you should take.
There is not enough room to fit in at a certain piece of information within the chart . Get a new chart
There is a chart without a name on in a patient's nodes. All paperwork should have Client name and number on it before it is written on.
Wednesday, June 22, 2005
x19 wip 2
1.
Why should resources be prepared prior to the start of activities’
-So that the procedure runs smoothly without any interruptions. This is important because the procedure may be aseptic and any breaks in it may increase chance of cross-infection
-To maximize professional appearance
2.
Why must the patient’s consent be confirmed prior to the start of any activity’
Undertaking any procedure without consent is both abuse and assault.
3.
What is an Aseptic technique’’
A procedure where sterility is strived for which discourages cross infection. In most circumstance, asepsis is practically impossible to achieve but this does not mean that it is not strived for.
4.
List the ways in which an aseptic technique can be breached accidentally.
-Not washing hand at appropriate times before, during or after the procedure
-Not checking to see if resource have not exceeded their expiry date
-Accidental touching of sterile and non-sterile surfaces
-Surfaces used have not been cleaned adequately prior to the start of the procedure
5.
What should you do if this happens’
In a professional manner, commence the whole procedure again if necessary. This is very important as cross-infection can kill
6.
You have been asked to get a trolley ready for a patient’s wound dressing. Describe how you will do this.
-Clean the trolley using hot water and detergent. Disposable cloths/paper towels must be used to wash/dry the trolley.
-New cloths/towels must be used for each area of the trolley cleaned.
-After it has been cleaned, each are of the trolley must not be touched again.
-Ensure that all necessary equipement is placed on the bottom of the trolley. Note to see that all sealed items are intact and are in date. Consult with registered practitioner and care plan if necessary.
7.
Describe how you would prepare a patient for a clinical activity commonly undertaken in your work area.
-Explain the procedure fully so that the client can give their full informed consent.
-Once this has been obtained, then position the client appropriately for the given procedure.
-At all stages, give reassurance and explanation to ensure informed consent and minimize anxiety
8.
What effect may a patient’s personal beliefs or preferences have on preparing them for and undertaking clinical activities’
-Certain client may need a procedure undertaker to be of a certain gender under certain circumstances. For example, a Muslim lady may require a female to catheters her and her husband to chaperone.
-Some procedures may be best performed if an individual wears a certain type of clothing. If clients choose to wear her/his own clothing then this must be accepted.
9.
Describe the difference between hazardous and non-hazardous waste.
Hazardous Waste
-This waste can cause harm to individuals if it is in an inappropriate place. Body products, because they may contain blood and/or pathogens may cause harm if ingested/inoculated into another person. It is important to dispose of them according to trust procedure.
Non-hazardous Waste
-This includes substance that, on there won dare not dangerous! Water, when used properly, is not hazardous. But when it is spilt on the flora it becomes hazardous.
10.
List the legislation and Trust policies/procedures relating to the disposal of waste.
Trust head quarters
Ward manager's office
Why should resources be prepared prior to the start of activities’
-So that the procedure runs smoothly without any interruptions. This is important because the procedure may be aseptic and any breaks in it may increase chance of cross-infection
-To maximize professional appearance
2.
Why must the patient’s consent be confirmed prior to the start of any activity’
Undertaking any procedure without consent is both abuse and assault.
3.
What is an Aseptic technique’’
A procedure where sterility is strived for which discourages cross infection. In most circumstance, asepsis is practically impossible to achieve but this does not mean that it is not strived for.
4.
List the ways in which an aseptic technique can be breached accidentally.
-Not washing hand at appropriate times before, during or after the procedure
-Not checking to see if resource have not exceeded their expiry date
-Accidental touching of sterile and non-sterile surfaces
-Surfaces used have not been cleaned adequately prior to the start of the procedure
5.
What should you do if this happens’
In a professional manner, commence the whole procedure again if necessary. This is very important as cross-infection can kill
6.
You have been asked to get a trolley ready for a patient’s wound dressing. Describe how you will do this.
-Clean the trolley using hot water and detergent. Disposable cloths/paper towels must be used to wash/dry the trolley.
-New cloths/towels must be used for each area of the trolley cleaned.
-After it has been cleaned, each are of the trolley must not be touched again.
-Ensure that all necessary equipement is placed on the bottom of the trolley. Note to see that all sealed items are intact and are in date. Consult with registered practitioner and care plan if necessary.
7.
Describe how you would prepare a patient for a clinical activity commonly undertaken in your work area.
-Explain the procedure fully so that the client can give their full informed consent.
-Once this has been obtained, then position the client appropriately for the given procedure.
-At all stages, give reassurance and explanation to ensure informed consent and minimize anxiety
8.
What effect may a patient’s personal beliefs or preferences have on preparing them for and undertaking clinical activities’
-Certain client may need a procedure undertaker to be of a certain gender under certain circumstances. For example, a Muslim lady may require a female to catheters her and her husband to chaperone.
-Some procedures may be best performed if an individual wears a certain type of clothing. If clients choose to wear her/his own clothing then this must be accepted.
9.
Describe the difference between hazardous and non-hazardous waste.
Hazardous Waste
-This waste can cause harm to individuals if it is in an inappropriate place. Body products, because they may contain blood and/or pathogens may cause harm if ingested/inoculated into another person. It is important to dispose of them according to trust procedure.
