Site Map Log Book Skills - MBBS 3

Interview a Patient with Abdomial Pain

Introduce yourself to patient
Establish rapport with patient
Asks about pain
Nature
Location
Provoking and relieving factors
Onset and duration
Raditation
Asks about associated symptoms
Nausea & Vomiting
Diarrhoea / Constipation
Rectal bleeding
Urinary symptoms
Date of last menstral period
etc...
Further History
Previous medical history
Family history
Medication and allergy history
Social history
Smoking and alcohol history
Care taken to
Use appropreate language
Use appropreate questions; open, closed & clarifying
Encourage and answer patients questions
Acknowledge patient concerns
Summary and analysis of history
Accurate documentation of history
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Assess Alcohol Intake and the CAGE Questionnaire

Introduce yourself and check the patient's identity
Establish and maintain rapport with patient
Use language the patient will understand
Enquire about alcohol intake
Type of alcohol
C.A.G.E
C - Ask if the patient has ever thought they should Cut down on alcohol intake
A - Ask if the patient has ever been Annoyed when other people criticise their drinking
G - Ask if the patient has ever felt Guilty about their drinking
E - Ask if the patient has ever needed a drink first thing in the morning (Eye opener)
Score the CAGE questionare of the patient
Give appropriate feedback to the patient on intake of alcohol
Suggest ways of cutting down if appropriate
Acknowlede patients concerns
Encourage questions from patient & deal with them appropriately
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Interview a Patient with Breathlessness

Introduces yourself to patient
Establish rapport with patient
Asks about breathlessness
Nature
Provoking and relieving factors
Exercise tolerance
Sleep disturbance
Asks about associated symptoms
Wheeze
Cough
Pain
Dizziness
etc...
Asks about smoking
Further History
Previous medical history
Medication and allergy history
Family history
Social history including current and previous occupations
Alcohol history
Care taken to
Use appropreate language
Use appropreate questions; open, closed & clarifying
Encourage and answer patients questions
Acknowledge patient concerns
Summary and analysis of history
Accurate documentation of history
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Interview a Patient with Chest Pain

Introduces yourself to patient
Establish rapport with patient
Asks about pain
Nature
Location
Provoking and relieving factors
Onset and duration
Raditation
Asks about associated symptoms
Breathlessness
Cough
Haemoptysis
etc...
Further History
Previous medical history
Family history
Medication and allergy history
Social history
Smoking and alcohol history
Care taken to
Use appropreate language
Use appropreate questions; open, closed & clarifying
Encourage and answer patients questions
Acknowledge patient concerns
Summary and analysis of history
Accurate documentation of history
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Interview a Patient with Depression

Introduce yourself and check the patient's identity
Establish rapport with patient
Appropriate use of questions, open, closed and clarifying
Use of verbal and non-verbal encouragement
Enquire about
Current mood
Current feelings
Onset of illness
Precipitating factors (life events)
Elicit CORE features of depression
Depressed mood
Loss of interest
Fatigability
Elicit COMMON features of depression
Reduced concentration
Poor self-esteem
Guilt
Pessimism
Elicit SOMATIC features of depression
Anhedonia
Early morning waking
Morning depression
Agitation or retardation
Enquire about
Sleep disturbance
Appetite for
Acknowledge patient concerns
Appropriate summary and analysis of findings
Encourage patient's questions and deal with them appropriately
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Assess Mental State and Cognition

Introduce yourself and check the patient's identity
Establish rapport with patient
Appropriate use of questions, open, closed and clarifying
Use of verbal and non-verbal encouragement
Note apperance and non-verbal behaviour
Dress
Gait
Activity
etc...
Observe patients social manner
Assess
Speach pattern
Abnormal thinking
Mood
Higher cognitive functions
Elicit abnormal experiences
Auditory hallucinations
Other hallucinations
Perform Mini Mental State Examination
Consider patient insight and attribution of problem
Summarise important features of mental state examination in psychopathological terms
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Elicit a History of Psychotic Symptoms (Delusions & Hallucinations)

Introduce yourself and check the patient's identity
Attempt to establish rapport with patient
Appropriate use of questions, open, closed and clarifying
Use of verbal and non-verbal encouragement
Elicit previous history of psychiatric disorder
Enquire about
Interference with thought
External forces controlling
Special meanings in events and experiences
Feelings of someone trying to harm patient
Feelings of grandiosity
Feelings of guilt & worthlessness
Hallucinations
Assess patient's insight and attribution of symptoms
Acknowledge patient's concerns and feelings
Encourage patient's questions and deal with them appropriately
Appropriate summary and analysis of findings
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Assess Suicidal Intent

