NVQ workbooks

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

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