Non-hazardous Waste
-This includes substance that, on there won dare not dangerous! Water, when used properly, is not hazardous. But when it is spilt on the flora it becomes hazardous.
10.
List the legislation and Trust policies/procedures relating to the disposal of waste.
Trust head quarters
Ward manager's office
11.
Describe how you would obtain a specimen from a patient and send it to the laboratory.
- Explain procedure to ensure informed consent.
- Maintaining auspices and using universal precautions (as required) obtain specimen and place in appropriate container
- This container must be labelled appropriated and be place in an appropriate form/have an appropriate form attached to it.
- It must be place in the correct place safely to be taken to the destination required
- The fact that the specimen has been taken is written in the care plan
12.
Describe how you would take a patient’s temperature.
- Gain client consent but explaining fully the procedure.
- Find out the most appropriate method of taking the temperature for the specific client.
- Undertake the procure, making sure that a full explanation is given at all times.
- Record the result on the appropriate place in the care plan.
- Dispose of any contaminated equipment as appropriate.
document any abnormalities and consult the Registered Nurse
13.
What is the normal body temperature when taken:
a) Orally’
35.5 - 37.5 deg C
b) Auxiliary’
35 - 36.9 deg C
c) Rectally’
37.8 deg C
14.
What does the term ‘pyrexia’ mean’ - A temperature higher than the levels mentioned above
15.
At what stage would a patient be considered to be pyrexia’ - See question 14
- Also a client may appear excessively hot and sweaty.
- The client may also be felling cold. The client should be encourage to remove excessively warm clothing/bed covering. if the client is unwilling to do this for whatever reason, explain that this is important for their well-being and inform the Registered Nurse
16.
List the common causes of pyrexia. - Infection
- Metabolic disorder
- It can be an indicator of other imminent problems such as stroke.
- The hypothalamus is the body's temperature regulator. A pyrexia or hyperthermia can be indicative of this in some instances.
17.
What symptoms does a pyrexia produce’
see question 15
18.
What does the term ’hypothermia’ mean’
Temperatures lower than 35.0’ C
19.
At what stage would a patient be considered to be hypothermic’
A client with a temperature below 35.0’ C
- 20.
What symptoms does ‘hypothermia’ produce’ - shivering
- extremities and skin generally cold to the touch
- parlour
- Client may not complain of feeling cold which is very dangerous - this can be very much so for elderly hypothermic.
- Reduced responsiveness
21.
Describe how you would care for a:
a) Pyrexial patient’
· Inform qualified nurse on duty
· A qualified nurse needs to be informed who is most likely to administer antipyretics (usually paracetamol) under the doctor's instruction.
Fundamental care would consist of:-
· Leave client with only minimal clothing and coverings whilst maximising dignity
· Offer the use of a fan
· Offer the use of a wet flannel
· Encourage fluid consumption
· Check temperature regularly and other observations regularly
b) Hypothermic patient’
· Inform qualified nurse on duty
· Use extra layers of blankets
· In a clinical setting, the use of a temperature raising fan system may be used at the advice of the doctor or nurse.
· Check temperature and other observations regularly
22.
List the different factors that may affect a patient’s temperature.
- Room temperature
- Client's ability to maintain a safe environment (client's ability to put extra clothes on if cold and take them off if too hot
- Mobility
- Client's neurological status. If the client has hypothalamic deficits, then internal temperature regulation may be affected so physical help may be required to regulate temperature.
- Physiological status. The client may have infection or other contrition which may cause temperature changes
23.
Describe how you would take a patient’s pulse and the observations you would make.
- Explained and discuss procedure to endure understanding and that consent is informed.
- Endeavour for the same time of day for recordings as well as client comfort to maximise consistency and continuity as well as eliminating stressors that could skew readings.
- Apply gentle pressure to the chosen artery (usually the radial artery due to it’s accessorily) for 60 seconds as this allows time for irregularities to show themselves.
- Regularity, rate and amplitude should be observed and recorded on the appropriate chart. Any abnormalities should be reported to the registered practitioner in charge without delay.
24.
What are the normal pulse rate ranges for:
a) Infants’
80-140
b) Children’
1-2yrs = 80-130
6-12 = 75-100
Adolescent = 60-100
c) Adults’
60-100
25.
What does the term ‘tachycardia’ mean’
Pulse more than 60
26.
What does ‘bradycardia’ mean’
Pulse less than 60
27.
Briefly explain why a patient may be:
a) tachycardia
- hyperthermia
- sympathetic nervous stimulation due to physical/emotional stress
- certain medication
- Heart disease
b) Bradycardic.
· cardiac impairment such as fast atrial fibrillation
· pyrexia
· hyperthyroidism
· anxiety
· myocardial infarction
· Parasympathetic nervous activation.
· Athletes can have brad
28.
Describe how you would measure a patient’s respiration rate and the observations you would make.
- Taking a client's respirations is the only time that it acceptable to undertake a procedure without first gaining the client's permission. This is due to the fact that saying you are going to count respirations can cause the client to focus on their respirationr4y rate. this may meant that clients breath at a faster rate/slower grate than they would be normally and not give an accurate reading
- Normally, during observation recording, at some point, the respiration rate is usually taken. Whilst taking the client's pulse can be very advantageous as the client is being quiet while the pulse is being taken. They are not concentrating one their breathing so the respiratory rate is considered to be as normal as it can be.
- Ideally, the respiratory rate is measured for one minute. It is considerate be the number of inspirations and expirations in one minute.