Introduce yourself and check the patient's identity
Establish rapport with patient
Appropriate use of questions, open, closed and clarifying
Use of verbal and non-verbal encouragement
Elicit previous histroy of psyciatric disorders
Especially previous suicide attempts
Assess
Current mood
Risk Factors
Plans and preparations for suicide
Acknowledge patient's concerns
Appropriate summary and analysis of findings
Encourage patient's questions and deal with them appropriately
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Interview a Patient with a Urological Complaint

Introduce yourself to patient
Establish rapport with patient
Enquires about main complaint
Asks about pain
Nature
Location
Provoking and relieving factors
Onset and duration
Periodicity
Radiation
Asks about associated symptoms and history
Prostatic symptoms
Haematuria
Dysuria
Urethral discharge
Sexual contacts
etc...
Further History
Previous medical history
Family history
Medication and allergy history
Social history
Smoking and alcohol history
Care taken to
Use appropreate language
Use appropreate questions; open, closed &clarifying
Encourage and answer patients questions
Acknowledge patient concerns
Summary and analysis of history
Accurate documentation of history
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Examine the Abdomen

Introduce yourself and check the patient's identity
Establish rapport with patient
Ask permission to examine & explain examination
Ensure adequate privacy for the examination
Position patient and expose appropriately maintaining patient dignity
Examine the hand
Examine the eyes
Examine the mouth
Examine the neck
Inspect the abdomen
Asks to cough looking for hernias
Ask if anywhere hurts
Palpate generally
Palpate each quadrant systematically
Palpate and Percuss
Liver
Spleen
Kidneys
Feel for abdominal aorta
Auscultate bowel sounds
Examine inguinoscrotal areas
Check femoral pulses
Suggest
Digital rectal examination
Assist in replacing the patient's clothing
Acknowledge patient concerns
Encourage patient's questions and deal with them appropriately
Appropriate summary and analysis of findings
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Examine Cranial Nerves

Introduce yourself and check the patient's identity
Establish rapport with patient
Explain examination & ask permission to examine
General inspection of face
Ask about smell and taste
Eyes
Test visual acuity and colour vision
Test visual fields by confrontation
Test pupillary responces
Use ophthalmoscope
Test eye movements
Check light touch in the three sections of the trigeminal
Test corneal reflex
Check muscles of mastication & facial expression
Test jaw jerk
Test hearing
Wispered words with distraction
Tuning fork test
Test palatal and tongue movement
Test gag reflex
Acknowlede patients concerns
Encourage questions from patient & deal with them appropriately
Appropriate summary & analysis of findings
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Examine the CVS Including Peripheral Pulses

Introduce yourself and check the patient's identity
Establish rapport with patient
Ask permission to examine & explain examination
Positions patient correctly
Examine Hands
Check for
Central cyanosis
Clinical anaemia
Jugular venous pressure
Check pulses
Radial - rate & rhythm
Brachial - character
Carotid
Ask to check blood pressure
Examine precordium & locate apex beat
Listen to
Heart sounds
Radiation of murmurs
Lung bases
Look for oedema
Peripheral
Sacral
Examine peripheral pulses
Summary and analysis of findings
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Examine the Ear Including the Use of the Auroscope

Introduce yourself and check the patient's identity
Establish rapport with patient
Explain procedure and obtain patient consent
Enquires about:
Hearing loss, characteristics and impact on life
Associated features, tinnitus and vertigo
Possible causes
Tests hearing with speech
Tests with tuning fork:
Weber
Rinne
Holds otoscope and patient's ear correctly
Identifies normal anatomy
Appropriate use of questions, open, closed and clarifying
Acknowledge patient concerns
Encourage patient's questions and deal with them appropriately
Appropriate summary and analysis of findings
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Examine the Eye Including the Use of the Opthalmoscope

Introduce yourself and check the patient's identity
Establish rapport with patient
Ask permission to examine & explain examination
Position patient Appropriately
Ask about specific symptoms or visual loss
Floaters
Halos
etc...
Examine
Visual Acuity
For afferent pupillary defect
Visual fields
Eye movements
Set and handle opthalmoscope correctly
Assess red reflex
Correct technique for viewing
Disk
Periphery
Appropriate use of questions, open, closed and clarifying
Acknowledge patient concerns
Encourage patient's questions and deal with them appropriately
Appropriate summary and analysis of findings
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Examine Gait and Co-ordination

