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68W LIMITED PRIMARY CARE
OFFICIAL QUESTIONS AND ANSWER
(UPDATED AND VERIFIED)
Intramuscular Injections - correct answer - Purpose:
- utilized when rapid absorption and long duration are desired
- used when administering viscous or irritating medications
- used when a large volume of medication is needed for a stronger effect Absorption rate: 10-20 minutes Duration: hours to weeks Needle: needle length: 1" to 2" for obese adults gauge: 20- 22 Site:
- deltoid muscle (primary injection site because of the faster absorption rate compared to other IM; up to 2 ml)
- vastus lateralis (one of the safest routes; up to 5 ml)
- gluteus maximus (used for larger volumes; may require a long needle; up to 5 ml)
When injecting in the gluteus maximus, we need to divide one buttock into four quadrants and inject the upper outer quadrant to avoid damage to the sciatic nerve Administering an intramuscular injection - correct answer -- select and expose injection site
- clean the injection site with an alcohol prep pad
- form a fold of skin at the injection site by gently pinching the skin
- hold syringe in the dominant hand between the thumb and index finger and position the needle bevel up at a 90 degree angle to the skin surface
- plunge the needle firmly and quickly into the muscle
- release hold on the skin with the non-dominant hand
- aspirate by pulling back slightly on the plunger of the syringe
- inject the medication using a slow and continuous movement
Used for patient who requests or receives medical/dental evaluation or treatment at an Army Medical Treatment Facility (MTF) used as a means of communication between medical personnel and the patient's commander SF 600 - correct answer - Chronological Record of Medical Care form used to document the chronological record of the patient's treatment Should include:
- Date and time of visit
- Medical Treatment Facility
- Signature of person making entry
History Taking Techniques - correct answer - 1) Observation - begins when patient walks through the door
- Listening - will help you find out the problem
- Open-ended questions - helps you get more complete and accurate information
- Provider obstacles - keep a good attitude and assume every patient has a legitimate complaint
- Patient obstacles - patient's w/o medical experience will very often request specific diagnostic studies, therefore, we must gain their trust
- Obtain a thorough history
- Maintain an index of suspicion
- Consider the mechanism of injury Triage - correct answer - Triage is about looking for signs and symptoms that could lead to serious illness or even death
- Combat medic will take the patient's vital signs and initiate an entry on SF 600 in a SOAP format by asking for the patient's HPI
- Physical examination will be performed by the Medical Officer Administering a subcutaneous injection - correct answer --select and expose injection site
- clean the injection site with an alcohol prep pad
- form a fold of skin at the injection site by gently pinching the skin with the thumb and fingers of the non-dominant hand and hold it firmly in place
- position the syringe with the bevel up at a 45 degree angle to the skin surface
- plunge the needle firmly and quickly into the fatty tissue below the skin
- aspirate by pulling back slightly on the plunger. If blood appears, dispose of the needle and syringe and start again at a different site note: failure to aspirate may cause the medication to be injected directly into the blood stream
- inject the medication with a slow and continuous movement
- with the needle at the same angle in which it was inserted
- DO NOT RECAP THE NEEDLE
- monitor the patient for at least 20 minutes for adverse reactions Correction procedures for an entry error - correct answer - Draw a single line through the information, write "Error," and your initials If you have finished the documentation and decide later information needs to be changed:
- add correct information
- reason for change
Disclosure of medical information is handled by... - correct answer
- the PA or the patient administrator (PAD) Subjective Information - correct answer - Subjective information is information that the patient tells you. It is what the patient reports he feels or understands as the problem. It is information that you cannot necessarily find in an examination.
