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This manual is designed for students enrolled in first semester of This manual is designed for students enrolled in first semester of academic year 2010-2011 academic year 2010-2011
dr. Rini Rachmawarni Bachtiar dr. Rini Rachmawarni Bachtiar dr. dr. Citra Citra Rosyidah Rosyidah
Team Team
BasicFaculty Diagnostic and Therapy of Medicine Hasanuddin University Faculty of Medicine 2010 Hasanuddin University 2010
Learning equipments 1. Student Clinical Skill Manual for Anamnesis and Vital Signs Examination Skills 2. Stethoscope, Thermometer, Sphygmomanometer and Mannequin 3. Patientss medical record, pen and pencil Learning Methods 1. Demonstration using the CSL manual 2. Lectures
3. Discussion 4. Active participation in the lab Skill (simulation) 5. Evaluation using check list with a scoring system
Activities Description I. Anamnesis Activities Time allocated 1. Introduction 5 minutes 2. Role play demonstration 30 minutes 1. Arranging the students seats 2. Instructor demonstrates an example on how to perform a systematic anamnesis. Students are asked to observe 3. Allowing students to ask any questions they have regarding the demos. Instructor emphazises all important points. 4. Students are given opportunity to observe and ask anything that needs to be clarified. Instructor will provide them with answers 3. Practicing the role play 100 minutes 1. Students are divided into pairs 2. Each couple will perform the role play, one person will act as a physician and the other will play the patient 3. Students are given a specific topic or chief complaint that will be explored by the assesor. 4. Instructor will supervise all the student activities using check list 5. Each students is expected to practice at least once during the day sessions. 4. Brain Storming / Discussion 15 minutes 1. Brain storming/Discussion: students are given the opportunity to raise any issues that Introduction Description
they might have including an y difficulties during the sessions. Students are also allowed to mention any good things that they have experienced in the class. Students are also asked their impression of being a patient. What could be done by the doctor to make the patient feeling more comfortable. 2. Instructor concludes the session by providing answers and feedback to any points that need clarification. Total time allocated 100 minutes
and ask anything that needs to be clarified. Instructor will provide them with answers 3. Practicing the role play 100 minutes 3. Students are divided into pairs 4. Each couple will perform the role play, one person will act as a physician and the other will play the patient 3. Students are given a specific topic or chief complaint that will be explored by the assesor. 4. Instructor will supervise all the student activities using check list 5. Each students is expected to practice at least once during the day sessions. 4. Brain Storming/Discussion 15 minutes 1. Brain storming/Discussion: students are given the opportunity to raise any issues that they might have including any difficulties during the sessions. Students are also allowed to mention any good things that they have experienced in the class. Students are also asked their impression of being a patient. What could be done by the doctor to make the patient feeling more comfortable. 2. Instructor concludes the session by providing answers and feedback to any points that need clarification. Total time allocated 100 minutes
Student Clinical Skill Manual for Anamnesis and Physical Examination Skills A. Anamnesis Skill
NO Clinical steps Case 1. Welcome the patient, standing up and shaking each other hands. Introduce yourself in a warm, friendly manner 2. Ask the patient to have a comfortable sit. It is necessary to sit facing your patient. 3. Give a positive response to build up a good relationship with your patient 4. Ensure comfort and privacy 5. Record the patients identity : name, age, address and occupation 6. Pronounce your words clearly using languange which the patient can easily understand 7. Know and Use the patients name during interviews 8. Ask about the patients chief complaint and try to clarify it. 9. Obtain a history of present illness. Try to ask about all information in a chronological manner up to day of interviews. Events related to the development of the symptoms should be recorded . 10. Perform an anemnesis of the associated system 11. Obtain past medical history focusing on any illnesses that are likely to be in conjuuction with the present complaints. 12. Obtain a family history as well as any environmental concerns. Ask the patient if there any family members who suffer or were suffering from the same illness. 13. Perform a Cross checking
the result, always place your view at a horizontal line to the column of the mercury. 15. Be able to report the results of the systolic and diastolic pressure measurements 16. Release the cuff , store it back and close the box
B. Pulse rate measurements NO Clinical steps Case 1. The patiens could be sitting or laying down 2. The arms should be relaxing, Undo all jewelleries and watches from the wrist 3. Compress the radial artery pulse with your index and middle finger at the lateral flection side of the patients wrist 4. Count the pulse for 30 seconds and multiply by 2 5. Record the rythim and the pulse quality 6. Write down the results C. Respiratory rate NO Clinical steps Case 1. Ask the patients to undo their clothes 2. Inspect the movement of the chest during respiration. Sometimes, it would be necessary to place your hands at the both sides of the chest to compare them. 3. During inspiration process, oberserve the chest for the presence of the lateral movement towards the ribs side , the widening of epigastrium space size and the enlargement of anteroposterior diameter of the chest 4. During expiration process, observe the chest for the presence of the inwards movement towards the ribs side, the shortening of both epigatrium space size and the anteroposterior diameter of the