- Rate, degree of effort, regularity and amplitude are observed. The number of FULL breaths (full inspirations and full exhalations) are recorded on the appropriate documentation and any abnormalities reported to the registered practitioner is informed of any abnormalities.
29.
List the different factors which may affect a patient’s respiration rate.
* Mood
* Body temperature
* General activity level
* General health
30.
What is a blood pressure’
The pressure of the blood against the walls of the arteries when the heart is contracted (systole) and when the heart is relaxed (diastole) in millimetres of mercury (mm Hg).
31.
Describe how you would take a patient’s blood pressure and the observations you would make.
* Explain the procedure with the client to reduce distress and facilitated consent being informed.
* Locate the brachial artery via palpation. Place the centre of the sphygmomanometer cuff that the artery is in the middle of it on the upper arm, approximately one inch above the brachial crease.
* Locate the radial pulse. Whilst inflating the cuff, palpate the radial artery until it disappears. Note the reading. Deflate the cuff and encourage the client to move and generally flex the arm concerned for approximately 15 seconds. This not only aids the return of blood to the arm but also reduces pain for the client.
* re-inflate the cuff to 30 mm Hg above where the palpable reading ceased, this time listen via a stethoscope, the bell of which is placed over the brachial artery at eh brachial crease. It must be noted that the second and third fingers are preferable for securing the bell of the stethoscope as the fist finger and thumb both have pulse of tier own which may interfere with accurate listening.
* deflate the cuff sat a rate of 2mm Hg per second noting when the hart beat becomes audible and when it ceases to be audible. Listen to rate, regularity and amplitude.
* remove the cuff and leave the client comfortable.
* Record findings on the appropriate documentation, informing a registered practitioner if there are any abnormities if necessary.
* record the reading on the
32.
In what ranges does a normal blood pressure fall for:
a) children’
- Ages three to five: 116/76
- Ages six to nine: 122/78
- Ages 10 to 12: 126/82
- Ages 13 to 15: 136/86
b) adults’
100/60 to 140/90
33.
What does the term ‘hypertension’ mean’
A systolic blood pressure of above 160 mm Hg or a systolic blood pressure above 100mm Hg.
34.
What symptoms may a hypertensive patient show’
- Red faces
- Head ache
- Stressed
35.
What does the term ‘hypotension’ mean’
A diastolic blood pressure of bellow 100 mmHg
36.
What symptoms may a hypertensive patient show’
- dizzy
- pallor
- feeling faint
- fainting on standing
- sudden unconsciousness
37.
List the different factors that may affect a patient’s blood pressure. - Mood
- Cardiac function
- degree of arthrosclerosis
- General heath
- Fluid balance
- Posture and positioning
38.
Describe how you would measure a patient’s blood glucose level.
* Determine that measurement is necessary
* Inform client of procedure, giving any information required to obtain informed consent.
*Choose a suitable finger. The thumb and first fingers are not usually used as these should be preserved to maximise dexterity. The side of the end of the finger is used to reduce risk of nerve damage. The majority of nerves are at the very tip of the finger. Individuals with diabetes mellitus can develop peripheral neuropathy - a condition where nerve sensitively in the extremities can be reducing over time, causing reduced sensation.
* Using clean cotton wool, cline the side of the end of the finger chose using water only.
* Dry thoroughly with a clean piece of cotton wool. The skin must be dry so that the blood does not become dilute and skew the result.
* Ensure lancet is correctly loaded in the gun to facilitate a smooth procedure and reduce anxiety in the client.
* Prick the finger, allowing a droplet of blood to appear. Do not apply excessive pressure to the finger as this gives skewed results. Wish an already loaded and switched on testing machine, place droplet of blood on test area.
* give client a piece of clean dry cotton wool and allow them to dab test site. This will help to reduce infection risk. Assist with disposal of cotton wool in yellow bag when it is finished with.
* wait for test reslut to appear. Then record it in the client’s care plan and inform registered practitioner of the result. - 39.
What is the normal range for blood glucose’
4 - 7 mmol of glucose.
40.
What does the term ‘hyperglycaemic’ mean’ - Blood Glucose in excess of 7 mmol
41.
What symptoms may a hyperglycaemic patient show’
* Polydipsia
* Polyuria
* Polyphagia
* Dehydration
* electrolyte imbalance
*Hypotension
* Abdominal Pain
* Vomiting
* Nausea
* Acidosis
* Cardiac abnormalities
* Central nervous depression
42.
What does the term ‘hypoglycaemia’ mean’
Blood Glucose less than of 4 mmol
43.
What symptoms may a hypoglycaemic patient show’
* Sweating
* Tremor,
* Weakness,
* Nervousness
* tachycardia,
* hypertension
* Mental disorientation
* convulsions
* unconsciousness
* shock
44.
List the different factors that may affect a patient’s blood glucose level.
- Mental state
- Physical state
- Dietary intake
- Dietary type
- Alcohol intake
45.
Describe how you would undertake a urinalysis and the general observations you would make.
- Explain and discuss the procedures with the client to ensure that the patient understand the procedure and give informed consent.
- Wash hands and apply suitable gloves.
- Collect urine in a clean container - sterile if possible. Preferable a midstream specimen as this will be freer of epithelial cells. Ideally, the urine should be as fresh from the patient as possible as it, urine, decays rapidly, growing organisms, etc, thus making tests invalid.