Introduce yourself and check the patient's identity
Establish rapport with patient
Explain examination & ask permission to examine
Observe body and limb posture
Examine tandem and heel-toe gait
Observe arm swing
Perform Romberg's test
Test for tremor
Resting
Postural
Action
Test for bradykinesia
Test tone
Upper limbs
Lower limbs
Able to differentiate spastic and rigid tone
Test co-ordination
Upper limbs
Lower limbs
Acknowlede patients concerns
Encourage questions from patient & deal with them appropriately
Appropriate summary & analysis of findings
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Examine the Inguinoscrotal Region including Lymph Nodes

Introduce yourself and check the patient's identity
Establish rapport with patient
Ask permission to examine & explain examination
Ensure appropriate position to examine the patient
Maintaining dignity of the patient
Warm hands
Ask the patient to cough and look for hernias
Examine
Femoral triangle
Inguinal canal
Femoral pulses
Scrotum
Feel for cough impulse
Assess if lump transilluminates
Suggests standing to assess
Varicocoele
Saphenofemoral varix
Restore patient's clothing
Care taken to
Use appropreate language
Use appropreate questions; open, closed & clarifying
Encourage and answer patients questions
Acknowledge patient concerns
Summary and analysis of findings
Wash hands
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Examine the Neck

Introduce yourself and check the patient's identity
Establish rapport with patient
Ask about relevant symptoms
Ask permission to examine & explain examination
Ensure appropriate position to examine the patient
Expose the neck adequately and observe the lump
Ask about
Pain and tenderness
Changes in the size of the lump
Palpate the lump
Test if lump moves on swallowing or protruding tongue
Assess if lump transilluminates
Auscultate the lump
Examine
Lymph nodes
Tracheal position
Ensure patient dignity is maintained
Replace clothes at the end of the procedure
Care taken to
Use appropreate language
Use appropreate questions; open, closed & clarifying
Encourage and answer patients questions
Acknowledge patient concerns
Summary and analysis of findings
Wash hands
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Examine the Sensory and Motor System in the Lower Limb

Introduce yourself and check the patient's identity
Establish rapport with patient
Explain examination & ask permission to examine
Put patient in appropriate position
Ensure adequate exposure of the legs
Inspect legs & feet for
Wasting
Fasciculations
Assess tone in the legs
Assess power (ensuring joint braced where appropriate)
Hip flexion & extension
Knee flexion & extension
Ankle dorsiflexion & plantar flexion
Eversion and inversion of the forefoot
Assess sensation in all dermatomes
Light touch
Pin prick
Assess vibration sense & proproception
Assess reflexes (with reinforcement if necessary)
Knee
Ankle
Planter response (Babinski reflex)
Test co-ordination
Heel / shin test
Observe gait
Acknowlede patients concerns
Encourage questions from patient & deal with them appropriately
Appropriate summary & analysis of findings
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Examine the Sensory and Motor System in the Upper Limb

Introduce yourself and check the patient's identity
Establish rapport with patient
Explain examination & ask permission to examine
Put patient in appropriate position
Ensure adequate exposure of arms
Inspect arms & hands for
Wasting
Fasciculations
Assess tone in arms & hands
Assess power (ensuring joint braced where appropriate)
Shoulder abduction
Elbow flexion & extension
Wrist long flexors & extensors
Finger flexion, extension & adduction
Thumb adduction
Assess sensation in all dermatomes
Light touch
Pin prick
Assess vibration sense & proproception
Assess reflexes (with reinforcement if necessary)
Bicepts
Tricepts
Supinator
Test co-ordination
Finger nose test
Acknowlede patients concerns
Encourage questions from patient & deal with them appropriately
Appropriate summary & analysis of findings
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Examine the Peripheral Veins in the Leg

Introduce yourself and check the patient's identity
Establish rapport with patient
Ask permission to examine & explain examination
Examine the leg veins with patient standing
Examine skin of leg
Varicosities
Eczema
Ulcers
Discolouration
Temperature
Elevate leg in the supine position
Empty veins
Apply tourniquet below sapheno-femeral junction
Ask patient to stand
Assess level of incompetence
Summary and analysis of findings
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Examine the Respiratory System

Introduce yourself and check the patient's identity
Establish rapport with patient
Ask permission to examine & explains examination
Position patient and expose chest appropriately
Examine hands
Check for
Central cyanosis
Raised JVP
Lymphadenopathy
Clinical anaemia
Assess for
Position of trachea
Position of apex beat
Chest expanstion
Percuss chest (front & back)
Auscultate
Air entry
All lobes (front & back)
Test for vocal & tactille fremitus
Summary and analysis of findings
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Examination of the Abdominal X-Ray in the Adult

