Cover
About the companion website
1 Measuring body temperature
1. Introduction
2. Indications
3. Methods for measuring body temperature
4. Procedure using an electronic tympanic thermometer
5. Mechanisms of heat loss
6. Factors that can cause a fluctuation in body temperature
7. Causes of pyrexia
2 Measuring pulse and blood pressure
1. Assessment of pulse
2. Assessment of perfusion: Capillary refill time
3. Non‐Invasive blood pressure measurement
4. Procedure for manual measurement of blood pressure
5. Automated blood pressure devices
3 Transcutaneous monitoring of oxygen saturations
1. Introduction
2. Indications
3. Cautions
4. Contraindications
5. Equipment
6. Procedure for transcutaneous monitoring of oxygen saturations
7. Complications
4 Peak expiratory flow
1. Introduction
2. Peak expiratory flow
3. Indications for recording PEF
4. PEF readings
5. Procedure
5 Venepuncture
1. Introduction
2. Equipment
3. Procedure
4. Complications
6 Managing blood samples correctly
1. Introduction
2. Indications
3. Contraindications
4. Equipment
5. Procedure for venepuncture
6. Complications
7. Blood tubes
8. Group and save
7 Taking blood cultures
1. Introduction
2. Indications
3. Equipment
4. Procedure
5. Complications
8 Measuring capillary blood glucose
1. Introduction
2. Hypoglycaemia (low blood sugar)
3. Hyperglycaemia (high blood sugar)
4. Indications
5. Equipment
6. Procedure for measurement
9 ECG monitoring
1. Introduction
2. Indications
3. ECG monitoring: Three cable system
4. ECG monitoring: Five cable system
5. Procedure
6. ECG monitoring: Trouble shooting
10 Recording a 12 lead ECG
1. Introduction
2. Indications
3. Procedure
4. Locating the intercostal spaces for the chest leads
5. Alternative chest lead placements
6. Labelling the 12 lead ECG
7. Standardisation
8. What the standard 12 lead ECG records
11 Basic respiratory function tests
1. Introduction
2. Obstructive disease
3. Restrictive disease
4. Indications
5. Cautions
6. Contraindications
7. Equipment
8. Procedure
12 Urine multi‐dipstick test
1. Introduction
2. Components of a urine dipstick
3. Indications
4. Equipment
5. Procedure for dipstick test
13 Advising patients on how to collect a mid‐stream urine specimen
1. Introduction
2. Indications
3. Contraindications
4. Procedure for MSU test
5. Results
6. Complications
14 Taking nose, throat, and skin swabs
1. Introduction
2. Indications
3. Cautions
4. Contraindications
5. Equipment
6. Procedure for insertion
7. Complications
15 Performing a pregnancy test
1. Introduction
2. Principles
3. Recognition of pregnancy
4. Indications
5. Contraindications
6. Equipment
7. Procedure
8. Results
9. Complications
16 Administering oxygen
1. Introduction
2. Indications
3. Components of oxygen therapy
4. Oxygen therapy devices
5. Procedure
6. Oxygen humidification
7. Prescription of oxygen therapy
8. Evidence of harm associated with oxygen therapy
17 Airway management
1. Introduction
2. Oropharyngeal airway
3. Nasopharyngeal airway
18 Ventilation
1. Introduction
2. Mouth to mouth ventilation
3. Mouth to mask ventilation (pocket mask)
4. Bag–mask ventilation
5. Minimising gastric inflation
19 Defibrillation (manual and automated)
1. Introduction
2. Background information
3. Indications
4. Cautions
5. Contraindications
6. Equipment
7. Defibrillation procedure (manual)
8. Defibrillation procedure (automated external defibrillation)
20 Cardiopulmonary resuscitation
1. Introduction
2. Cardiac arrest rhythms
3. Cardiac arrest team
4. Reversible causes of cardiac arrest
5. Equipment
6. Procedure
21 Establishing peripheral intravenous access
1. Introduction
2. Indications
3. Contraindications
4. The IV cannula
5. Choosing the site of cannulation
6. Sites for cannulation
7. Equipment list
8. Procedure for IV cannulation
9. Complications
10. Useful tips
22 Use of infusion devices
1. Introduction
2. Indications
3. Cautions
4. Contraindications
5. Equipment
6. Procedure for infusion
23 Making up drugs for parenteral administration
1. Introduction
2. Equipment
3. Preparation
4. Cautions and contraindications
5. Procedure
6. Post‐procedure checks
24 Dosage and administration of insulin and use of sliding scales
1. Introduction
2. Types of insulin
3. Prescribing insulin
4. Administration
5. Sliding scales
6. Indications
7. Setting up a sliding scale insulin regime
8. Stopping a sliding scale
9. Problems encountered
25 Administering a subcutaneous injection
1. Introduction
2. Contraindications
3. Equipment
4. Procedure for insertion
5. Complications
26 Intravenous injections
1. Introduction
2. Equipment
3. Procedure for IV infusion
4. Cautions
5. Common problems
27 Administration of blood transfusion
1. Introduction
2. Blood components and their uses
3. Patient identification
4. Documentation
5. Traceability
6. Equipment
7. Monitoring priorities in a patient receiving a blood transfusion
8. Adverse reactions to blood transfusion
28 Male and female urinary catheterisation
1. Introduction
2. Indications
3. Types of catheters
4. Procedure for male urinary catheterisation
5. Procedure for female urinary catheterisation
29 Instructing patients in the use of devices for inhaled medication
1. Introduction
2. Types of inhaler device
3. Indications
4. Equipment
5. Procedure for instructing patients in the use of devices for inhaled medication
6. Use of a spacer device
30 Skin suturing
1. Introduction
2. Pre‐procedure considerations
3. Indications
4. Cautions
5. Relative contraindications
6. Equipment
7. Procedure for suturing
8. Complications
31 Application of a sling
1. Introduction
2. Types of slings
3. Procedure for the application of a broad arm sling
4. Procedure for the application of an elevation sling
5. Improvised slings
32 Safe disposal of clinical waste, needles, and other ‘sharps’
1. Introduction
2. Indications
3. Cautions
4. Contraindications
5. Equipment
6. Procedure for insertion
7. Complications
33 Arterial blood gas sampling
1. Introduction
2. Indications
3. Cautions
4. Allen's test
5. Contraindications
6. Equipment
7. Procedure for insertion
8. Complications
34 Examination of the ear
1. Introduction
2. Otological symptoms
3. Conditions encountered on examination
4. Indications
5. Cautions
6. Equipment
7. Procedure
8. Complications
35 Ophthalmoscopy
1. Introduction
2. Ophthalmological problems
3. Indications
4. Contraindications
5. Equipment
6. Procedure for examination
36 Relieving foreign body airway obstruction
1. Introduction
2. Signs
3. Procedure
4. Follow‐up management
Index
End User License Agreement

