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Limited Primary Care Study Guide – Complete With Solutions DD Form 689 - answer 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 SF 600 - 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 Correction procedures for an entry error - 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
- date and initial
- Do not skip lines or leave any spaces above signature HIPAA - answer Health Insurance Portability and Accountability Act a federal law protecting the privacy of patient-specific health care information Access to patient's medical information may be given too... - answer - the patient
- patient care personnel
- medical researcher
- medical educators Exceptions for those that can access a patient's medical information are... - answer - if access is court ordered by law
- if access if needed for hospital accreditation
- if access is authorized by the patient via a written document Disclosure of medical information is handled by... - answer the PA or the patient administrator (PAD) History Taking Techniques - 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
- 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 Subjective Information - 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 - answer factual information that can usually be measured or observed
- vital signs
- physical examination findings
Profiles - 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 - 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 Bedrest - answer means the patient is restricted to their bed, with allowances for necessary travel to the dining facility and latrine. They may not perform military duties Infection, Asepsis, and Sterile Technique - answer microorganisms - answer 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 Environmental factors that affect the growth of microorganisms are... - answer - oxygen
- nutrients
Chain of infection - 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)
- susceptible host vehicle to transmission - answer means by which the microorganism gets from the reservoir to the portal of entry direct contact - spreads pathogens from one person to another through body contact (ex: touching) indirect contact - when an object harbors a pathoegen and carries it from an infected person to a new victim (ex: syringes) human carrier - does not exhibit the symptoms of a disease but carry the pathogens and transmit them to others airborne transmission - dust particles carrying microbes or spores blown from place to place (ex: sneezing)
water-borne transmission - public water such as pools and lakes contaminated with feces food-borne transmission - food that is spoiled, uncooked, or contaminated 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 - 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 - 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
Contact precautions Airborne precautions - 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 - 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 - 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 - 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 Surgical asepsis - answer a sterile technique; all microorganisms are destroyed from surfaces before they can enter the body; therefore, no organisms are carried to the patient
- used in dressing changes, administering parenteral medications, and performing surgical and other procedures such as urinary catheterization
- sterile to sterile remains sterile. Sterile to clean becomes contaminated Patient Care Hand Wash - answer reduces the number of microorganisms being transmitted from the patient to the healthcare provider and from the hospital environment to the patient handwashing should be performed before and after patient contact, after contact with dirty or contaminated materials, and after you remove your gloves The hand wash duration will be a minimum of 10 to 15 seconds, but could last as long as 2 minutes or longer, depending on the potential for contamination with microorganism Sterile gloves - answer establishes a barrier to microorganisms from provider to patient and patient to provider
- required to maintain sterile field during hands on procedure
- other bacteria produce enzymes that destroy blood cells, stop normal blood clotting, or consume muscle fibers that increase their virulence
- host resistance - naturally occurring body floras have antibiotic properties that resist the development of pathogens Nosocomial infections - answer Nosocomial infections are infections that patients acquire in the health care facility Reasons for nosocomial infections:
- number of disease-causing microorganisms in the facility
- many microorganisms are resistant to antibiotics
- many potential reservoirs for pathogenic growth
- IV fluids
- foods
- biological materials
- equipment Nosocomial infections can lengthen the patient's hospital stay, increase the cost of treatment, and even cause death Administering Injections - answer
Sterility of the needle - answer All parts of the needle are sterile. We must be careful not to touch the hub it may contaminate the needle and possibly pass an infection to the patient Only the outside protective cover may be touched Appropriate needle length - answer Factors that determine needle length include:
- the type of injection to be given (intradermal, subcutaneous, or intramuscular)
- the size of the patient (obese, thin)
- the injection site (shorter for deltoid compared to gluteus) Appropriate needle gauge - answer The proper gauge of a needle is based on the viscosity of the medication. Large gauge needles are needed for viscous (thick) medications The larger the number of a gauge, the smaller the bore Sterility of the syringe - answer the inside of the barrel, the rubber portion and the shaft of the plunger, and the needle adapter are all sterile parts of the syringe. Do not touch the adapter or the shaft of the plunger. Contamination could cause an infection in the patient. The outside of the syringe barrel does not have to be kept sterile Appropriate sized syringe - answer - check medication label to determine whether a glass or plastic syringe should be used (some medications deteriorate in a plastic syringe)
- the syringe should be large enough to hold the entire dose and the calibration small enough todraw up an accurate dose
Drawing medication from a vial steps - answer 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 calibration mark
- expel any air that may be in syringe by flicking it
- verify correct dosage by holding the syringe at eye level and ensuring edge of plunger is exactlyon prescribed calibration mark - recap needle via the scoop method recapping needles - answer Only clean needles are recapped. To recap a clean needle, place the needle cover on the work surface, and with the dominant hand holding the syringe, use the scoop method to insert the needle into the protective cap
Reconstitute medication - answer - select the correct medication. Normally, the powdered medication is packaged with its diluent in the same box
- clean the stoppers on both vials with alcohol
- withdraw correct amount of diluent required to reconstitute medication
- hold the powdered medication vial horizontally, insert the needle through the stopper, inject the diluent, and withdraw the needle
- gently invert the vial several times until all the powder is dissolved note: check the medication label to see if the medication should be inverted gently or requires vigorous mixing
- change the needle to the appropriate size for route of administration and withdraw reconstituted solution from vial
- verify the correct dosage after needle has been withdrawn note: if the vial with powdered medication contains air, the diluent may be difficult to inject. Air may have to be withdrawn to allow the diluent to be injected Special considerations when drawing medications from an ampule - answer - filter needles are normally used when drawing medications from an ampule
- when filter needles are used to draw up medication, the needle should be changed before the medication is given to the patient
gauge: 25 to 27 Syringe: tuberculin or other 1.0 ml syringe Site:
- inner forearm (primary injection site)
- back of upper arm
- on back below the shoulder blades
- free of hair, tattoos, and hair
- not over a vein or bony area
- medication placement is just below the epidermis Position: 15-20 degrees Administering an Intradermal Injection - answer - Identify the patient and ask if they have any allergies or if there is possibility that they may be pregnant
- verify appropriate needle, syringe, and medication
- select and expose injection site
- clean the injection site with an alcohol prep pad. Start at the injection site with a spiral motion,clean outward 3 inches
- pull skin below the injection site downward and hold slightly taut with index finger of nondominant hand
- position the syringe with the bevel up at 15-20 degree angle to the skin surface
- insert the needle just until the bevel disappears under the skin surface
- do not aspirate. With non-dominant hand, push the plunger slowly forward until all medication has been injected and a "wheal" appears at the site. The appearance of a wheal indicates the medication has entered the area between the intradermal tissues
- if the wheal does not appear, withdraw the needle completely, dispose it, and try again If there is a known allergy, do not administer the medica Subcutaneous Injections - answer Purpose:
- Utilized when absorption rate desired is slower than IM route (slowest absorption rate)
- used for small amounts (less than 2ml) of watery and nonirritating medication
- use for administering medication such as insulin Absorption rate: 15-30 minutes Duration: hours to weeks Needle: needle length: 1/2" to 1" gauge: 23 to 25 Site:
- rear lateral aspect of the upper arm (<0.5ml)
- vastus lateralis (<2.0ml)
- abdomen (insulin is administered here) Position: 45 degrees