Use of the abdominal X-ray as an extension of the examination of the abdomen
Identify patient:
Name
Date of birth
Date of X-ray
Position of the patient
Straight
Rotated
Bony skeleton:
Identify and check integrity of the components of the skeleton in the abdomen and pelvis
Identification of the major structures and organs
Recognise the presence of
Air or fluid levels in the hollow viscera
Air under the diaphragm
Calcification of soft tissues
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Examination of the Chest X-Ray in the Adult

Use of the chest X-ray as an extension of the examination of the chest
Identify patient:
Name
Date of birth
Date of X-ray
Position of the patient:
Straight
Rotated
Orientation of film
Bony skeleton:
Identify and check integrity of the components of the skeleton in the chest
Heart and mediastinum:
Size
Shape
Position
Trachea:
Central or deviated
Pleura:
Normal or thickened
Diaphragm:
Shape and position
Cardiophrenic angles
Lung fields - Identification and systematic examination of:
Upper zones
Middle zones
Lower zones
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Interpretation of Clinical Chemistry Test Results

Interpretation of clinical chemistry test results
Choosing clinical chemistry tests and investigations in the adult patient
Making use of reference ranges to interpret test results
Interpretation of
Routine tests e.g.
Endocrinological tests e.g.
Metabolic tests e.g.
Immunological tests e.g.
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Interpretation of the Full Blood Count and Haematological Indicies

Use of the full blood count in clinical investigation of the adult patient
Interpretation of:
Haemoglobin (Hb)
Red cell count (RBC)
Red cell indicies (e.g. PCV, MCH, MCHC, MCV)
Interpretation of additional tests in the investigation of anaemia
Blood film
Serum ferritin
Serum B12
Red cell folate
Reticulocyte count
Interpretation of
Total white cell count (WBC) and differential white cell count
Platelet count
Initial investigation of haemostasis and the coagulation system
The international normalized ratio (INR) in monitoring anticoagulant therapy
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Basic Airway Skills

Check for responsiveness by verbal and physical stimnulation
Open airway appropriately using jaw thrust or head tilt / chin lift
Indicates caution in potential neck injury
Checks in mouth for foreign objects
Use suction or indicate would do so
Airway adjuncts
Measure and insert Guedel airway appropriately
Measure and insert nasopharyngeal airway correctly
Checks for breathing for 10 seconds
Starts manual ventilation with bag-valve-mask
Ensure adequate chest excursion
Ensure appropriate rate
Administer oxygen
Select appropriate oxygen mask
Ensure oxygen is connected
Indicates need for definitive airway as appropriate
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Take a Blood Pressure

Introduce yourself and check the patient's identity
Establish rapport with patient
Explain procedure and obtain patient concent
Ensure patient has rested for five minutes where appropriate
Position patient and equipment appropriately
Apply appropriate size cuff correctly
Locate brachial pulse
Place stethoscope over brachial pulse in antecubital fossa
Inflate cuff to appropriate level
Measure systolic and diastolic readings in mmHg
Remove cuff
Report reading and interprete correctly
Document blood pressure
Use appropriate language
Encourage patient's questions and deal with them appropriately
Acknowledge patient concerns
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Perform a BM Test

Introduce yourself and check the patient's identity
Establish rapport with patient
Explain procedure and obtain patient consent
Chose an appropriate place for test and ensure patient is warm
Ensure patient is sitting or lying down
Assemble equipment
Insert strip
Calibrate machine as appropriate
Wash hands and put on gloves
Insert autolet sharply into skin drawing blood
Obtain a hanging drop of blood without undue squeezing of puncture site
Drop blood onto test strip
Wait until the machine records a reading
Safely dispose of sharps
Check haemostasis
Dispose of strip and gloves
Record reading in notes
Acknowledge patient concerns
Encourage patient's questions and deal with them appropriately
Appropriate interpretation of value
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Cannulation and Setup a Drip

Introduce yourself and check the patient's identity
Establish rapport with patient
Explain procedure and obtain patient consent
Position and expose patient appropriately
Wash hands
Assemble equipment
Select suitable IV cannula
Remove fluid bag & giving set from packaging
Close tap and insert drip set into bag
Run through IV infusion set
Apply tourniquet and identify suitable vein
Put on gloves
Clean skin with suitable agent
e.g. isopropyl alcohol 70%
Allow to air dry
Retract the skin to stabilise the vein and insert cannula
On flashback withdraw needle and advance cannula
Release torniquet
Apply pressure over the tip of cannula to prevent blood loss
Dispose of needle appropriately
Connect IV infusion set
Ensure running at an appropriate speed
Tape cannula in place after drying skin
Observe puncture site for swelling
Remove all waste and dispose of it correctly
Remove gloves and wash hands
Document start time of infusion
Encourage patient's questions and answer them appropriately
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Hand Washing

