68W Limited Primary Care Study Guide Review, Exams of Medicine

68W Limited Primary Care Study Guide Review

Typology: Exams

2024/2025

Available from 11/06/2024

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68W Limited Primary Care Study Guide Review
1.DD Form 689: Individual sick call slip that initiates the sick call process
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
2.SF 600: 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
3.Correction procedures for an entry error: 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
- date and initial
- Do not skip lines or leave any spaces above signature
4.HIPAA: Health Insurance Portability and Accountability Act
a federal law protecting the privacy of patient-specific health care
information
5.Access to patient's medical information may be given too...: - the patient
- patient care personnel
- medical researcher
- medical educators
6.Exceptions for those that can access a patient's medical information are...:
- if access is court ordered by law
- if access if needed for hospital accreditation
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68W Limited Primary Care Study Guide Review

  1. DD Form 689: Individual sick call slip that initiates the sick call process 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
  2. SF 600: 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
  1. Correction procedures for an entry error: 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
  • date and initial
  • Do not skip lines or leave any spaces above signature
  1. HIPAA: Health Insurance Portability and Accountability Act a federal law protecting the privacy of patient-specific health care information
  2. Access to patient's medical information may be given too...: - the patient
  • patient care personnel
  • medical researcher
  • medical educators
  1. Exceptions for those that can access a patient's medical information are...:
  • if access is court ordered by law
  • if access if needed for hospital accreditation

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  • if access is authorized by the patient via a written document

4 / 37 disposition log

  1. the combat medic will retrieve the patient's medical record and initiate an entry on a SF 600, or the Chronological Record of Medical Care

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  1. 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
  2. Physical examination will be performed by the Medical Officer
  1. Subjective Information: 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
  1. Objective Information: factual information that can usually be measured or observed
  • vital signs
  • physical examination findings
  1. Profiles: - 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
  1. Quarters: 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.

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  1. Infection, Asepsis, and Sterile Technique:
  2. microorganisms: microorganisms are microscopic living cells found almost everywhere in the environment. Some microorganisms are beneficial, whereas, others are harmful all human beings contain helpful microorganisms in and on their bodies microorganisms that cause disease are called pathogens
  3. Environmental factors that affect the growth of microorganisms are...:
  • oxygen
  • nutrients
  • temperature
  1. most grow at normal body temperature
  2. cold temps often slow the growth
  3. high temps usually kill most organisms
  • moisture
  • pH
  • Light
  1. Types of microorganisms: 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)
  2. Communicable diseases: diseases that can spread from one person to anoth- er
  3. Contagious diseases: diseases that are easily and rapidly spread

8 / 37 from one person to another

  1. epidemic: a large number of people in the same area are infected in a relatively short time
  2. Chain of infection: 1) pathogenic microorganism - microorganism that cause disease

10 / 37 blood-borne transmission - through transfusion, kidney dialysis, and injections

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  1. Susceptible hosts: 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
  2. Asepsis Terminology: 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)
  3. Medical asepsis: a clean technique; practice designed to minimize the number of microorganisms or preventing transmission of microorganisms from one per- son/source to another
  4. Infection Control Techniques: - 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
  • Wear gloves, protective eye wear, masks, gowns, and shoe covers to protect you if appropriate and possible. Change gloves after each patient contact

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  • Avoid talking, sneezing, or coughing directly over open wounds or a sterile field
  • Isolate patients with contagious diseases
  1. What is the single most effective measure to prevent the spread of dis- ease?: Handwashing
  2. There are three types of transmission-based precautions: Airborne precau- tions Droplet precautions Contact precautions
  3. Airborne precautions: 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
  4. Droplet precautions: 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
  5. Contact precautions: 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
  6. Neutropenic (reverse isolation) precautions: for weakened immune response patients

14 / 37 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

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  1. prodromal stage - from onset of initial symptoms such as fatigue or low-grade fever to more severe symptoms

17 / 37 3)full stage of illness - when symptoms are acute and specific to the type of infection such as lesions covering the body or high fever

  1. convalescent stage - when acute symptoms of the infection subside and the person recovers
  1. Factors that influence infection: 1) body's defense mechanism
  1. specific portal of entry - microorganisms cause disease only if they gain access to the body through a specific portal 3)number of microorganisms - the greater the number of pathogens, the greater the opportunity to cause disease
  2. virulence is the pathogen's strength to cause disease
  • some bacteria form protective capsules that increase their virulence
  • other bacteria produce enzymes that destroy blood cells, stop normal blood clotting, or consume muscle fibers that increase their virulence
  1. host resistance - naturally occurring body floras have antibiotic properties that resist the development of pathogens
  1. Nosocomial infections: Nosocomial infections are infections that patients ac- quire in the health care facility Reasons for nosocomial infections:
  1. number of disease-causing microorganisms in the facility
  2. many microorganisms are resistant to antibiotics
  3. many potential reservoirs for pathogenic growth
  • IV fluids
  • foods -biological materials
  • equipment

19 / 37 the seal has previously been broken and the equipment must be discarded

20 / 37 ensure that the rubber stopper inside the syringe is forming a good seal. If the plunger is stuck or does not move smoothly, discard the syringe

  1. Drawing medication from a vial: We need to verify drug label and check the container for defects
  • Compare the medication with the medical officer's orders three times
  1. when we obtain the medication from the storage
  2. when withdrawing the medication 3)When returning the medication to storage
  • examine the container for defects
  1. examine rubber stopper for defects such as small holes
  2. hold to light to check for foreign particles and change in color and consistency
  3. check the expiration date
  4. determine whether the medication was stored properly If there is any evidence of contamination, discard the container
  1. Drawing medication from a vial steps: We may have to premix the medication by shaking it or rolling it in our hands to ensure that the medication is re-suspended
  • clean the rubber stopper with an alcohol prep pad
  • remove protective cover of the needle with non-dominant hand
  • add amount of air in syringe equal to amount of medication that will withdraw from vial
  • insert the needle into the rubber stopper. Avoid contamination by ensuring the hub of the needle does not touch the rubber stopper
  • inject air from syringe into vial
  • invert the vial while keeping the needle tip in the solution
  • withdraw the medication by pulling the plunger back to the desired