- Immerse the test strip in the urine, completely immersing the test reagent areas and then remove immediately and remove the excess urine by tapping the stick on the side of the container.
- Wait the prescribed time stated in the information for the test strips so t5hat an accurate reading can be made. The strips should also be held at an angle which does not allow urine to drip from test strip to test strip, thus invalidating test.
- Discard the test strip in a clinical waist bag. Discard urine appropriately
46.
When performing a urinalysis, what may the presence of the following indicate: - a) pH’
Presence of infection
change in body pH - i.e. - acidosis/alkyinosis - b) increased pH’
‘ ? infection - c) ketones’
Diabetic ketoacidosis
Metabolism of fat
starvation
Untreated Diabetes Mellitus - d) glucose’
Diabetes mellitus
Trauma
Altered renal function - e) blood’
Haemorrhage
Trauma
Infection
Altered renal function - f) protein’
? in pregnancy
? in high protein diet
cardiac failure
severe hypertension
infection
asymptomatic renal disease
47.
What do you do with the results of your measurements (e.g. TPR, blood glucose, urinalysis, etc)’
- record appropriately in the correct part of the client's care plan
48.
What would you do differently if any of these results were abnormal’
- report any abnormalities to the appropriate registered practitioner
49.
If you felt unsure of a procedure, how would you obtain the appropriate information’
- Check in the procedures file located in the ward manager's office.
50.
Briefly explain why it is important to follow procedures for clinical activities as specified’
- So that the results are valid in that the same is done with regard to a test to help to remove extraneous factors
51.
What should you do if you are unable to obtain a patient’s clinical observations or specimen as requested’
If the observation/specimen was omitted, then this fact should be mentioned to the qualified nurse. if necessary, it may be necessary for it to be recorded in the care plan that the test is still required
If the client declines the test to be undertaken, then the client has the right to decline. In this case it is important to explain to the client that it is medically important for the test to be undertaken. If they still decline it must be reported to the regerestered nurse and recorded in the care plan. if the observation is really vital then it may be necessary for the fact to be passed on to the doctor
52.
List the clinical observations commonly undertaken in your work area.
- Temperature
- Pulse
- Respirations
- Blood pressure
- Lying and Standing Blood Pressure
- Blood sugar levels
- Urinalysis
- Pulse oximitry
- Weight
- Girth
- ECG
Monday, May 23, 2005
TC1 WIP
KNOWLEDGE EVIDENCE QUESTIONS
UNIT TC1 - RECORD AND EVALUATE AN ECG AT REST
1.
Describe the basic structure and function of the cardiovascular system ie: heart, vessels and circulations.
Heart
2.
Draw a diagram of the conducting system of the heat.
Briefly describe the normal conduction pathway of the heart.
The bundle of His emits an electrical discharge which is picked up by the syno-atrial node. This then
3.
The normal heart produces a typical waveform.
(a) What is this normal rhythm called?
Sinus rhythm - as it originates from the sino-atrial node
(b) Draw a diagram of this waveform.
(c) Briefly describe its five components.
P = Atrial polarisation
Q R S = ventricular polarisation
T = ventricular re-polarisation
4.
How would you know if this conducting system was damaged by disease?
There will be alteration from previous ECGs
There are deviations from normal waveforms
T waves could be inverted
5.
Briefly describe some common disturbances of heart-rhythm and their causes.
Atrial Fibrillation.
Where the atrial muscle is not working as one and all the cells contract disryhmically
6.
What do the electrodes of the ECG record?
the electrical output of the heart
7.
Very briefly, what is the significance of the grid on the ECG paper?
this provides a benchmark against which the waveform and rhythm may be measured
8.
Ventricular ectopic beats can occur in healthy people when they are associated with an excess of tea, coffee or alcohol - TRUE or FALSE.
True
9.
A patent's ECG tracing shows ventricular fibrillation – why should this give cause for concern?
This constitutes a cardiac arrest and no pulse will be present.
Cardiopulmonary resuscitation is indicted
10.
You observe the abnormal rhythm of ‘asystole’ – what does this signify?
there is not cardiac contraction what so ever. If it is caught soon enough this can be chemically reversed. How this cannot be reversed by defibrillation.
11.
What is the advantage of the 12 lead ECG?
It looks at the heart in 12 ways.
It is a non-invasive way of gaining quite an accurate picture of the heart.
12.
Draw a diagram showing where these 12 leads are placed on the body.
13.
How can we avoid an erroneous recording/reading?
Ask the client to stay very still
Try to keep the leads still
Try to eliminate all extraneous power sources that may interfere with the process.
Ensure that all mobile phones are switched off in the vicinity
Ensure correct placement of electrodes
14.
Why is it important to check the ECG equipment prior to use? Briefly list the specific types of electrocardiograph.
To see if it is functioning correctly as to reduce the risk of hardware error.
12 lead
12 lead right sided
12 lead taken on the back on left or right
24 hour tape
3 lead
15.
(a) How do you prepare a patient for an ECG?
(b)Is the preparation any different between a routine or emergency procedure for ECG?
a) wash and dry hands
explain procedure to obtain informed consent
lie the patient down with 2 pillows (any deviation from this should be recorded on the ECG after production
raise bed to height that suits worker.
apply stickers to appropriate parts of the body
turn on ECG machine and ensure correct operation.
