First Skills Test on Tuesday...Need Advice

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We are being tested on Ht, Wt, Handwashing, Restraints, BP's, and sterile gloving.

Ht & Wt..no problem...scale is easy to operate.

Handwashing they didn't show us, but APPEARS from our text that after you remove rings and watch, you wet, use 3 to 5 ml of soap, lather for 15 minutes, and run the water from the wrist to the fingers (?) w/out touching the sides of the basin, then grab a towel, pat dry, shut of water with clean towel, and use non-petroleum based lotion.

The restraints, I'm not worried about.

Sterile gloving, I have a set I'm going to be practicing with...so my first question is this..no matter how careful I am...the bottom of the glove seems to "roll" as it's being slid over my hand...I try to pull the wrist of the glove out to allow room, but on the back of my hand, no matter how you do it, it rolls...does this matter since the end of the glove is eventually going to end up past your wrist?

Also, on BP's, we were taught the "NCLEX Hospital" way, and our demonstration was poor and only presented once.

It appears the steps are as follows: (assuming the patient is already sitting with arm extended, legs uncrossed).

1. Find the Brachial artery.

2. Place cuff 1" above bend in the elbow with the "artery" arrow pointed toward the brachial artery. Place the stethoscope on that point.

HERE IS WHERE I GET CONFUSED! I think I'm supposed to...

3. Slowly pump the cuff up, taking note the systolic reading where you start to hear the pulse while pumping up.

4. Once you get the systolic reading, pump 30 mm beyond that.

5. Slowly release the valve, paying close attention to see if the systolic is the same going down as it was pumping up.

6. Watch for the read of the diastolic number where the pulse disappears.

7. Let the valve all the way out.

8. Remove the cuff

9. Inform the patient of the reading and record it.

There were also two instances where she said you could get a false high or a false low. I just want to be familiar with that. It was in relation to using the wrong size cuff or pumping it incorrectly.

Going forward i'm going to be recording these sessions, but i thought we would go back over it...and we didn't.

THANKS!

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HERE IS WHERE I GET CONFUSED! I think I'm supposed to...

3. Slowly pump the cuff up, taking note the systolic reading where you start to hear the pulse while pumping up.

4. Once you get the systolic reading, pump 30 mm beyond that.

5. Slowly release the valve, paying close attention to see if the systolic is the same going down as it was pumping up.

6. Watch for the read of the diastolic number where the pulse disappears.

7. Let the valve all the way out.

8. Remove the cuff

9. Inform the patient of the reading and record it.

There were also two instances where she said you could get a false high or a false low. I just want to be familiar with that. It was in relation to using the wrong size cuff or pumping it incorrectly.

Going forward i'm going to be recording these sessions, but i thought we would go back over it...and we didn't.

THANKS!

you have the cuff placed on the arm and it is centered about 1 inch above the brachial artery.

You palpate the brachial artery, rapidly inflate the cuff until the artery pulsation is obliterated and then 20 to 30 mm Hg beyond. This will avoid missing an auscultatory gap which is a period when Korotkoff's sounds disappear during auscultation.

Deflate the cuff slowly and evenly about 2 mm Hg per heartbeat.

Note the points at which you hear the first appearance of sounds, the muffling of sound, and the final disappearance of sound. These are phases I, IV, and V of Korotkoff's sounds.

Korotkoff sound I, soft and clear tapping is the systolic pressure.

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Specializes in Pediatrics, High-Risk L&D, Antepartum, L.

Handwashing they didn't show us, but APPEARS from our text that after you remove rings and watch, you wet, use 3 to 5 ml of soap, lather for 15 minutes, and run the water from the wrist to the fingers (?) w/out touching the sides of the basin, then grab a towel, pat dry, shut of water with clean towel, and use non-petroleum based lotion.

Sterile gloving, I have a set I'm going to be practicing with...so my first question is this..no matter how careful I am...the bottom of the glove seems to "roll" as it's being slid over my hand...I try to pull the wrist of the glove out to allow room, but on the back of my hand, no matter how you do it, it rolls...does this matter since the end of the glove is eventually going to end up past your wrist?

Handwashing...15 minutes of lathering? That's a REALLY long time. We were told to sing happy birthday 2 times and you know you are done. If you lather for 15 minutes your skin will fall in a week...and your patient will be annoyed when you stand there lathering and not helping them. I forget the exact time to be honest.

The sterile gloves...I'm not sure I'm fully understanding what is happening. I will tell you that sometimes those gloves just don't go on right. They do not have to be on perfectly. The key is to make sure you don't break sterile field. So if you pull the glove on and your hand is covered and up at the wrist something isn't sitting right...that's fine.

For the BP we are actually taught to palpate the BA until we no longer feel it and then deflate the cuff. We are then told to wait a couple of minutes and then take the actual blood pressure adding on that 30. I'm not sure how comfortable it would be to palpate, go above 30 and take the BP right away since you need to get the scope over the BA. Now that being said...they know we aren't doing it that way in the hospital and don't care that we do it the way it's really done. We had to know the "proper" way but on the floor we don't do it.

Now all this being said...procedures and expectations may and probably will vary from institution to institution. For example...we really didn't have to do much to show hand washing. We went to a sink did it and we were done. We never did height and weight because it's not something we will really be doing in the hospital.

There are a lot of things I see on here that people are actually being tested on and we are not. We may have to show we practiced it in skills lab but there's no real test.

