Welcome to Online Health Expert's Brand New Allied Health Care Clinical Skills Links Page. Please check back frequently for updates.
Before moving on to the clinical skills links, I would highly recommend watching the Understanding Medical Words (Terminology) Tutorial from National Library of Medicine. It is very interactive and is a FUN way to learn Medical Terminology before you continue reading your medical and surgical books.
Click on the Link Below:
Medical Terminology Tutorial for Everyone from NLM at National Institutes of Health (NIH)
Also Here is (*NEW*) the link for Anatomy (Body parts in health and disease along with Medical and Surgical Procedures - Animated) Videos from National Library of Medicine at National Institutes of Health:
Anatomy Videos
Allied Healthcare Clinical Skills:
1) Vital Signs:
Vital Signs (also Cardinal Signs) are the "most important" (Vital or Cardinal) "objectively elicitable" (watched, measured and monitored and brought forth through observation and manipulation with or without the use of instruments - Signs) characteristic findings that provide key statistics pertaining to an individual's level of physical functioning.
Normal vital signs change dynamically with age, weight, exercise tolerance and condition.
The four vital signs include information regarding heart beat (pulse [P] - rate, rhythm, character, strength/volume and the condition of the arterial wall), respiration [R](rate, depth and pattern), temperature [T] (measured as tympanic, temporal, oral, axillary or rectal temperature) and arterial blood pressure [BP] [measured indirectly using an appropriately sized cuff (length of the cuff covering 80% of the limb circumference and the width of the cuff covering at-least 40% of the limb circumference - cuffs that are smaller give an inappropriately higher BP reading and the cuffs that are larger give inappropriately lower BP readings) (sphygmomanometer) in the limbs - arm (brachial artery), forearm (radial artery), thigh (popliteal artery) or leg (posterior tibial or dorsalis pedis artery).
The Pulse [P] is counted for 1 minute & is recorded in beats per minute (bpm).
Peripheral Pulse site locations videos.
The Respiration [R] is counted for 1 minute & recorded in cycles per minute (cpm). The patient should not be told that you are going to measure their Respiration as this is the only vital sign that can be voluntarily controlled and thus respiration and pulse are usually counted one after the other in one session without the knowledge of the patient and then noted in the patient chart.
PS. In adult males the movement during respiration is best appreciated by looking at the abdominal movement with each breath whereas in adult females the upper chest movement is more readily appreciable and used to count respiration.
The Temperature [T] is recorded in degrees Fahrenheit (⁰F) or degrees Centigrade/Celsius (⁰C).
Measurement of Tympanic temperature.
Measurement of Temporal Temperature.
Measurement of Oral Temperature.
Different Sites and Thermometers being used.
The Blood Pressure [BP] is then measured and recorded as:
Systolic BP/Diastolic BP mm Hg (millimeters of Mercury) example: 118/72 mm Hg.
It is best to first use the Palpation method to estimate the Systolic (Top) BP before getting both the final Systolic and Diastolic (Bottom) BP reading using the Auscultatory (using a Stethoscope) method. This is done to avoid seriously underestimating the patient's Systolic BP because of the Auscultatory Gap (sounds are absent in patients with very high Systolic BP especially in older patients (most likely due to stiffer arterial walls - arteriosclerosis, though the exact cause is unknown) who are at an increased risk of Stroke) during Phase II Korotkoff sounds.
PS: The Patient should not have eaten food, drank alcohol/caffeine drinks, smoked or chewed tobacco or exercised with the past 30 minutes of measuring the Vital Signs as eating, drinking and smoking tend to elevate and exercising tends to lower the numbers.
Ideally, the patient should be seated in a chair with his/her back rested and feet flat on the ground (crossing of feet has been shown to greatly increase one's BP).
The patient should be instructed to relax and not move or talk during the procedure.
Introduce yourself, Positively identify your patient, wash your hands and keep OSHA and HIPAA guidelines in mind and Please do not leave documentation for later. Document immediately and properly in the patient chart.
The Normal Values of Vital Signs (Adults):
Pulse[P]: 60 - 100 bpm, more suitable range for younger adults is 50 - 80 bpm.
Heart rate (Pulse) below 60 bpm is called Bradycardia and above 100 bpm Tachycardia
Respiration[R]: 12 -18/20 cpm
Respiratory rate below 12 cpm is called Bradypnea and above 20/24 is called Tachypnea
Temperature[T]: 97.0 ⁰F - 99.9 ⁰F or 36.1 ⁰C - 37.7 ⁰C/ average 98.6 ⁰F or 37.0 ⁰C
Fever is also called Pyrexia. Temperature below 95 ⁰F or 35 ⁰C is called Hypothermia and temperature above 104 ⁰F or 40 ⁰C is called Hyperthermia.