chest 5. Note any supporting respiratory muscle usages 6. Count breaths for the minimum of 1 minute 7 Record the rythim, frequency and any abnormal breathing movements. D. Temperature Measurements NO Clinical steps Case 1. Make sure the thermometer column has been set up at above 35.5 degree celcius 2. Place the tip of the mercury thermometer to the apical side of left axillary fold with a maximum adduction of the shoulder joint 3. Allow 3-5 minutes before reading the results 4. Write down and report the results. A. Basic Physical Examination (Inspection, Palpation,
1. Observe the body build of the patient e.g. athletic, cachetic or overwight 2. Compare the ratio of the head size and body length 3. Observe the type of the movement 4. Record any obvious deformities or abnormalities 5. Note hair texture, skin, conjunctivaea, sclerae and nails 6. Apparent state of comfort or distress.e.g. anxious, depressed, shy, moaning in pain etc 7 Additional signs B. Palpation NO Clinical steps Case 1. Position your self at the patients right side
2. Examined areas should be free from clothes 3. Make sure that your hands are not cold 4. Palpation could be conducted in several ways : Using your index finger and thumb for measuring the size Using your index, middle and ring fingers all together for measuring the consistency and quality Using the palmar surface to dectect an y pulsations or vibrations/thrills 5. Apply a little pressure using your fingertip or the palmar. This could help us to detect any anbnormal pain that could be seen through the patients expression. C. Percussion NO Clinical steps Case 1. Preparing the middle finger of the left hand in hyperextension position. Placing this finger on the body surface where percussion is to be performed 2. Gently apply a pressure using the interphalangeal joint to the body surface and avoid contact between this percussion site and any other parts of your left hand 3. Put your right hand in an oblique position facing upwards and place it near the percussion site 4. Setting your middle finger up in a flextion and relaxed position ready to perform the percussion procedure 5. With a quickly but relaxed movement from your right hand wrist joint, tap the middle finger of your left hand attached to the percussion surface using the middle finger of your right hand 6. Use your fingertip and tap in a 90-degree angle to the percussion surface 7 Percuss as light as possible that can produce a clear sound
D. Auscultation NO Clinical steps Case 1. Use a stethoscope with small hose (25-30cm) 2. Place the earpieces appropriately inside your external ear, make sure it is in a fixed position not being pressed 3. Use the back side of the stethoscope to perform a chest examination. The diafragma side is to be used to perform an abdominal examination.
13. Show the empathy 14. Be friendly and Be able to ease up the patient 15. Be polite and dress up appropriately 16. Close the anamnesis session by acknowledging the patient Medical Aspects 17. Identity: Name, Age, Address, Occupation are to be listed and asked clearly 18. Ask the chief complaint 19. Ask any other complaints 0: not demonstrated 1: Demonstrated, not completely address some points 2: Correctly demonstrated
the hose and placing the scale vertically 5. Using the stethoscope and making sure the bell is alread y opened 6. Put on the cuff so that it could be circling around the patients arm with an appropriate pressure. Place it at approxiamtely 2 cm above the elbow and 7. Being able to palpate the brachial artery pulsation at the medial side of cubital fold 8. Palpate the brachial artery pulse using one finger and inflate the cuff quickly to 30 mmHg above the pressure whereby the pulse of the brachial artery disappears. Release the pressure slowly until you feel the brachial arter ys pulse again. Report this result as a rough estimated of Systolic pressure (palpatoir) 9. Use the stethoscope and place the bell at the pulsation site 10. Inflate the cuff to 30 mmHF above the estimated systolic pressure 11. Monitor the beats using a stethoscope and slowly release the pressure (3 mmHg per second). Report the level at which you initially hear beats as the systolic pressure 12. Continue to lower the pressure until the sounds muffle and disappear and report it as the diastolic pressure 13. Be able to record the blood pressure as systolic over diastolic 14. Undo the cuff and tidy it up B. Pulse rate measurements 1. Position the patients arm in a relaxing way 16. Use the index and middle finger to palpate the radial artery 17. Count the pulse rate frequency for the minimum of 15 seconds 18. Report the result for a full minute C. Temperature measurements 19. Ensuring the thermometer column has been set up at above 35.5 degree celcius
20 Place the tip of the mercury thermometer to the apical side of left axillary fold with a maximum adduction of the shoulder joint 21 Allow 3-5 minutes before reading the results D. Respiratory rate measurements 1. Ask the patient to undo their clothes (in either a sitting or laying down position) 2. Perform inspection or palpation using both hands at the back or directly to the chest and count the repiratory rate for a minimum of 15 seconds 3. Report the respiratory rate for a full minute Ket: 0: not demonstrated 1: Demonstrated, not completely address some points 2: Correctly demonstrated a. Blood Pressure Measurement: Overall score Score = ---------- X 100% = 28 %
Makassar, .................2010
Instructor .........................................
