UAB PCT Training

When should you release the tourniquet?

BEFORE removing needle!

Call MET team if: blood pressure?

BP <90 or >180

CAUTI

CAUTI = catheter-associated UTI - can occur if Foley catheter bag not kept below bladder level

CUS

CUS: how we communicate concern for patient safety, levels of escalation C = I am Concerned U = I am Uncomfortable S = I believe Safety is at risk

2 benefits of hourly rounding?

Cuts down on call lights because patient will know when you'll return. Reduces patient falls & skin breakdown (i.e. pressure ulcer).

Call MET team if: heart rate?

HR <45 or >130

Additional patient labels can be printed through the __ system.

Health Quest

Hill Rom

IV pumps/biomedical supplies vendor

What are some reasons why you might not be able to measure BP in a patient's arm?

IV, AV shunt (dialysis), cast, wound, post mastectomy, sore

2 things you must remember in role of patient observer?

If patient is on suicide precautions, you must ALWAYS be within arm's length. Someone must RELIEVE you for lunch & breaks.

Call MET team if: O2 sat?

O2 sat <90% on O2

Pulse oximetry is a measure of __.

O2 saturation (gives idea of how well patient breathing properly)

When is it okay to override scanning process when drawing blood?

ONLY in emergency situations

2 examples of nice activities?

getting blanket/pillow for patient, getting cup of water/ice for patient

Never measure oral temperature on a patient who is __.

having trouble breathing

systolic pressure

heart is contracting (highest pressure point)

diastolic pressure

heart is relaxed & filling with blood (lowest pressure point)

Body temperature is a measure of the body's ability to make & get rid of __.

heat

TED hose & sequential compression device (SCD)

help increase circulation to prevent blood clot formation

hypertension

high blood pressure (systolic over 140 mm/Hg)

Pulse is a measure of __.

how fast heart is beating

When a patient dies, you must check with the nurse to see if:

if the death is a coroner's case (requires investigation)

When & how should you mix a specimen when drawing blood?

immediately after drawing each tube - gently invert tube (do not shake!)

advance directive

patient-provided legal document with instructions prepared to address situations in which they may become incapable of making their own decisions

It is helpful to place which electrodes first?

V1, V2, V4, V6 - then fill in V3 & V5 between them

Which patients are required to get a CHG bath daily?

patients with a central venous line (CVL) or peripherally inserted central catheter (PICC)

Code Silver

police emergency (i.e. active shooter)

What should you use to sanitize collection site when drawing blood, if patient is sensitive to alcohol?

povidone-iodine prep

lead wire

provides connection between electrode & monitoring device

What might give you inaccurate results when taking a patient's BP?

pumping the cuff several times in a row, using the wrong size cuff

tachycardia

rapid heart rate (over 100 bpm)

Most accurate route for taking patient's temp?

rectal - 1° higher than oral

axillary

relating to armpit

Teletracking: red means?

request for patient room to be stat cleaned (red "C")

Varicella Zoster Virus (VZ) Precautions

requires: hand hygiene ** DO NOT enter room if you are not immune to chickenpox!

Airborne Precautions

requires: hand hygiene, N95 respirator - used for pathogens that can spread long distances (i.e. TB, shingles, chickenpox, etc.)

Contact Precautions

requires: hand hygiene, gloves, gown - used for C. diff, MRSA, etc.

Droplet Precautions

requires: hand hygiene, mask - used for pathogens that can spread within short distances up to 3 feet (i.e. flu, meningitis, etc.)

service recovery

response to patient complaint

The lead connected to the __ is a neutral lead; it is only there to complete an electrical circuit & plays no role in the EKG itself.

right ankle

Where is the 1st intercostal space located?

right below clavicle

4 pillars of AMC 21?

satisfaction, quality, financial, advancement of knowledge

Stericycle

sharps/biohazard services

What are some age-related changes regarding skin?

skin becomes thinner, drier, less elastic, & more fragile as subcutaneous fat diminishes

bradycardia

slow heart rate (less than 60 bpm)

intercostal space

space between 2 ribs

How does bedside shift report benefit the nurse?