Normal Body Temperature by Age and Site by WelchAllyn
Blood Pressure[BP] Systolic <
120 mm Hg, Diastolic
<
80
Joint National Committee seventh (JNC 7)
recommendations to diagnose and manage Hypertension are as follows:
JNC 7 Hypertension Reference Card
Please click on the following links & watch the following videos and practice a lot!
University of Florida Vital Signs Video Link
University of Virginia School of Medicine, Vital Signs Video Link - Dr. John Gazewood
These videos are NOT perfect samples (Temperature is skipped) but are very close except that the patients back and feet are not supported.
For Pediatric Vital Signs, Please click on the links below: (Source: www.cc.nih.gov)
Age appropriate Pediatric Vital Signs
How to use the following Pediatric Blood Pressure Charts
Blood Pressure Levels for Boys by Age and Height Percentile
Blood Pressure Levels for Girls by Age and Height Percentile
The complete 60 page 4th report on Pediatric Hypertension at www.nhlbi.nih.gov
Please print the information from the above links for Reference on the run or use your smart devices!
I hope you will master these vital skills and use them wisely and save lives. This skill is an integral part of every Physical Examination and every face to face TRIAGE [a process of categorizing patients into Tri - three categories (the need for emergency, urgency or routine care) based on severity of their condition depending upon age - time they have left before they will need an intervention].
Thank you for learning the Vital Skill of obtaining Vital Signs at Online Health Expert.
Sincerely,
Dr. Harish Malik
2) Venipuncture (Phlebotomy) or simply Blood Collection is an important skill and more detailed Free information can be found at the web-path link from University of Utah Phlebotomy Tutorial. Always positively identify and label the specimen and document the procedure immediately after the procedure keeping in mind OSHA and HIPAA guidelines.
WEB PATH Phlebotomy Link (Please Finish Reading everything on Web Path before watching the Videos. )
Some selected great YouTube videos:
Vacutainer Method of Venipuncture/ Phlebotomy
Videos on "How to safely Perform Venipuncture/Phlebotomy?"
Infant Heel Blood Collection Method.
Click on the following link to obtain more information on getting Certified in USA as a Phlebotomist and learn more about this field:
National Phlebotomy Association
Always be alert of the fact that children and sometimes adults may be apprehensive or scared of blood draw and be prepared if the patient feels faint or passes out during or after the procedure.
Thank you for improving your Venipuncture/Phlebotomy or Blood Drawing Skills and Knowledge via links provided at Online Health Expert.
Sincerely,
Dr. Harish Malik
3) Medical Math, Dosage Calculation and Drug Administration: Nursing Dosage Calculation coming soon....
Medical Assisting Dosage Calculation Formula:
BASIC MATH OPERATIONS and NUMBERS An interesting NOTE!!
Math can be easily and quickly learned through our general and basic understanding of life itself. I am not sure if you have heard this one, but I have been using it for years now, we have only 10 single digits in math because we only have 10 fingers (including the 2 thumbs) and by the ways 10 toes too! Our Math has a base 10 for this reason!! Also the Basic Math Operations of Addition (+), Subtraction (-), Multiplication (X) and Division grow in complexity and difficulty level just like their counterparts in Life!!
Addition (+) can be thought off as very similar to Friendship (you add something to their life and they add something to yours but you are not sharing everything yet!) which is very easy for most of us; Subtraction (-) is very similar to Stealing or Snatching or taking away (or making enemies) what is not yours, a little bit more difficult and you can get caught and some people do have problem mastering this; Multiplication (X) is like Marriage (partner, boy friend or girlfriend where you live together and ideally share everything) and is like fast friendship or fast addition or a very fast friendship that has resulted in Marriage!! not everyone's cup of tea these days!! so some folks do have a problem with this esp., without a calculator/phone; Lastly Division involves Subtracting or Stealing or taking away or Cheating at every step (long division), its anyone's guess if that happens the Multiplication or Marriage or Partnership won't last for long and will result in separation or Divorce which is hard for everyone, making Division the hardest of the Basic Math operations to master without the help of your phone or calculator!!
So, in the increasing order of difficulty we have the following:
Addition = Friendship
Subtraction = Stealing
Multiplication = Marriage
Division = Divorce
You will need to know these Basic Math Operations, Ratios, Fractions, and Percentages (if you are not allowed to use a calculator or you don't have access to one) and Conversion tables for the metric, household and the apothecaries system (or have access to an online calculator or conversion tables and also the patient's age, height, weight, BSA etc., besides you will have to learn how to read a Prescription Rx. or (Order) -- its parts, abbreviations used, generic and brand names and the seven patient rights in order to properly calculate the medication (drug) dosages and administer it with proficiency including the most important part Documentation!!