This manual is designed for students enrolled in first semester of academic year 2007-2008
Team
dr. Rini Rachmawarni Bachtiar dr. Citra Rosyidah
Editor
Dr. Baedah Madjid, Sp.Mk
Aims Being able to perform a systematic Physical Examination include Inspection, Palpation, Percussion and Auscultation e. Preparing the patient prior to the physical examination f. Conducting a direct Inspection and evaluating general appearance of patients body part g. Performing a palpation using the finger and its top side, hands or both palms to measure Vital signs h. Producing a clear percussion sound by performing a correct percussion procedure. i. Performing a correct Auscultation procedure using a stethoscope Learning equipments 4. Student Clinical Skill Manual for Basic Physical Examination Skills 5. Stethoscope and Mannequin 6. Patientss medical record, pen and pencil Learning Methods 6. Demonstration using the CSL manual 7. Lectures 8. Discussion 9. Active participation in the lab Skill (simulation) 10. Evaluation using check list with a scoring system
Activities Description
Physical Examination
Activities Time allocated 1. Introduction 5 minutes Introduction 2. Role play demonstration 30 minutes 1. Arranging the students seats 2. Instructor demonstrates an example on how to perform a comprehensive physical examination covering all aspects of Inspection, Palpation, Percussion and Auscultation. Two instructors are performing the procedures, one of them will be playing the doctor and the other will act as the patient. Students are asked to observe 3. Allowing students to ask any questions they have regarding the demos. Instructor emphazises all important points. 4. Students are given opportunity to observe and ask anything that needs to be clarified. Instructor will provide them with answers 3. Practicing the role play 100 minutes 5. Students are divided into pairs 6. Each couple will perform the role play, one person will act as a physician and the other will play the patient 3. Students are given a specific topic or chief complaint that will be explored by the assesor. Description
4. Instructor will supervise all the student activities using check list 5. Each students is expected to practice at least once during the day sessions. 4. Brain Storming/Discussion 15 minutes 1. Brain storming/Discussion: students are given the opportunity to raise any issues that they might have including any difficulties during the sessions. Students are also allowed to mention any good things that they have experienced in the class. Students are also asked their impression of being a patient. What could be done by the doctor to make the patient feeling more comfortable. 2. Instructor concludes the session by providing answers and feedback to any points that need clarification. Total time allocated 100 minutes
7 Additional signs B. Palpation NO Clinical steps Case 1. Position your self at the patients right side 2. Examined areas should be free from clothes 3. Make sure that your hands are not cold 4. Palpation could be conducted in several ways : Using your index finger and thumb for measuring the size Using your index, middle and ring fingers all together for measuring the consistency and quality Using the palmar surface to dectect an y pulsations or vibrations/thrills 5. Apply a little pressure using your fingertip or the palmar. This could help us to detect any anbnormal pain that could be seen through the patients expression. Percussion C. Percussion NO Clinical steps Case 1. Preparing the middle finger of the left hand in hyperextension position. Placing this finger on the body surface where percussion is to be performed 2. Gently apply a pressure using the interphalangeal joint to the body surface and avoid contact between this percussion site and any other parts of your left hand 3. Put your right hand in an oblique position facing upwards and place it near the percussion site 4. Setting your middle finger up in a flextion and relaxed position ready to perform the percussion procedure 5. With a quickly but relaxed movement from your right hand wrist
joint, tap the middle finger of your left hand attached to the percussion surface using the middle finger of your right hand 6. Use your fingertip and tap in a 90-degree angle to the percussion surface 7 Percuss as light as possible that can produce a clear sound iii. Auscultation NO Clinical steps Case 1. Use a stethoscope with small hose (25-30cm) 2. Place the earpieces appropriately inside your external ear, make sure it is in a fixed position not being pressed 3. Use the back side of the stethoscope to perform a chest examination. The diafragma side is to be used to perform an abdominal examination.