Attach leads
take reading
throughout the procedure, reassure client, answering questions within support worker role or seeking assistance when questions/problems are outside role.
b)there is no difference in non-emergency and emergency protocols.
16.
(a) Identify some anxieties that a patient might express when informed that he/she will need an ECG. How would you deal with this?
(b) Consider a patient from a different cultural background.
What would you do if a patient refused to have an ECG, for whatever reason?
a)Will it hurt?
no there will be no pain (except for hirsute males when the stickers are removed from the chest area)
will i get an electric shock?
No, this is taking a reading of the electrical activity of the heart, not giving out an electric current
Is it alright?
As a healthcare support worker, I am not permitted to pass comment on ECGs as I do not have the knowledge base to read them, nor the accountability to stand by what is said. It is the role of the doctor to report on all ECGs.
b) In certain cultures, male workers are not permitted to touch or care for female clients.
17.
If the ECG printout was poorly printed, what adjustments would you consider to rectify this?
check all the electrodes are connected properly
check to see that there are no extraneous electrical currents in the vicinity, ie mobile phones, electric mattress motors.
ask the patient to remain as still as possible.
relocate limb leads, if necessary, when they are in a stable position where their movement is minimized
18.
You’ve just taken the ECG and identified some abnormality. What do you do next?
As with all ECGs, they should be presented to a doctor. This must be done with the utmost expedition as it is very important as cardiac damage may be occurring or, in the worse case scenario, death could occur if nothing is done.
19.
What is the effect of Digoxin on the ECG?
This would show the complexes being further apart as digoxin has a slowing effect on the heart.
20.
What should be done before the ECG recording is filed away?
It must be signed by a doctor
It must have the following information on it:-
date
time
patient
existence of pain at time of ECG
whether the filter was on or not.
21.
How would you care for the ECG machine one you have finished using it?
22.
How and why does an ECG recording differ in a child?
UNIT TC1 - RECORD AND EVALUATE AN ECG AT REST
1.
Describe the basic structure and function of the cardiovascular system ie: heart, vessels and circulations.
Heart
The heart and circulatory system
The function of the heart is to continuously supply the whole of the body with blood to function properly. Fresh blood brings oxygen and food to the tissues and carries away unwanted carbon dioxide and other waste products.
The blood circulates around your body through a closed system of blood vessels. The heart is the pump, which pumps it around. It has four chambers and a one-way valve system. Each contraction, or heart beat, pumps blood forward into the arteries. The arteries divide off into smaller and smaller branches to supply a microscopic network of capillaries, distributing the blood to every part of your body.
Blood is collected from the capillaries by the veins. The branches of the veins join to form larger veins delivering blood back to your heart. Blood from your veins fills the heart as it relaxes during the interval between each contraction.
This total circulatory system is called the cardiovascular system. It contains about eight pints of blood, which your heart is continuously re-circulating. Each day, your heart beats about 100,000 times and pumps about 5,000 gallons of blood.
The heart is in fact two separate pumps, which work together. The right side of the heart receives dark, deoxygenated blood, which has circulated around your body. It pumps this to your lungs, where it picks up a fresh supply of oxygen and becomes bright red again.
The left heart receives fresh blood from the lungs and pumps it into the arteries, which supply the rest of the body. Each side of the heart has a thin-walled ‘collecting reservoir’ (the atrium) which helps to fill the thick-walled major pump (the ventricle). The heart wall is made of a special sort of muscle called the myocardium.
Like every other living tissue, the myocardium itself needs to be continuously supplied with fresh blood. This supply of blood comes from the coronary arteries.
2.
Draw a diagram of the conducting system of the heat.
Briefly describe the normal conduction pathway of the heart.
The bundle of His emits an electrical discharge which is picked up by the syno-atrial node. This then
3.
The normal heart produces a typical waveform.
(a) What is this normal rhythm called?
Sinus rhythm - as it originates from the sino-atrial node
(b) Draw a diagram of this waveform.
(c) Briefly describe its five components.
P = Atrial polarisation
Q R S = ventricular polarisation
T = ventricular re-polarisation
4.
How would you know if this conducting system was damaged by disease?
There will be alteration from previous ECGs
There are deviations from normal waveforms
T waves could be inverted
5.
Briefly describe some common disturbances of heart-rhythm and their causes.
Atrial Fibrillation.
Where the atrial muscle is not working as one and all the cells contract disryhmically
6.
What do the electrodes of the ECG record?
the electrical output of the heart
7.
Very briefly, what is the significance of the grid on the ECG paper?
this provides a benchmark against which the waveform and rhythm may be measured
8.
Ventricular ectopic beats can occur in healthy people when they are associated with an excess of tea, coffee or alcohol - TRUE or FALSE.
True
9.
A patent's ECG tracing shows ventricular fibrillation – why should this give cause for concern?
This constitutes a cardiac arrest and no pulse will be present.
Cardiopulmonary resuscitation is indicted
10.
You observe the abnormal rhythm of ‘asystole’ – what does this signify?
there is not cardiac contraction what so ever. If it is caught soon enough this can be chemically reversed. How this cannot be reversed by defibrillation.
11.
What is the advantage of the 12 lead ECG?
It looks at the heart in 12 ways.
It is a non-invasive way of gaining quite an accurate picture of the heart.
12.
Draw a diagram showing where these 12 leads are placed on the body.
13.
How can we avoid an erroneous recording/reading?