List of Illustrations

Chapter 1
1. Figure 1.1 Electronic tympanic thermometer.
2. Figure 1.2 Inserting an electronic tympanic thermometer.
Chapter 4
1. Figure 4.1 Set the pointer on the peak flow meter scale to zero.
2. Figure 4.2 Ask the patient to breathe out as hard and as fast as possible int...
Chapter 5
1. Figure 5.1 Vacutainer device and needle.
2. Figure 5.2 Insert the needle into the vein.
Chapter 7
1. Figure 7.1 Blood culture bottles.
Chapter 11
1. Figure 11.1 Lung volumes. TV (Tidal Volume); FRC (Functional Residual Capacit...
2. Figure 11.2 Volume–time graph.
Chapter 12
1. Figure 12.1 Reading the dipstick results.
Chapter 13
1. Figure 13.1 How to obtain an MSU in a male.
Chapter 14
1. Figure 14.1 Taking a nose swab.
Chapter 15
1. Figure 15.1 The front and back of β‐HCG strip packaging made by INVITECH, as ...
2. Figure 15.2 The maximum/marker line; urine should not to beyond this line whe...
3. Figure 15.3 The control and test lines showing positive, negative, and invali...
Chapter 16
1. Figure 16.1 Non‐rebreathing oxygen mask.
Chapter 17
1. Figure 17.1 Measuring an oropharyngeal airway.
2. Figure 17.2 Three sizes of oropharyngeal airways.
3. Figure 17.3 Insertion of an oropharyngeal airway.
4. Figure 17.4 Two sizes of nasopharyngeal airways.
5. Figure 17.5 Insertion of a nasopharyngeal airway.
Chapter 18
1. Figure 18.1 Applying a ventilation mask to the face.
2. Figure 18.2 Two‐person technique for bag–mask ventilation.
Chapter 19
1. Figure 19.1 Monophasic and biphasic defibrillation waveforms.
Chapter 20
1. Figure 20.1 Resuscitation Council (UK) algorithm for in‐hospital resuscitatio...
2. Figure 20.2 Check patient’s response.
3. Figure 20.3 Activate the emergency button.
4. Figure 20.4 Check for signs of life and signs of normal breathing.
5. Figure 20.5 Performing chest compressions.
6. Figure 20.6 Position of hands in performing chest compressions.
7. Figure 20.7 Defibrillation.
8. Figure 20.8 Pocket mask.
9. Figure 20.9 Bag–valve–mask device.
Chapter 22
1. Figure 22.1 Volumetric device.
2. Figure 22.2 Syringe pump.
Chapter 26
1. Figure 26.1 Connecting the giving set to the IV fluid bag.
Chapter 28
1. Figure 28.1 Two way catheter.
2. Figure 28.2 Components needed for catheterisation.
3. Figure 28.3 Mannequin model portraying correct positioning for a male patient...
4. Figure 28.4 Sterile drape placed correctly over patient with collecting tray ...
5. Figure 28.5 Cleaning the meatus and glans penis with sterile gauze in non‐dom...
6. Figure 28.6 Anaesthetic gel being applied around the meatus.
7. Figure 28.7 Anaesthetic gel being inserted into the urethra via meatus.
8. Figure 28.8 De‐gloving first pair of used sterile gloves.
9. Figure 28.9 Penis held at 90° to the vertical whilst inserting the catheter i...
10. Figure 28.10 Ensure penis is held at 90° while advancing catheter.
11. Figure 28.11 Catheter being inserted until the hilt of the catheter is in con...
12. Figure 28.12 Urine flow prompts inflation of catheter balloon using the pre‐f...
13. Figure 28.13 Pulling back on catheter confirming catheter balloon position ab...
14. Figure 28.14 Catheter bag being attached to catheter port.
15. Figure 28.15 External anatomy of female urogenital area.
16. Figure 28.16 Cleaning the urethral opening and surroundings with antiseptic s...
17. Figure 28.17 Catheter insertion into urethral orifice.
18. Figure 28.18 Urine flow achieved indicating catheter tip is in bladder.
Chapter 31
1. Figure 31.1 Broad arm sling: place the triangular bandage against the casualt...
2. Figure 31.2 Broad arm sling: move the lower tip of the bandage up to meet the...
Chapter 34
1. Figure 34.1 Examination of the ear.
Chapter 35
1. Figure 35.1 Ophthalmoscopy: correct positioning.
Chapter 36
1. Figure 36.1 Back slaps.
2. Figure 36.2 Abdominal thrusts.