8 Show an ability to compare both side of the chest movement by placing one hand on the right chest and the other hand on the left chest Percussion 9 Gently apply a pressure using the interphalangeal joint of the left hands middle finger to the body surface and avoid contact between this percussion site and any other parts of your left hand 10 Perform the percussion using the middle finger of the right hand 11 The middle finger of the right hand has to be at a 90-degree angle to the middle finger of the left hand 12 The right hand should be relaxing and allocate the movement to the wrist 13. Produce an appropriate sound for the percussed area Auscultation 14 Preparing the stethoscope 15 Allow 2-3 seconds to hear at one site before moving on to the other area 16 Report the auscultation results (e.g. Respiratory sounds, Heart sounds and peristaltic) Ket: 0: not demonstrated 1: Demonstrated, not completely address some points 2: Correctly demonstrated
This manual is designed for students enrolled in first semester of academic year 2010-2011
Team
Prof. Dr. dr. Syakib Bakri, SpPD-KGH dr. Rini Rachmawarni Bachtiar
Editor
Dr. Baedah Madjid, Sp.MK dr. Jimmy R. Masykur, MM
Definition
Injecting medications is an invasive procedure in which drugs are deposited into body tissue using a sterile needle. Drug absorbtion rate and its pharmacodynamic will be very much influenced by the characteristic of body tissue where they are injected. It is imperative to measure the exact dose and uderstand the chemical elements of the medication prescribed, as well as the anatomy of the injection sites before performing an injection. Intramuscular injection provides a more rapid absorption due to muscles vascularitation. Tissue damages could be minimised by administering the medication deep inside the muscle. A subcutaneous injection aims to administer a medication into a subcutaneous layer located just under the skin. Subcutaneous layer lacks of blood vessels, therefore the injected medication is generally absorbed more slowly than that given using an intramuscular injection. Subcutaneus tissue consists of paian receptors, hence only a small-dose, water-soluble and no- irritable medication is allowed to be delivered in this manner. Intracutaneous injection is performed to administer medication inside the skin tissue. This method of injection are often used for: 1. Obtaining local reaction 2. Conducting immunisation, e.g BCG ijnection
Learning Goals
- Preparing all instruments needed for intramuscular, subcutaneous, and intracutaneos injection procedure. - Locating appropriate intramuscular, subcutaneuos, and intracutaneous injection sites - Performing a intramuscular injection according to the standardized procedure.
Learning equipments:
1. Student CSL manual for intramuscular injection 2. Hand washing area with soap and antiseptic liquid 3. Sterile container layered with gauzed pad
4. 1 cc syringe with 18 or 20-gauge needle filled with desired solution 5. Alcohol swab/antiseptic 6. Container for syringe disposal
Learning methods: 1. Demonstration using the manual 2. Lectures/guidance 3. Discussion 4. Active participation in the skill lab (simulation) 5. Evaluation using check list with scoring system
Activities Description
Activities Time allocated 1. Introduction 5 minutes Introduction 2. Role play demonstration 30 minutes 1. Arranging the students seats 2. Instructor demonstrates an example on how to perform intramuscular, subcutaneous, and intracutaneous injection using a mannequin. Students are aske to observe 3. Allowing students to ask any questions they have regarding the demos. Instructor emphazises all important points. 4. Students are given opportunity to observe and ask anything that needs to be clarified. Instructor will provide them with answers 3. Practicing the role play 50 minutes 7. Students are divided into pairs 8. Each couple will perform the role play, one person will act as the injector and the other will play the observer/assistant role 3. Students are allowed to take turn on performing the intramuscular, subcutaneous, and intracutaneous injection using mannequin 4. Instructor will supervise all the student activities using check list 5. Each students is expected to practice at least once during the day sessions. 4. Brain Storming/Discussion 15 minutes Brain storming/Discussion: students are given the opportunity to raise any issues that they might have including any difficulties during Description
the sessions. Students are also allowed to mention any good things that they have experienced in the class. Total time allocated 100 minutes
used swab directly to disposal box after being used. Allowing the skin to dry. 8. Stretching the skin at the buttocks area using your left finger OR Pulling up the muscle in Qudariceps femoris/deltoideus areas. 9. Inserting the needle at 90-degree angle straight in to the skin surface. Inserting only of the needle length below the skin surface. 10. Pull back slightly on the plunger to aspirate for blood. If no blood appears, slowly inject the medication into the muscle. 11. Covering the injection site immediately with the alcohol sponge, apply gently pressure. Quickly remove the needle. 12. Massaging the injection site. 13. Tiding up the patient 14. Taking all equipments back to the instrument table to be cleaned 15. Performing an antiseptic hand washing
B. Subcutaneous Injection NO Clinical steps Case 1. Preparing all instruments 2. Skin testing to asses for the likelihood of allergy 2. Explaining the entire procedures to the patients 3. Arranging an appropriate position for the patient 4. Performing an antiseptic hand washing