Importance of hand washing in control of cross infection in the ward and clinic
Hand washing to be performed before and after each physical examination procedure
Use of
Water
Soap
Nail brush
Correct technique
Palms & dorsal surfaces
Each finger individually
Finger tips and nails
Duration of washing
Hand drying
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Record an ECG

Introduce yourself and check the patient's identity
Establish rapport with patient
Explain procedure and obtain patient concent
Position and expose patient appropriately
Apply ECG stickers to correct position on chest and limbs
Connect leads appropriately
Record ECG
Label ECG correctly
Remove stickers from patient and ensure patient is comfortable and fully dressed
Use appropriate language
Encourage patient's questions and deal with them appropriately
Acknowledge patient concerns
Assess ECG for immediate life threatening abnormalities
Place ECG in the correct notes
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Instructs on the use of an Inhaler

Introduce yourself and check the patient's identity
Establish rapport with patient
Explain the importance of technique and ensures understanding
Check patients understanding of asthma and the role of inhalers
Show patient how to shake inhaler
Ask patient to breath out fully before using inhaler
Show patient how to co-ordinate inhaler action while breathing in
Instruct the patient to hold their breath for 10 seconds after inhalation
Explain to repeat after one minute (time to refill aerosol chamber)
Indicate how often to use inhaler
Use appropriate language
Check patient has understood the procedure
Encourage patient's questions and deal with them appropriately
Acknowledge patient concerns
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Peak Flow Reading

Introduce yourself and check the patient's identity
Establish rapport with patient
Explain the importance of technique and ensures understanding
Check patients understanding of asthma
Prepares meter appropriately
Ask patient to take a deep breath and seal lips around the mouthpiece
Ask patient to blow as fast as possible into the meter
Read meter correctly
Check peak flow against standard chart or patients personal record
Indicates whether peak flow technique is satisfactory and comment on value
Encourage patient's questions and deal with them appropriately
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Sterile Scrub Technique and Gown

Remove all jewellery, except wedding ring
Don a theatre cap and mask in theatre
Lay out gown and gloves in aseptic manner
Open scrub brush before wetting hands
Turn on taps
Ensure suitable water temperature
Scrub with appropriate skin disinfectant
Scrub from fingertips towards elbows
Concentrate on glove area
Use scrubbing brush appropriately
Rinse from fingertips towards elbows
Use elbows to turn off taps
Dry hands
Pick up gown and insert arms
Ensure that the outside is not touched
Stand still while assistant fastens gown
Put gloves on in a sterile manner
Keep hands above the waist
Maintain sterility throughout procedure
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Test Urine and Interpret the Results

Put on gloves
Ensure urine sample is fresh
Check dipstick container
Correct sticks
Expiry date
Remove a single stick and close container
Dip stick into urine for 1 second and tap off excess urine
After dipping hold strip horizontal until test is complete
Read stick after appropriate time
Dispose of stick and gloves
Wash hands
Record the results in notes
Appropriate interpretation of results
Acknowledges need to send urine to lab or otherwise
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Insert a Urinary Catheter into a Male

Introduce yourself and check the patient's identity
Establish rapport with patient
Explain procedure and ensure consent
Assemble equipment on trolley
Position patient and expose the groin area
Wash hands and put on gloves using aseptic technique
Lay out trolley using aseptic technique
Pick up penis in swab and clean using no touch technique
Create sterile field with sterile towels
Retract foreskin if appropriate
Insert local anaethetic
Allow time for anaethetic to work
Lay catheter between legs correctly
Insert catheter correctly and atraumatically
Ensure urine is seen before inflating catheter balloon
Inflate balloon with an appropreate volume of sterile water
Withdraw catheter to optimal position
Connect to bag
Return foreskin appropriately
Ensure patient dignity is maintained
Replace clothes at the end of the procedure
Dispose of waste correctly
Remove gloves and wash hands
Acknowledges patient's concerns
Records catheter size and volume of urine obtained in notes
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Venepuncture

Introduce yourself and check the patient's identity
Establish rapport with patient
Explain procedure and obtain patient consent
Ensure patient is sitting or lying down
Select appropriate equipment
Choose appropriate bottles for tests required
Put on gloves
Apply tourniquet and select vein
Clean site
Insert needle into vein
Retract skin to stabilise vein
Insert appropriate bottles and wait while blood sample is aspirated
Change bottles atraumatically
Remove needle and dispose of it safely
Label bottles & forms
Use appropriate language
Encourage patient's questions and deal with them appropriately
Acknowledge patient concerns
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Any comments or feedback please contact me by email:
Tom Williams