NEVER FORGET TO RECONFIRM ALLERGIES BEFORE ADMINISTERING ANY MEDICATION TO ANY PATIENT!!
Without getting into all those details here is the formula that works for solids (tablets, capsules, caplets, spansules etc.) and liquids (syrups, elixers, injectables other than IVs or IOs which first need to be constituted and administered at a certain rate like drops/min or gtts/min or mL/hr which I will list separately!!)
By the ways cc and ml are same!! No difference at all. 1 c.c. is the amount of space which is a cube whose each side is 1 centimeter and it can hold 1 milliliter of any liquid.
The Nursing Dosage Calculation for IVs...coming soon!!!.....Please Check Back.....
4) Suture Removal and Surgical Staples Removal Video Links for Allied Health Care Professionals:
Please remember that the incision site must first be inspected by the Health Care Provider and orders written for suture removal. When documenting suture or staple removal, please document the inspection findings (any redness, swelling, discharge and type of discharge - serous, serosanguinous, purulent etc) before and after the procedure and any complications. Also you will be required to write the total number of sutures/ staples present and the site/ location and how many were removed. If any were left behind please document the reason.
The YouTube videos may not work at places where YouTube is blocked, so I have attached the direct link for a very short non YouTube video.
Before moving on to the clinical skills links, I would highly recommend watching the Understanding Medical Words (Terminology) Tutorial from National Library of Medicine. It is very interactive and is a FUN way to learn Medical Terminology before you continue reading your medical and surgical books.
Click on the Link Below:
Medical Terminology Tutorial for Everyone from NLM at National Institutes of Health (NIH)
Also Here is (*NEW*) the link for Anatomy (Body parts in health and disease along with Medical and Surgical Procedures - Animated) Videos from National Library of Medicine at National Institutes of Health:
Anatomy Videos
Allied Healthcare Clinical Skills:
1) Vital Signs:
Vital Signs (also Cardinal Signs) are the "most important" (Vital or Cardinal) "objectively elicitable" (watched, measured and monitored and brought forth through observation and manipulation with or without the use of instruments - Signs) characteristic findings that provide key statistics pertaining to an individual's level of physical functioning.
Normal vital signs change dynamically with age, weight, exercise tolerance and condition.
The four vital signs include information regarding heart beat (pulse [P] - rate, rhythm, character, strength/volume and the condition of the arterial wall), respiration [R](rate, depth and pattern), temperature [T] (measured as tympanic, temporal, oral, axillary or rectal temperature) and arterial blood pressure [BP] [measured indirectly using an appropriately sized cuff (length of the cuff covering 80% of the limb circumference and the width of the cuff covering at-least 40% of the limb circumference - cuffs that are smaller give an inappropriately higher BP reading and the cuffs that are larger give inappropriately lower BP readings) (sphygmomanometer) in the limbs - arm (brachial artery), forearm (radial artery), thigh (popliteal artery) or leg (posterior tibial or dorsalis pedis artery).
The Pulse [P] is counted for 1 minute & is recorded in beats per minute (bpm).
Peripheral Pulse site locations videos.
The Respiration [R] is counted for 1 minute & recorded in cycles per minute (cpm). The patient should not be told that you are going to measure their Respiration as this is the only vital sign that can be voluntarily controlled and thus respiration and pulse are usually counted one after the other in one session without the knowledge of the patient and then noted in the patient chart.
PS. In adult males the movement during respiration is best appreciated by looking at the abdominal movement with each breath whereas in adult females the upper chest movement is more readily appreciable and used to count respiration.
The Temperature [T] is recorded in degrees Fahrenheit (⁰F) or degrees Centigrade/Celsius (⁰C).
Measurement of Tympanic temperature.
Measurement of Temporal Temperature.
Measurement of Oral Temperature.
Different Sites and Thermometers being used.
The Blood Pressure [BP] is then measured and recorded as:
Systolic BP/Diastolic BP mm Hg (millimeters of Mercury) example: 118/72 mm Hg.
It is best to first use the Palpation method to estimate the Systolic (Top) BP before getting both the final Systolic and Diastolic (Bottom) BP reading using the Auscultatory (using a Stethoscope) method. This is done to avoid seriously underestimating the patient's Systolic BP because of the Auscultatory Gap (sounds are absent in patients with very high Systolic BP especially in older patients (most likely due to stiffer arterial walls - arteriosclerosis, though the exact cause is unknown) who are at an increased risk of Stroke) during Phase II Korotkoff sounds.