5. Locating the injection sites : - Arm : Patient may either stand up or sit down - Abdomen : patient may either sit or lay down - Legs : patient may sit down using a bed or a chair 6. Uncovering the injection sites from clothes 7. Sterilising the injection sites using alcohol swab. Discarding the used swab directly to disposal box after being used. Allowing the skin to dry. 8. For normal patient: stretch both side of the skin OR simply grasp the skin at the injection site For Obese patient: grasp the skin at the injection site and administer the medication inside the skin fold. 9. Inserting the needle with the bevel facing upwards 10. Inserting the needle at 45-degree angle 11. Slowly injecting the medication 12. Quickly removing the needle. apply an antiseptic swab to the injection site 13. Tiding up the patient 14. Taking all equipments back to the instrument table to be cleaned 15. Performing an antiseptic hand washing
C. Intracutaneous Injection NO Clinical steps Case 1. Preparing all instruments 2. Explaining the entire procedures to the patients 3. Arranging an appropriate position for the patient 4. Performing an antiseptic hand washing 5. Locating the injection sites : - Lower Arm : The ventral side at 1/3 length of the lower arm measured from the elbow (or about 2/3 measured from
the wrist area). Only a healthy skin area is allowed to be injected. Blood vessels must be avoided. This is the site for injection of Mantoux test and skin test - Upper Arm : Place 3 fingers of your hand from the bone that goes across the top of the upper arm (this is called the acriomion process) untill you reach the median side of detoid muscle. This site of injection is for BCG.
6. Uncovering the injection sites from clothes 7. Sterilising the injection sites using alcohol swab. Discarding the used swab directly to disposal box after being used. Allowing the skin to dry. 8. Stretching the skin with your left hand 9. Inserting the needle with the bevel facing upwards 10. Inserting the needle at 15-20-degree angle 11. Slowly injecting the medication, making the wheal under the skin 12. Quickly removing the needle. Pat dry, do not apply pressure and acohol swab to the site. 13. Tiding up the patient 14. Taking all equipments back to the instrument table to be cleaned 15. Performing an antiseptic hand washing
3. Arranging an appropriate position for the patient 4. Performing an antiseptic hand washing 5. Locating the injecti on sites : - The right and left side of Gluteus Maxi mus muscle (buttockmuscle). Location : The injection is given at 1/3 length of a line drawn from the anterior superior iliac spine to the iliac crest - Quadriceps Femoris muscle (thigh muscle) - Deltoideus muscle (upper arm muscle) 6. Uncovering the injection sites from clothes 7. Sterilising the injection sites using al cohol swab. Discarding the used swab directly to disposal box after being used. Allowing the skin to dry. 8. Stretching the skin at the buttocks area using your left finger OR Pulling up the muscle in Qudariceps femoris/deltoideus areas. 9. Inserting the needle at 90-degree angle straight in to the skin surface. Inserting only of the needle length below the skin surface. 10. Pul l back sli ghtly on the plunger to aspirate for blood. If no blood appears, slowl y inject the medication into the muscle. 11. Covering the injection site immediately with the alcohol sponge, appl y gently pressure. Quickly remove the needle. 12. Massaging the injection site. 13. Tiding up the patient 14. Taking all equipments back to the instrument table to be cleaned
15. Performing an antiseptic hand washing Ket: 0: not demonstrated 1: Demonstrated, not completely address some points 2: Correctly demonstrated Overall score Score = ---------- X 100% = 30 %
B. Subcutaneous Injection NO Clinical steps Case 1. Preparing all instruments 2. Skin testing to asses for the likelihood of allergy 3. Explaining the entire procedures to the patients 4. Arranging an appropriate position for the patient 5. Performing an antiseptic hand washing 6. Locating the injection sites : - Arm : Patient may either stand up or sit down - Abdomen : patient may either sit or lay down - Legs : patient may sit down using a bed or a chair 7. Uncovering the injection sites from clothes 8. For normal patient: stretch both side of the skin OR simply grasp the skin at the injection site For Obese patient: grasp the skin at the injection site and administer the medication inside the skin fold. 9. Inserting the needle with the bevel facing upwards 10. Inserting the needle at 45-degree angle 11. Slowly injecting the medication 12. Quickly removing the needle. apply an antiseptic swab to the injection site 13. Tiding up the patient 14. Taking all equipments back to the instrument table to be cleaned 15. Performing an antiseptic hand washing
Ket: 0: not demonstrated 1: Demonstrated, not completely address some points 2: Correctly demonstrated Overall score Score = ---------- X 100% = 30
Makassar, .................2010 Instructor ........................................... C. Intracutaneous Injection NO Clinical steps Case 1. Preparing all instruments 2. Explaining the entire procedures to the patients 3. Arranging an appropriate position for the patient 4. Performing an antiseptic hand washing 5. Locating the injection sites : - Lower Arm : The ventral side at 1/3 length of the lower arm measured from the elbow (or about 2/3 measured from the wrist area). Only a healthy skin area is allowed to be injected. Blood vessels must be avoided. This is the site for injection of Mantoux test and skin test - Upper Arm : Place 3 fingers of your hand from the bone that goes across the top of the upper arm (this is called the acriomion process) untill you reach the median side of detoid muscle. This site of injection is for BCG.