standardized communication method, increases accountability & skill level of new RN's, saves time for caregiver

Health Quest

system for admission, discharge, & transfer

Lawson

system for ordering supplies

When taking a patient's blood pressure, the top number is the __ pressure & the bottom number is the __ pressure.

systolic / diastolic

first beat of BP reading?

systolic pressure

5 vital signs?

temperature, pulse, respirations, blood pressure, pain assessment

pneumothorax

air in lung & chest wall, causing collapse

How should the needle & bevel be oriented when drawing blood?

align needle with vein, bevel facing up (#'s on butterfly needle facing up)

Blood pressure is a measure of __.

amount of force exerted by blood against walls of artery

Tasks you may perform in US role?

answering phones, ordering supplies

V5 electrode placement?

anterior axillary line at 5th intercostal space

How often should communication boards be updated?

at least once per shift & PRN comfort/medication updates

Least accurate route for taking patient's temp?

axillary (under armpit) - 1° less than oral

Telemetry monitors should only be removed from patient when:

bathing, or going off unit for procedure

unit of measurement for pulse?

beats per minute (bpm)

Should sputum collection by expectoration take place before or after the patient is given antibiotics?

before

Code Q

behavioral issue/problem

Foley catheter bags must be kept __ patient's bladder level.

below

sternum

breastbone

unit of measurement for respirations?

breaths per minute

What should you do before removing a telemetry monitor?

call Central Monitoring (4-6515)

What should you do if you have equipment issues during the scanning process when drawing blood?

call HSIS Help Desk

If your patient is experiencing decreased LOC or chest pain, you should:

call MET team

radial pulse

can be found on wrist, just under thumb

What should you use to sanitize collection site when drawing blood, if patient NOT sensitive to alcohol?

chloraprep

AIDET

AIDET: how we interact with patients (during handoff also) A = Acknowledge I = Introduce D = Duration E = Explanation T = Thank-you

How should you sanitize the collection site when drawing blood?

clean with concentric circles radiating outward

4 reasons why a blood specimen may be rejected by the laboratory?

clotted, quantity not sufficient (QNS), hemolysis, contamination

clavicle

collar bone

electrode

conductive pad attached to skin

How should you count a patient's pulse if rhythm is regular & rate seems normal?

count pulse for 30 sec, then x 2

How should you count a patient's pulse if rate is unusually fast or slow?

count pulse for 60 sec

How should you count a patient's respirations?

count respirations for 30 sec, then x 2 - count when patient is at rest, right after counting pulse - 1 respiration = 1 inhalation (rise) + 1 exhalation (fall) - don't let patient know you're counting or they may subconsciously alter their breathing

How does bedside shift report benefit the patient & family?

decreases anxiety because patients feel more informed, increases compliance with their plan of care

last beat of BP reading?

diastolic pressure

All drains, Foley catheter bags, etc. must be __ before transport.

drained

Oxygen is considered a __.

drug

chest tubes

evacuate air/fluid in order to re-expand lung tissue & to prevent pneumothorax

Code Yellow

external (i.e. tornado) or internal (i.e. bomb threat) disasters

Code Red

fire

Impact/PowerChart

patient's electronic medical record

PCT role in sepsis prevention?

- assessing patient's vital signs & mental status every 4 hrs - document in iView & report to bedside nurse immediately

sepsis

- caused by body's immune system working overtime to fight bacterial infection in blood - can lead to systemic organ failure

4 things skin should be assessed for?

- color - temp (hot/cool) - turgor (elasticity) - moisture (wet/dry)

Do not leave a tourniquet on for more than:

1 min

What are some signs of respiratory distress?

- complaints of trouble breathing - can't speak in full sentences - gasping for air - lower than usual O2 level (O2 sat less than 90% at any point) - coughing - pain with breathing

What are some things you should report if noticed in a patient with a chest tube?