PS: The Patient should not have eaten food, drank alcohol/caffeine drinks, smoked or chewed tobacco or exercised with the past 30 minutes of measuring the Vital Signs as eating, drinking and smoking tend to elevate and exercising tends to lower the numbers.
Ideally, the patient should be seated in a chair with his/her back rested and feet flat on the ground (crossing of feet has been shown to greatly increase one's BP).
The patient should be instructed to relax and not move or talk during the procedure.
Introduce yourself, Positively identify your patient, wash your hands and keep OSHA and HIPAA guidelines in mind and Please do not leave documentation for later. Document immediately and properly in the patient chart.
The Normal Values of Vital Signs (Adults):
Pulse[P]: 60 - 100 bpm, more suitable range for younger adults is 50 - 80 bpm.
Heart rate (Pulse) below 60 bpm is called Bradycardia and above 100 bpm Tachycardia
Respiration[R]: 12 -18/20 cpm
Respiratory rate below 12 cpm is called Bradypnea and above 20/24 is called Tachypnea
Temperature[T]: 97.0 ⁰F - 99.9 ⁰F or 36.1 ⁰C - 37.7 ⁰C/ average 98.6 ⁰F or 37.0 ⁰C
Fever is also called Pyrexia. Temperature below 95 ⁰F or 35 ⁰C is called Hypothermia and temperature above 104 ⁰F or 40 ⁰C is called Hyperthermia.
Normal Body Temperature by Age and Site by WelchAllyn
Blood Pressure[BP] Systolic <
120 mm Hg, Diastolic
<
80
Joint National Committee seventh (JNC 7)
recommendations to diagnose and manage Hypertension are as follows:
JNC 7 Hypertension Reference Card
Please click on the following links & watch the following videos and practice a lot!
University of Florida Vital Signs Video Link
University of Virginia School of Medicine, Vital Signs Video Link - Dr. John Gazewood
These videos are NOT perfect samples (Temperature is skipped) but are very close except that the patients back and feet are not supported.
For Pediatric Vital Signs, Please click on the links below: (Source: www.cc.nih.gov)
Age appropriate Pediatric Vital Signs
How to use the following Pediatric Blood Pressure Charts
Blood Pressure Levels for Boys by Age and Height Percentile
Blood Pressure Levels for Girls by Age and Height Percentile
The complete 60 page 4th report on Pediatric Hypertension at www.nhlbi.nih.gov
Please print the information from the above links for Reference on the run or use your smart devices!
I hope you will master these vital skills and use them wisely and save lives. This skill is an integral part of every Physical Examination and every face to face TRIAGE [a process of categorizing patients into Tri - three categories (the need for emergency, urgency or routine care) based on severity of their condition depending upon age - time they have left before they will need an intervention].
Thank you for learning the Vital Skill of obtaining Vital Signs at Online Health Expert.
Sincerely,
Dr. Harish Malik
2) Venipuncture (Phlebotomy) or simply Blood Collection is an important skill and more detailed Free information can be found at the web-path link from University of Utah Phlebotomy Tutorial. Always positively identify and label the specimen and document the procedure immediately after the procedure keeping in mind OSHA and HIPAA guidelines.
WEB PATH Phlebotomy Link (Please Finish Reading everything on Web Path before watching the Videos. )
Some selected great YouTube videos:
Vacutainer Method of Venipuncture/ Phlebotomy
Videos on "How to safely Perform Venipuncture/Phlebotomy?"
Infant Heel Blood Collection Method.
Click on the following link to obtain more information on getting Certified in USA as a Phlebotomist and learn more about this field:
National Phlebotomy Association
Always be alert of the fact that children and sometimes adults may be apprehensive or scared of blood draw and be prepared if the patient feels faint or passes out during or after the procedure.
Thank you for improving your Venipuncture/Phlebotomy or Blood Drawing Skills and Knowledge via links provided at Online Health Expert.
Sincerely,
Dr. Harish Malik
3) Medical Math, Dosage Calculation and Drug Administration: Nursing Dosage Calculation coming soon....
Medical Assisting Dosage Calculation Formula:
BASIC MATH OPERATIONS and NUMBERS An interesting NOTE!!
Math can be easily and quickly learned through our general and basic understanding of life itself. I am not sure if you have heard this one, but I have been using it for years now, we have only 10 single digits in math because we only have 10 fingers (including the 2 thumbs) and by the ways 10 toes too! Our Math has a base 10 for this reason!! Also the Basic Math Operations of Addition (+), Subtraction (-), Multiplication (X) and Division grow in complexity and difficulty level just like their counterparts in Life!!