6. Uncovering the injection sites from clothes 7. Sterilising the injection sites using alcohol swab. Discarding the used swab directly to disposal box after being used. Allowing the skin to dry. 8. Stretching the skin with your left hand 9. Inserting the needle with the bevel facing upwards 10. Inserting the needle at 15-20-degree angle 11. Slowly injecting the medication, making a tiny bubble under the skin 12. Quickly removing the needle. Pat dry, do not apply pressure and acohol swab to the site.
13. Tiding up the patient 14. Taking all equipments back to the instrument table to be cleaned 15. Performing an antiseptic hand washing
Ket: 0: not demonstrated 1: Demonstrated, not completely address some points 2: Correctly demonstrated
STUDY OBJECTIVES
After completing this skill training, students are expected to be able in: 1. preparing materials and instruments needed in changing dry bandage 2. performing a correct and efficient procedure in changing dry bandage
4. 5. 6. 7. 8. 9.
some tape, plaster (depends on the need) biodegradable bin extra gauze and surgipad or ABD pad patients own robe tape lifter (optional) measuring tool
LEARNING METHOD
1. 2. 3. 4. 5. Skill demonstration based on the manual Lecture Discussion Active participation in conducting the skill (simulation) Evaluation using provided check list with scoring system
MEDICS/PARAMEDICS CONCERN
During process of removing or placing a bandage, be very careful not to displace the wound drain (if any). If the wound is complete and dry, it is possible to achieve optimal recovery without bandaging. The medical officer has to wear gloves and place the used gauze and bandage in the biodegradable bin. In the case of possible ocular contamination, e.g. blood burst, wearing specific spectacles is highly recommended.
GERIATRIC CONSIDERATION
Older peoples skin texture is generally much thinner and un-elastic. Therefore, it requires thorough care when removing the tape.
ACTIVITIES DESCRIPTION
ACTIVITIES TIME DESCRIPTION 1. Introduction 5 minutes Introduction Speech 2. Role Play: asking and 30 minutes 1. Arranging students seat
answering question 2. Two instructors (an instructor and coinstructor) giving examples on ho to change bandage. One instructor acts as a doctor and the other as the patient. Students thoroughly observe. 3. Students are given opportunity to ask questions; instructors explain important aspects related to the topic 4. Students observe and ask questions; instructors replay. 3. Role play with feed 100 minutes 1. Students are grouped in pairs. A mentor back is required to observe every 2 pairs 2. In each role play, one student acts as a doctor who is changing the bandage and the other as the patient 3. Mentors supervise the performed procedures using check list 4. Ever y student should at least has one chance 4. Brain storming and 15 minutes 1. Brain storming/discussion: Which part discussion that is easy to perform?, what are the difficult parts?, What are the patients-act students feel? What can a doctor improve to make the patients more comfortable? 2. Instructors summarize by explaining the last question and giving necessary enlightenment Total allocated time 150 minutes
No. ACTIVITIES
1. Explain the procedure to the patient by describing the overall wound caring steps 2. Organize all the needed instruments and materials on the table beside the patients bed (do not open yet) 3. Get a disposable paper bag, fold the upper lid, and place it somewhere within your hands reach 4. Close the assessment rooms door or curtain, or organize the curtain to surround the bed. Close all open windows 5. Position the patient in a comfortable setting, place the patients bath robe supporting the wound. Instruct the patient not to touch the wound site or the sterilized instruments. 6. Wash hands thoroughly 7. Wear a pair of clean disposable gloves, remove any tapes, straps or bandages 8. Remove the tape by peeling from side then carefully pulling it parallel to the skin toward the bandage (in case of any tape remnants, it can be cleaned with acetone) 9. Using gloved hands or forceps, lift the bandage while at the same time maintain the used dirty surface out of the patients sight 10. Should the bandage stuck to the wound, easy the peeling process with sterile solution or water 11. Observe character and drainage volume of the bandage 12. Dispose the used bandage in the provided bin; avoid contaminating outer surface of the bin. Release the gloves, by start pulling from inside out. Dispose in the proper bin 13. Uncover the sterilized bandage tray. Place the tray on the table beside patients bed. Bandages, scissors and forceps must always be
SCORE 1 2 3
17.
