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.