Ask the client to stay very still
Try to keep the leads still
Try to eliminate all extraneous power sources that may interfere with the process.
Ensure that all mobile phones are switched off in the vicinity
Ensure correct placement of electrodes
14.
Why is it important to check the ECG equipment prior to use? Briefly list the specific types of electrocardiograph.
To see if it is functioning correctly as to reduce the risk of hardware error.
12 lead
12 lead right sided
12 lead taken on the back on left or right
24 hour tape
3 lead
15.
(a) How do you prepare a patient for an ECG?
(b)Is the preparation any different between a routine or emergency procedure for ECG?
a) wash and dry hands
explain procedure to obtain informed consent
lie the patient down with 2 pillows (any deviation from this should be recorded on the ECG after production
raise bed to height that suits worker.
apply stickers to appropriate parts of the body
turn on ECG machine and ensure correct operation.
Attach leads
take reading
throughout the procedure, reassure client, answering questions within support worker role or seeking assistance when questions/problems are outside role.
b)there is no difference in non-emergency and emergency protocols.
16.
(a) Identify some anxieties that a patient might express when informed that he/she will need an ECG. How would you deal with this?
(b) Consider a patient from a different cultural background.
What would you do if a patient refused to have an ECG, for whatever reason?
a)Will it hurt?
no there will be no pain (except for hirsute males when the stickers are removed from the chest area)
will i get an electric shock?
No, this is taking a reading of the electrical activity of the heart, not giving out an electric current
Is it alright?
As a healthcare support worker, I am not permitted to pass comment on ECGs as I do not have the knowledge base to read them, nor the accountability to stand by what is said. It is the role of the doctor to report on all ECGs.
b) In certain cultures, male workers are not permitted to touch or care for female clients.
17.
If the ECG printout was poorly printed, what adjustments would you consider to rectify this?
check all the electrodes are connected properly
check to see that there are no extraneous electrical currents in the vicinity, ie mobile phones, electric mattress motors.
ask the patient to remain as still as possible.
relocate limb leads, if necessary, when they are in a stable position where their movement is minimized
18.
You’ve just taken the ECG and identified some abnormality. What do you do next?
As with all ECGs, they should be presented to a doctor. This must be done with the utmost expedition as it is very important as cardiac damage may be occurring or, in the worse case scenario, death could occur if nothing is done.
19.
What is the effect of Digoxin on the ECG?
This would show the complexes being further apart as digoxin has a slowing effect on the heart.
20.
What should be done before the ECG recording is filed away?
It must be signed by a doctor
It must have the following information on it:-
date
time
patient
existence of pain at time of ECG
whether the filter was on or not.
21.
How would you care for the ECG machine one you have finished using it?
22.
How and why does an ECG recording differ in a child?
Z8
KNOWLEDGE EVIDENCE QUESTIONS
UNIT Z8 - SUPPORT CLIENTS WHEN THEY ARE DISTRESSED
1.
What do you understand the term “distress” to mean?
2.
Draw a spider chart showing the potential causes of distress.
3.
Describe how the care environment can be stressful to many clients.
4.
Identify the common causes of distress in your work area for:-
a) patients.
b) relatives.
c) staff.
5.
Draw a spider chart showing the physical and emotional signs of distress a patient may exhibit.
6.
What measures could you take to prevent a client from becoming distressed?
7.
Describe how you would try to reduce a client’s distress.
8.
What factors may inhibit the effective use of methods to reduce distress?
9.
What is your responsibility once the client’s distress has settled?
10.
How can you prevent the client from feeling embarrassed about their distress?
11.
Briefly explain how an individual’s personal beliefs and preferences affects their expression of distress and the support you give.
12.
In what instances may a client’s distress affect the well being of a member of staff?
13.
What are the warning signs that you or a colleague are becoming too involved?
14.
Identify ways of managing your own feelings aroused by an individual’s distress.
15.
A distressed client indicates that he/she is likely to harm him/herself. What actions should you take?
16.
How would you seek help if you felt unsure of procedures?
17.
The distressed client starts asking questions about their diagnosis/treatment/prognosis. What do you do?
18.
What do you understand the term “counselling” to mean?
19.
Describe the basic skills you think a counsellor needs to have.
20.
What factors may inhibit the effective use of counselling skills?
UNIT Z8 - SUPPORT CLIENTS WHEN THEY ARE DISTRESSED
1.
What do you understand the term “distress” to mean?
2.
Draw a spider chart showing the potential causes of distress.
3.
Describe how the care environment can be stressful to many clients.
4.
Identify the common causes of distress in your work area for:-
a) patients.
b) relatives.
c) staff.
5.
Draw a spider chart showing the physical and emotional signs of distress a patient may exhibit.
6.
What measures could you take to prevent a client from becoming distressed?
7.
Describe how you would try to reduce a client’s distress.
8.
What factors may inhibit the effective use of methods to reduce distress?
9.
What is your responsibility once the client’s distress has settled?
10.
How can you prevent the client from feeling embarrassed about their distress?
11.
Briefly explain how an individual’s personal beliefs and preferences affects their expression of distress and the support you give.
12.
In what instances may a client’s distress affect the well being of a member of staff?
13.
What are the warning signs that you or a colleague are becoming too involved?
14.
Identify ways of managing your own feelings aroused by an individual’s distress.
15.
A distressed client indicates that he/she is likely to harm him/herself. What actions should you take?