placed in the sterilized tray, or on the inner surf ace of the tray cover (additional sterile area). Open the antiseptic bottle or package; and pour some amount of the solution in to the provided basin, or on gauze Should the gauze package become wet by antiseptic solution, then the preparation process has to repeated all over again Wear a sterile pair of gloves (Picture 125) Inspect the wound. Thoroughly observe the condition, stitches integration or newly developed skin flap, and drainage character. (if required, palpate the wound site with the non dominant part of the hands, which will not have any direct contact with the sterile materials Clean the wound with prescribed antiseptic solution or with physiologic saline solution. Hold the antiseptic dipped gauze with forceps. Use different gauze for each cleaning. Starts from the poorly contaminated to the heavily contaminated area, away from the incision line or the wound edge Use new gauze for wound drying or incision purpose. Clean based on step 17 description Apply antiseptic ointment; similar way to the cleaning technique. Do not apply the ointment on the drainage site. Apply dry sterile bandages on the incision or wound site: Apply one bandage each time (Picture 127) Apply thinly crafted gauze (4x4) or tefla as contact layer In case with drainage placement, apply 4x4 gauze on the drainage surrounding insertion site Apply the second layer of gauze Apply a thicker surgipad or ABD pad (blue line in the middle of the pad indicates outer surface) (Picture 128) Secure the bandage with tapes or Montgomery straps, or bandages Remove the gloves and dispose in the provided bin Dispose all used materials, then help the patient regain his/her comfortable position Wash hands Make some notes on wound, bandage and drainage observation and caring section. Record bandage replacement procedure along with patients responds.
After completing this skill training, students are expected to have the ability of changing wet bandage
STUDY OBJECTIVES
After completing this skill training, students are expected to be able in: 1 preparing materials and instruments needed in changing wet bandage 2. performing a correct and efficient procedure in changing wet bandage
ACTIVITIES DESCRIPTION
ACTIVITIES TIME DESCRIPTION 1. Introduction 5 minutes Introduction Speech 2. Role Play: asking and 30 minutes 1. Arranging students seat answering question 2. Two instructors (an instructor and coinstructor) giving examples on ho to change wet to dry bandage. One instructor acts as a doctor and the other as the patient. Students thoroughly observe. 3. Students are given opportunity to ask questions; instructors explain important aspects related to the topic 4. Students observe and ask questions; instructors replay. 3. Role play with feed 100 minutes 1. Students are grouped in pairs. A mentor back is required to observe every 2 pairs 2. In each role play, one student acts as a doctor who is changing the bandage and the other as the patient 3. Mentors supervise the performed procedures using check list 4. Ever y student should at least has one chance 4. Brain storming and 15 minutes 1. Brain storming/discussion: Which part discussion that is easy to perform?, what are the difficult parts?, What are the patients-act students feel? What can a doctor improve to make the patients more comfortable? 2. Instructors summarize by explaining the last question and giving necessary enlightenment Total allocated time 150 minutes
No. ACTIVITIES
1. Explain the procedure to the patient by describing the overall wound caring steps 2. Organize all the needed instruments and materials on the table beside the patients bed (do not open yet) 3. Get a disposable paper bag, fold the upper lid, and place it somewhere within your hands reach 4. Close the assessment rooms door or curtain, or organize the curtain to surround the bed. Close all open windows 5. Position the patient in a comfortable setting, place the patients bath robe supporting the wound. Instruct the patient not to touch the wound site or the sterilized instruments. 6. Wash hands thoroughly 7. Place a water proof pad underneath the patient 8. Wear a pair of clean disposable gloves, remove any tapes, straps or bandages 9. Remove the tape by peeling from side then carefully pulling it parallel to the skin toward the bandage (in case of any tape remnants, it can be cleaned with acetone) 10. Using gloved hands or forceps, lift the bandage while at the same time maintain the used dirty surface out of the patients sight 11. Should the bandage stuck to the wound, do not easy the peeling process by wetting. Slowly, peel the bandage by releasing the dryclotted exudates. Inform the possibility of pain and other uncomfortable feelings that might be induced by this procedure 12. Observe character and drainage volume of the bandage 13. Dispose the used bandage in the provided bin; avoid contaminating outer surface of the bin. Release the gloves, by start pulling from inside out. Dispose in the proper bin
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14. Uncover the sterilized bandage tray. Place the tray on the table beside patients bed. Bandages, scissors and forceps must always be placed in the sterilized tray, or on the inner surf ace of the tray cover (additional sterile area). Open the antiseptic bottle or package; and pour some amount of the solution in to the provided basin. And add some small holed-gauze. 15. Wear a sterile pair of gloves (Picture 125) 16. Inspect the wound. Thoroughly observe the condition, stitches integration or newly developed skin flap, and drainage character. (if required, palpate the wound site with the non dominant part of the hands, which will not have any direct contact with the sterile materials 17. Clean the wound with prescribed antiseptic solution or with physiologic saline solution. Hold the antiseptic dipped gauze with forceps. Use different gauze for each cleaning. Starts from the poorly contaminated to the heavily contaminated area, away from the incision line or the wound edge 18. Apply wet softly-crafted gauze exactly covering the wound site. For deeper wound, apply a bundle/package of gauze by folding the gauze edge with forceps. Slowly insert the gauze in to the wound until all wound surfaces have direct contact with the gauze. 19. Apply dry sterile 4x4 gauze on top of the previous wet gauze 20. Finally, apply a thicker surgipad or ABD pad 21. Secure the bandage with tapes or Montgomery straps, or bandages 22. Remove the gloves and dispose in the provided bin 23. Dispose all used materials, then help the patient regain his/her comfortable position 24. Wash hands 25. Make some notes on wound, bandage and drainage observation and caring section. Record bandage replacement procedure along with patients responds.