- age, sex, race and first day of last menstrual period (FDLMP)
- chief complaints
- HPI - contains all of the relevant information to the patient's chief complaint
- past medical/surgical/social history
- last oral intake
- events leading up to illness or injury
Objective Information - correct answer - factual information that can usually be measured or observed
- vital signs
- physical examination findings Profiles - correct answer -- profiles should be written in nonmedical language and should be specific concerning physical limitations
- profiles should contain a specific expiration date
- profiles and duty limitations are only strong recommendations issued by medical authorities. Commanders may require a soldier to break their profile. In such an instance, the commander takes responsibility for his/her action Quarters - correct answer - means restriction and rest in the patient's place of domicile (ex: barracks), this includes freedom to move within their living space, to and from the dining facility and/or medical facilities. They may not perform military duties and quarters normally will not exceed 72 hours
- cold temps often slow the growth
- high temps usually kill most organisms
- moisture
- pH
- Light Types of microorganisms - correct answer - Algae - resemble plant cells and are found in sunlit water Fungi - includes yeasts and molds (tinea pedis or athlete's foot) Protozoa - single-celled microorganisms (trichomonas vaginalis) Bacteria - single-celled organisms without a nucleus. Spore forming bacteria are the most difficult to control and destroy because the spores protect the bacteria from extreme conditions Viruses - must use the host's ability to make protein and energy. Immunization is the most effective means for preventing viral infections (ex: polio) Communicable diseases - correct answer - diseases that can spread from one person to another
Contagious diseases - correct answer - diseases that are easily and rapidly spread from one person to another epidemic - correct answer - a large number of people in the same area are infected in a relatively short time Chain of infection - correct answer - 1) pathogenic microorganism
- microorganism that cause disease
- reservoir - any living or inanimate object where a microorganism can multiply or survive
- portal of exit - from which the microorganism can leave the reservoir. Includes all body orifices with their natural discharges
- vehicle to transmission - the means by which the microorganism gets from the reservoir to the portal of entry (direct contact, airborne, etc)
- Portal of entry - location through which the microorganism can enter the host (both natural body orifices and those created)
Vectors - living carriers of pathogens that spread disease onto food that people eat or when they bite a victim blood-borne transmission - through transfusion, kidney dialysis, and injections Susceptible hosts - correct answer - Healthy people have a variety of non-specific defenses such as the skin and fever and specific defenses such as the body's immune system People with compromised immune systems are more susceptible to infection. These includes: hospitalized patients, ill or inactive patients, poor nutrition, infants, older adults, injury, wounds, shock, and trauma, side effects of medications, and emotional factors such as stress Asepsis Terminology - correct answer - Dirty - any object or person that has not been cleaned or sterilized for removal of microbes Contaminated - object was clean or sterile but has now touched a dirty object
Clean - implies that many or most microbes have been removed Sterile - means the item is FREE of all microbes and spores Disinfectants - destroys most pathogens but not necessarily their spores Sterilization - destroys all microbes and spores by exposing to heat or to chemical disinfectants long enough to kill all microbes and spores (autoclave) Medical asepsis - correct answer - a clean technique; practice designed to minimize the number of microorganisms or preventing transmission of microorganisms from one person/source to another Infection Control Techniques - correct answer -- Must use standard precautions in the care of ALL patients. This is so that we can reduce risk from both known and unknown sources of infection because ALL patients are considered infected with blood-borne pathogens
Airborne precautions - correct answer - tiny microorganisms from evaporated droplets remain suspended in the air or are carried on dust particles and inhaled (small droplets that remain somewhat suspended) precaution: private rooms that have negative air flow pressure (to be specially filtered or discharged outdoors) and doors should remain closed Diseases: tuberculosis, measles, and chicken pox Droplet precautions - correct answer - microorganisms are propelled through the air from an infected person who is sneezing, coughing, talking (larger droplets that do not remain suspended) precaution: private room or share with same infectious patient and door should remain open (not diffusing) Diseases: meningitis, pneumonia, influenza
Contact precautions - correct answer - direct contact between a susceptible host's body surface and an infected person. This is the most frequent mode of disease transmission precaution: private room or share with same infectious patient and the doors may remain open. Wear gloves when entering the room and remove them before leaving. HANDWASHING with an antimicrobial/antiseptic agent diseases: skin and wound infections, hepatitis, herpes simplex virus Neutropenic (reverse isolation) precautions - correct answer - for weakened immune response patients precaution: Other people's microorganisms are kept away from the patient. We are putting on protection to prevent the spread of germs and diseases to the patient diseases: burns, bone marrow transplant, HIV, chemotherapy Those individuals that enter the room must wear masks and handwash before entering the room