We are having IV competency coming up. We have to prepare and spike a bag in 10 minutes (start to finish...meaning it's not at all setup so we have to get the bag and tubing out, together, in the machine set the machine, prime the pump with a 100 bag rather then 100 to prove we can do it without a large fluid loss). After that we have to show all sorts of other things...hanging meds, back flow into a piggy bag, IV push meds and I forget what else.

We don't have much more then that. So things will vary so it's sometimes hard to say what the right way is since we are frequently taught different things.

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Specializes in med/surg, telemetry, IV therapy, mgmt.

here are some web links to help you out:

donning sterile gloves

http://www.piercing.org/training/donning%20sterile%20gloves/donning.htm - donning sterile gloves. includes pictures.

http://www.ansellhealthcare.com/university/riskmihospital/donningtsgloves.aspx - closed and open donning of sterile gloves

http://home.pineland.net/crsbna/html/donin.htm - pictorial on how to don sterile gloves

handwashing

http://pcchu.peterborough.on.ca/obappen8.htm - handwashing procedure

http://eaglevisioneditions.com/documents/18%20medical%20asepsis.pdf - this nursing lab exercise has instructions on handwashing as well as drawings and explanations on how to apply and remove sterile gloves.

taking blood pressure

http://nursing.about.com/od/assessmentskills/ht/bloodpressure.htm - how to take a blood pressure

https://allnurses.com/forums/f50/hearing-bps-177877.html - hearing bps

http://www.ktl.fi/publications/ehrm/product2/part_iii3.htm - blood pressure measurement where peak inflation level is determined first by palpating a radial pulse, inflating cuff and then determining the point at which the pulse is obliterated.

http://homepage.smc.edu/wissmann_paul/anatomy1/1bloodpressure.html - how to take a blood pressure

http://www.uams.edu/csc/programs/orientation/bloodpressure.htm - how to take a blood pressure

http://medicine.osu.edu/exam/ - from ohio state university college of medicine, an interactive guide to physical examination for 8 body systems and includes sounds. has an interactive blood pressure cuff (the link is toward the bottom of the page, "take a blood pressure") where you click on a blood pressure bulb to start the inflation of the cuff. you will then hear and watch the manometer and tell the program what the final blood pressure is. it re-cycles to give you lots of practice!

http://www.sweethaven.com/free-ed/healthcare/lessonmain.asp?cnum=1&icode=fra0204 - taking and monitoring vital signs. from sweethaven's health care.

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Specializes in Geriatrics, Cardiac, ICU.

Handwashing is 15 seconds.

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Handwashing is 15 seconds.

Typo on my part...yes, 15 seconds.

THANKS TO ALL who took the time to read my looooong post. I've been rounding up "victims" this week to practice on.

I was kidding my neice that I needed her and her sister to come down so I could practice injections...they eventually came down for my VS practice.

I will read all links provided! Thanks again!

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Specializes in Pediatrics, High-Risk L&D, Antepartum, L.

I was kidding my neice that I needed her and her sister to come down so I could practice injections...they eventually came down for my VS practice.

I knew somebody who kept a BP cuff at the front door and you basically couldn't com in unless you had your BP taken.

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Specializes in Geriatrics, Cardiac, ICU.
Typo on my part...yes, 15 seconds.

THANKS TO ALL who took the time to read my looooong post. I've been rounding up "victims" this week to practice on.

I was kidding my neice that I needed her and her sister to come down so I could practice injections...they eventually came down for my VS practice.

I will read all links provided! Thanks again!

You will do fine. Practice, practice, practice.

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There were also two instances where she said you could get a false high or a false low. I just want to be familiar with that. It was in relation to using the wrong size cuff or pumping it incorrectly.

THANKS!

here's a list of many ways to find a false high or false low BP reading:

1) taking BP when the person is anxious or angry or has just been active - falsely high because of sympathetic nervous system stimulation

2) faulty arm position: if above level of the heart - falsely low because this eliminates the effect of hydrostatic pressure

if below level of the heart - falsely high because of additional force of gravity added to brachial artery pressure

3) person supports own arm - falsely high diastolic because sustained isometric muscular contraction

4) faulty leg position - falsely high systolic and diastolic because translocation of blood volume from dependent legs to thoracic area

5) examiner's eyes are not level with meniscus of mercury column:

looking up at meniscus - falsely high because of parallax

if looking down on meniscus - falsely low

6) inaccurate cuff size:

if cuff too narrow for extremity - falsely high because needs excessive pressure to occlude brachial artery

if cuff is too loose or uneven or baldder balloons out of wrap - falsely high because needs excessive pressure to occlude brachial artery

7) failure to palpate radial artery while inflating:

inflating not high enough - falsely low systolic - because miss initial systolic tapping or may tune in during auscultatory gap

inflating cuff too high - causes pain

8) pushing stethoscope too hard on brachial artery - falsely low diastolic because excessive pressure distorts artery and the sounds continue

9) deflating cuff:

too quickly - falsely low systolc and/or falsely high diastolic because insufficient time to hear tapping

too slowly - falsely high diastolic because venous congestion in forearm makes sounds less audible

10) halting during descent and reinflatintg cuff to recheck systolic - falsely high diastolic because venous congestion in forearm

11) failure to wait 1 - 2 minutes before repeating entire reading - falsely high diastolic because of venous congestion in forearm

12) any observer error:

examiner's "subconscious bias", a preconceived idea of what blood pressure reading should be

examiner's haste

faulty technique

examiner's digit preference "hears" more results that end in zero than would occur by chance alone

diminished hearing acuity

defective or inaccurately calibrated equipment

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I'm printing this one off...Thank you Ginger!

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