16.
How would you seek help if you felt unsure of procedures?
17.
The distressed client starts asking questions about their diagnosis/treatment/prognosis. What do you do?
18.
What do you understand the term “counselling” to mean?
19.
Describe the basic skills you think a counsellor needs to have.
20.
What factors may inhibit the effective use of counselling skills?
X12 wip
KNOWLEDGE EVIDENCE QUESTIONS UNIT X12 - SUPPORT CLIENTS DURING CLINICAL ACTIVITIES 1. List the main treatments, investigations and procedures carried out in your work area.
Catheterisation
Lumber puncture
Sterile wound dressings
Blood pressure
Venopuncture
Temperature
Pulse
Pulse oximitry
Respirations
Weight
Girth
Receiving of blood and blood products
Receiving medication
2. Choose one of the above and describe the: Catheterisation
a) Preparation the patient needs prior to this.
· Ensure that the Registered Practitioner has explained the procedure and that the client fully understands what is going to happen before, during and after the procedure. If necessary, show them a leg bag and catheter, for example.
· Prepare the client for the procedure:-
i. Adjust clothing as necessary
ii. Offer toilet facility use
iii. Ensure client is comfortable
· Gather all necessary equipment required, i.e., a range of catheters for the appropriate gender, sterile glove for the Practitioner, sterile water for meatal cleansing, lubricant anaesthetic gel, appropriate catheter bag etc. Ensure that all packed items have intact packaging and are in date.
· Apply clean latex gloves and plastic apron, after washing and drying hands, and clean trolley with hot water and detergent, drying thoroughly afterwards, using clean wipes and paper towels for each area. Remove gloves and apron and place in appropriate bin.
· Place all equipment on bottom tray of trolley
· Ensure privacy for the patient: draw the blinds, close the door.
· Wash hands and dry. Apply latex gloves and plastic apron.
b) Support the patient may need during this.
Explain that the procedure will be uncomfortable and that any excessive pain should be reported.
Explain all procedures before and during to reduce anxiety
If questions asked are outside the scope of the worker, seek assistance from Registered Practitioner.
c) Care the patient will need after the activity.
Client may need assistance to readjust clothing
Client may need to be made comfortable again
Client may need assistance with adjusting catheter bag.
d) Common adverse reactions to the treatment/investigation/procedure and action you should take in this event.
On occasions, there may be some urethral trauma resulting in frank blood emanating from the meatus. If this occurs, then inform the registered practitioner and record the fact in the care plan.
3. Why is it important to ensure that the patient is informed of the nature of the treatment/investigation/procedure and the equipment to be used?
So any consent is informed
If consent is not informed, then abuse and assault occur.
4. What is meant by the term “informed consent”?
Clients are given all information necessary to make a decision as to have the procedure or not.
5. Why do patients need to sign a consent form prior to some treatments, investigations and procedures?
Some procedures can incur some degree of risk. It is important the clients know the degree of this risk prior to commencement of any procedure and must legally sign to say that they have been informed of the risk and they are happy for the procedure to be undertaken.
6. What happens if the patient refuses the treatment, investigation or procedure prescribed?
If this occurs, it is the role of ANY worker, regardless of role, to see that the client’s wishes are upheld. It is also very important that the registered practitioner is informed and that the objection is recorded in the client’s medical notes and care plan.
7. A patient asks you a detailed question about their test, its effects and the results of it. What should be your response?
Say that what they have asked is without your role and that you will ask a registered practitioner to come and speak to them.
8. Why is it important to check that: a) the patient has complied with any pre-treatment/investigation/procedure instructions?
Non-compliance may have fatal consequences
b) The patient understands any post-treatment/investigation/procedure instructions?
Non-compliance may have fatal consequences
9. Briefly explain the effects a patient’s personal beliefs and preferences may have on others and the treatment/investigation/procedure.
Some procedures require accessing of intimate parts of clients so it may be necessary for the same gender to perform some tasks.
Client may of dress codes that do not facilitate the regimens for certain treatments so a way around them must be sort
Some individuals may have certain diets, i.e. vegan, so some medication, i.e., the flu jab which is cultured using eggs, may not be desirable to them.
10. A specimen has been taken. a) What information needs to be put on the specimen container and form?
Full nameDate of birthHospital number
Date and time of specimen
Type of specimen
Ward
Hospital
Any other necessary information
b) How is the specimen despatched to the laboratory?
It is placed in the appropriate container which has been labelled and then put in the appropriate packaging and appropriately labelled.
It is then place in the designated collection point to be taken to the lab.
It may be necessary to arrange for some specimens to be fast tracked to the lab. This can be done by the worker or it may be necessary to arrange someone else to undertake the task rapidly.
11. Why is confidentiality important when dealing with specimens?
Patients may not want everyone to know that they have had a certain type of test taken, i.e. a pregnancy test or HIV test.
1. List the ways infection can be passed to the patient before, during or after a procedure.
Before
Not washing hands
Dirty equipment in place before commencement of activity
Patient may already be infected prior to commencement
During
Not washing hands
Dirty equipment being used for the procedure
Already infected client may have infection transferred to a clean area where they were not infected before hand, i.e., MRSA from client’s hand goes into wound.
After
Not washing hands
Dirty equipment not being cleaned or removed post activity.