This edition first published 2020
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Library of Congress Cataloging‐in‐Publication Data

Cover Design: Wiley
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1
Measuring body temperature

Introduction

Normal body temperature ranges between 35.8 °C and 37.2 °C (depending on circadian variation and from which part of the body it is measured)
Core temperature represents the balance between the heat generated by body tissues during metabolic activity, especially of the liver and muscles, and heat lost during various mechanisms
Taken orally, temperature has been found to be 0.5–1 °C lower than when measured from the rectum
The most widely used device to measure temperature is the infrared tympanic thermometer (Figure 1.1). This is inserted into the external acoustic meatus and measures the infrared radiation emitted from the tympanic membrane
Temperature is regulated by the thermoregulatory centre in the hypothalamus through various physiological mechanisms, e.g. sweating, dilation/constriction of peripheral blood vessels and shivering

An electronic tympanic thermometer inserted into the left ear of a male patient. — **Figure 1.1** Electronic tympanic thermometer.

Indications

Acute illness – part of the ABCDE approach
Routine observations

Methods for measuring body temperature

Tympanic thermometer (most commonly used method)
Rectal thermometer (particularly in hypothermia)
Oesophageal/nasopharangeal probes
Bladder probe
Pulmonary artery catheter

Procedure using an electronic tympanic thermometer

Assemble equipment: electronic tympanic thermometer, new hygiene probe, and waste bag
Identify correct patient
Introduce yourself to the patient
Explain procedure to the patient and gain consent
Ascertain which ear was used for previous readings
Wash hands
Turn on electronic thermometer and attach new hygienic probe cover following manufacturer’s recommendations
Gently pull back the pinna upwards and backwards and insert the thermometer in the external acoustic meatus (Figure 1.2)
Press the button on the device to measure the temperature and a reading should appear
Remove the thermometer from the ear canal and then dispose of the hygiene probe into the waste bag
Wash hands
Document information on temperature chart of correctly identified patient including time and date taken
Clear away equipment and ensure that the electronic tympanic thermometer is stored following the manufacturer's guidelines

A woman standing beside a male patient (lying in bed) while inserting an electronic tympanic thermometer into the left ear of the patient. — **Figure 1.2** Inserting an electronic tympanic thermometer.

Mechanisms of heat loss

Radiation: flow of heat from a higher temperature (the body) to a lower temperature (environment surrounding the body)
Convection: heat transfer by flow or movement of air
Conduction: heat transfer due to direct contact with cooler surfaces
Evaporation: perspiration, respiration, and breaks in skin integrity

Factors that can cause a fluctuation in body temperature

The body's circadian rhythms: temperature is higher in the evening than the morning; the difference can be as much as 1.5 °C. If temperature is being recorded every 4–6 hours, the optimum time for detecting a pyrexia is probably between 7 and 8 p.m.
Ovulation
Exercise and eating can cause a rise in temperature
Old age: there is an increased sensitivity to cold and there is generally a lower body temperature
Illness, e.g. sepsis

Causes of pyrexia

Infection
Hyperthyroidism
Malignancy
Drug allergy
Surgery – tissue damage
Damage to the central nervous system
Allergic reaction to blood transfusion
Heat stroke

Medical Student Survival Skills

Procedural Skills

About the companion website