This manual is designed for students enrolled in first semester of academic year 2010-2011
DDT Team
dr. Rini Rachmawarni Bachtiar dr. Citra Rosyidah
Indication 1. Routine hand washing: Before beginning a routine work and before going home Before and after performing examination to a patient When go out of a toilet Before wearing gloves After releasing gloves 2. Aseptic hand washing: Before performing an invasive intervention Any possibility that the hand is contaminated Aim After participating in this activitity, the students are able to perform routine and aseptic hand washingiswa harus sudah mampu melakukan cuci tangan rutin, pembuatan preparat tegak dari spec properly.
Learning equipment Flowing water Liquid soap Antiseptic solution Hand napkin or tissue
B. Aseptic Hand Washing 1. Perform routine hand washing 2. Rinse both of the arm until the elbow by using the flowing water. 3. Pour 3 mL of antiseptic to the palm of the hands, spread them until the circle of the hands, fingers, and between the fingers. 4. Dry them with the air.
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This manual is designed for students enrolled in first semester of academic year 2010-2011
Team
dr. Rini Rachmawarni Bachtiar dr. Citra Rosyidah
The radiology examination is one of the important examinations for diagnosing a disease, so we should properly know the appropriate examinations for each organ, the procedures, and the possible finding of the examinations.
General Aim: After participating in this activity, the students are able to differentiate the kinds of radiology examination and know the densities ithat occur in eash examination.
Spesific Aim: 1. Know the positions for radiology examinations.. 2. Able to identify the density in the x-ray. 3. Able to identify the density in the photo with contrast (IVP, Colon in Loop, MD photo, Oesophagography,Arteriography, dan Cor Analisis) 4. Able to identify the density in the mammography 5. Able to identify the density in the ultrasonography 6. Able to identify the density in the CT-scan 7. Able to identify the density in the MRI
Learning media and equipments 1. Manual skills lab for radiology 2. Light box 3. Radiology photo
Learning Methods 11. Demonstration using the CSL manual 12. Lectures 13. Discussion 14. Active participation in the lab Skill (simulation) 15. Evaluation using check list with a scoring system
CLINICAL ACTIVITY
decubitus (R/L) atau oblique 5. Identify the kinds of the radiology examination : - X-ray (thorax, extremities,BNO dll) - Colon in Loop - MD - Foto Oesofagography - IVP - Mammography - USG - CT Scan - MRI 6. Identif y the densities in each examination: Conventional photo( x-ray and contrast photo): - Radioopaque - Hiperradioopaque (metal density) - Intermediate
The densities of ultrasonography: - Hiperechoic - Hipoechoic - Normoechoic (isoechoic) CT-Scan: - Hiperdense - Hipodense - Isodenes MRI (T1 & T2): - Hiperintense - Hipointense - Isointense
SKILL CHECKLIST INTRODUCTION TO THE BASICS OF RADIOLOGY Score No Evaluated Frequency 0 1 2 1 2 3 4 5 Examine the identities of the patient and the photo marker Set the photo properly Determine the photo position Mention the kinds of radiology examinations (case) Identify the density of these examination (above)
6 Mention the kinds of nonconventional radiology examination (case) 7 Identify the density of these examination (above)
0: not demonstrated 1: Demonstrated, not completely address some points 2: Correctly demonstrated
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