2. Briefly explain the meaning of the following terms for cleanliness: a) socially clean Washed “normally” i.e., with water and detergent
b) Disinfection
Microbes are reduced to a safe level
c) Sterilisation
All microbes are removed
3. If you felt unsure of procedures, how would you obtain the relevant information?
It would be necessary to seek out information either from a registered practitioner or from the standards in the ward manager’s office.
Catheterisation
Lumber puncture
Sterile wound dressings
Blood pressure
Venopuncture
Temperature
Pulse
Pulse oximitry
Respirations
Weight
Girth
Receiving of blood and blood products
Receiving medication
2. Choose one of the above and describe the: Catheterisation
a) Preparation the patient needs prior to this.
· Ensure that the Registered Practitioner has explained the procedure and that the client fully understands what is going to happen before, during and after the procedure. If necessary, show them a leg bag and catheter, for example.
· Prepare the client for the procedure:-
i. Adjust clothing as necessary
ii. Offer toilet facility use
iii. Ensure client is comfortable
· Gather all necessary equipment required, i.e., a range of catheters for the appropriate gender, sterile glove for the Practitioner, sterile water for meatal cleansing, lubricant anaesthetic gel, appropriate catheter bag etc. Ensure that all packed items have intact packaging and are in date.
· Apply clean latex gloves and plastic apron, after washing and drying hands, and clean trolley with hot water and detergent, drying thoroughly afterwards, using clean wipes and paper towels for each area. Remove gloves and apron and place in appropriate bin.
· Place all equipment on bottom tray of trolley
· Ensure privacy for the patient: draw the blinds, close the door.
· Wash hands and dry. Apply latex gloves and plastic apron.
b) Support the patient may need during this.
Explain that the procedure will be uncomfortable and that any excessive pain should be reported.
Explain all procedures before and during to reduce anxiety
If questions asked are outside the scope of the worker, seek assistance from Registered Practitioner.
c) Care the patient will need after the activity.
Client may need assistance to readjust clothing
Client may need to be made comfortable again
Client may need assistance with adjusting catheter bag.
d) Common adverse reactions to the treatment/investigation/procedure and action you should take in this event.
On occasions, there may be some urethral trauma resulting in frank blood emanating from the meatus. If this occurs, then inform the registered practitioner and record the fact in the care plan.
3. Why is it important to ensure that the patient is informed of the nature of the treatment/investigation/procedure and the equipment to be used?
So any consent is informed
If consent is not informed, then abuse and assault occur.
4. What is meant by the term “informed consent”?
Clients are given all information necessary to make a decision as to have the procedure or not.
5. Why do patients need to sign a consent form prior to some treatments, investigations and procedures?
Some procedures can incur some degree of risk. It is important the clients know the degree of this risk prior to commencement of any procedure and must legally sign to say that they have been informed of the risk and they are happy for the procedure to be undertaken.
6. What happens if the patient refuses the treatment, investigation or procedure prescribed?
If this occurs, it is the role of ANY worker, regardless of role, to see that the client’s wishes are upheld. It is also very important that the registered practitioner is informed and that the objection is recorded in the client’s medical notes and care plan.
7. A patient asks you a detailed question about their test, its effects and the results of it. What should be your response?
Say that what they have asked is without your role and that you will ask a registered practitioner to come and speak to them.
8. Why is it important to check that: a) the patient has complied with any pre-treatment/investigation/procedure instructions?
Non-compliance may have fatal consequences
b) The patient understands any post-treatment/investigation/procedure instructions?
Non-compliance may have fatal consequences
9. Briefly explain the effects a patient’s personal beliefs and preferences may have on others and the treatment/investigation/procedure.
Some procedures require accessing of intimate parts of clients so it may be necessary for the same gender to perform some tasks.
Client may of dress codes that do not facilitate the regimens for certain treatments so a way around them must be sort
Some individuals may have certain diets, i.e. vegan, so some medication, i.e., the flu jab which is cultured using eggs, may not be desirable to them.
10. A specimen has been taken. a) What information needs to be put on the specimen container and form?
Full nameDate of birthHospital number
Date and time of specimen
Type of specimen
Ward
Hospital
Any other necessary information
b) How is the specimen despatched to the laboratory?
It is placed in the appropriate container which has been labelled and then put in the appropriate packaging and appropriately labelled.
It is then place in the designated collection point to be taken to the lab.
It may be necessary to arrange for some specimens to be fast tracked to the lab. This can be done by the worker or it may be necessary to arrange someone else to undertake the task rapidly.
11. Why is confidentiality important when dealing with specimens?
Patients may not want everyone to know that they have had a certain type of test taken, i.e. a pregnancy test or HIV test.
1. List the ways infection can be passed to the patient before, during or after a procedure.
Before
Not washing hands
Dirty equipment in place before commencement of activity
Patient may already be infected prior to commencement
During
Not washing hands
Dirty equipment being used for the procedure
Already infected client may have infection transferred to a clean area where they were not infected before hand, i.e., MRSA from client’s hand goes into wound.
After
Not washing hands
Dirty equipment not being cleaned or removed post activity.
2. Briefly explain the meaning of the following terms for cleanliness: a) socially clean Washed “normally” i.e., with water and detergent
b) Disinfection
Microbes are reduced to a safe level
c) Sterilisation
All microbes are removed
3. If you felt unsure of procedures, how would you obtain the relevant information?
It would be necessary to seek out information either from a registered practitioner or from the standards in the ward manager’s office.