- excessive/bloody drainage - change in vital signs/cognition - cool, pale, or clammy skin

signs of sepsis?

- low BP (less than 100 mm/Hg) - high RR (over 22 breaths/min) - acute mental status change

What should you do if your patient is having trouble breathing or other signs of respiratory distress?

- move patient to more comfortable/sitting upright position - report to nurse/hit call button if urgent, or code button if emergency - encourage incentive spirometer use - cough & deep breathing exercises

5 items every paper chart must have on the front?

- name - room # - allergies (or NKA) If ordered: - isolation precautions - DNR

4 reasons for bedside shift report?

- patient safety - improves handoff communication - decreases medical errors & readmissions - reduces # of duplicated tests

When drawing blood, each sample must be labeled with what 4 things?

- patient's full name & DOB - MR # - location/date & time - collector's name & initials

When should a patient get a CHG bath?

- required daily: if patient has CVL or PICC - prior to surgery

negative pressure rooms

- used for patients under Airborne Precautions - verify by checking monitor - patients should only leave room if they must go to a procedure (i.e. surgery)

4 ways to prevent contamination of patient's skin with bacteria from bath supplies?

- wipe bath basin with purple wipes before & after use - don't store items in basin - use one basin for washing & another for rinsing - store basins separately & upside down

What should you ask a female patient before measuring BP in her arm?

- Have you ever had a mastectomy? - Do you have a birth control implant in either arm?

A properly tied tourniquet has a __.

1-handed release

When taking an oral temp, wait __ min or use another route if the patient has recently had anything to eat or drink, chewed gum, or smoked.

15 min

V2 electrode placement?

4th intercostal space, to the left of sternum

V1 electrode placement?

4th intercostal space, to the right of sternum

4 UAB core values?

Do Right, Always Care, Work Together, Own It

PCT limitations when transporting a patient on oxygen?

RN must accompany PCT during transport if: - O2 level is >40% - O2 tank is turned to 10L or more

Teletracking: brown means?

patient room is dirty

Code Pink

infant/child abduction

LOC

level of consciousness

hypotension

low blood pressure (systolic less than 100 mm/Hg)

What should you do before applying TED hose to a patient?

measure both legs

Code Blue

medical emergencies (i.e. heart attack, respiratory failure, etc.)

V6 electrode placement?

mid-axillary line at 5th intercostal space

V4 electrode placement?

midclavicular line at 5th intercostal space

V3 electrode placement?

midway between V2 & V4

unit of measurement for blood pressure?

mm/Hg

2 functions of respiratory system?

move O2 in, take CO2 out (waste)

anterior

nearer the front

TED hose must be removed at least __ daily to inspect patient's skin & provide skin care.

once

Healthstream/UAB Learning System

online education system

VasTech

online staff scheduling

What type of soap should be used when bathing a patient?

only use hospital-provided liquid soap

Most common route for taking patient's temp?

oral (under tongue)

When drawing blood, not following the correct __ could lead to inaccurate test results, due to interaction of tube additives.

order of collection

4 P's of hourly rounding?

pain, position, potty, possessions

Patient Portal

patient access to their healthcare information

Teletracking

patient flow tracking

Teletracking: yellow means?

patient room is being cleaned

Teletracking: green means?

patient room is clean & ready

You cannot wear gloves while __ a patient.

transporting

2 examples of important activities?

turning patient, walking patient

durable power of attorney

type of advance directive specifying individual who will act/decide on behalf of patient in unforeseen circumstances

living will

type of advance directive specifying patient's wishes regarding life-sustaining/life-saving measures, organ donation, etc.

2 types of dying processes?

urgent dying (usually unexpected), normal dying

Call MET team if: urine output?

urine output <30 ml/hr or <360 ml/12 hrs

telemetry

used to reflect underlying heart conditions by constantly monitoring heart's activity

How should you orient a label on a specimen tube when drawing blood?

vertically

2 examples of vital activities?

vital signs, stat labs

Tasks you may perform in PCT role?

vital signs, venipuncture, EKG's