Addition (+) can be thought off as very similar to Friendship (you add something to their life and they add something to yours but you are not sharing everything yet!) which is very easy for most of us; Subtraction (-) is very similar to Stealing or Snatching or taking away (or making enemies) what is not yours, a little bit more difficult and you can get caught and some people do have problem mastering this; Multiplication (X) is like Marriage (partner, boy friend or girlfriend where you live together and ideally share everything) and is like fast friendship or fast addition or a very fast friendship that has resulted in Marriage!! not everyone's cup of tea these days!! so some folks do have a problem with this esp., without a calculator/phone; Lastly Division involves Subtracting or Stealing or taking away or Cheating at every step (long division), its anyone's guess if that happens the Multiplication or Marriage or Partnership won't last for long and will result in separation or Divorce which is hard for everyone, making Division the hardest of the Basic Math operations to master without the help of your phone or calculator!!
So, in the increasing order of difficulty we have the following:
Addition = Friendship
Subtraction = Stealing
Multiplication = Marriage
Division = Divorce
You will need to know these Basic Math Operations, Ratios, Fractions, and Percentages (if you are not allowed to use a calculator or you don't have access to one) and Conversion tables for the metric, household and the apothecaries system (or have access to an online calculator or conversion tables and also the patient's age, height, weight, BSA etc., besides you will have to learn how to read a Prescription Rx. or (Order) -- its parts, abbreviations used, generic and brand names and the seven patient rights in order to properly calculate the medication (drug) dosages and administer it with proficiency including the most important part Documentation!!
NEVER FORGET TO RECONFIRM ALLERGIES BEFORE ADMINISTERING ANY MEDICATION TO ANY PATIENT!!
Without getting into all those details here is the formula that works for solids (tablets, capsules, caplets, spansules etc.) and liquids (syrups, elixers, injectables other than IVs or IOs which first need to be constituted and administered at a certain rate like drops/min or gtts/min or mL/hr which I will list separately!!)
Order (units) X Quantity (or Vehicle) (units)
Dosage = ______________________________________
Supply on Hand (units)
Dosage = Order (units) X Quantity (or Vehicle) (units) ÷ Supply on Hand (units)
Note: Before putting in the values you might need to convert Order or Supply in a manner that both MUST have the same units so that they will cancel each other and your answer will be in the units of the Quantity or the Vehicle that is carrying the medication like a tablet, caplet or a liquid in ml or cc!! If you are lucky they may already be same, but if they aren't you will need to know or have access to conversion tables and use them to convert one into the other so that both have same units like mg and mg or mcg (microgram) and mcg. If you don't convert they wont cancel each other out and you will get the wrong Dosage which can harm the patient or in the worse case scenario kill the patient!!
By the ways cc and ml are same!! No difference at all. 1 c.c. is the amount of space which is a cube whose each side is 1 centimeter and it can hold 1 milliliter of any liquid.
The Nursing Dosage Calculation for IVs...coming soon!!!.....Please Check Back.....
4) Suture Removal and Surgical Staples Removal Video Links for Allied Health Care Professionals:
Please remember that the incision site must first be inspected by the Health Care Provider and orders written for suture removal. When documenting suture or staple removal, please document the inspection findings (any redness, swelling, discharge and type of discharge - serous, serosanguinous, purulent etc) before and after the procedure and any complications. Also you will be required to write the total number of sutures/ staples present and the site/ location and how many were removed. If any were left behind please document the reason.
The YouTube videos may not work at places where YouTube is blocked, so I have attached the direct link for a very short non YouTube video.
How to Remove Sutures and Staples.
Direct Link: Removal of Surgical Sutures.
This Direct Link explains the importance of cutting the suture very close to the skin in order to prevent the contaminated part of the suture outside to pass through the suture track. Please notice that when the suture is being pulled out, one should always pull it towards the incision line. What is missing in this video is that you should remove the alternate sutures in order to prevent wound dehiscence (splitting open of the incision).
In the first video please note that the Suture cutting scissor has a curved grove close to the tip to easily get under the suture.
The Instructor in the second video does a great job at teaching the how's and whys of suture removal and surgical staple removal.
Thank you for updating your medical knowledge and clinical skills at Online Health Expert. I encourage each one of you to join Online Health Expert (Free and more interactive version) and share your knowledge, ask questions, and leave comments and feedback.
Sincerely,
Dr. Harish Malik
Direct Link: Removal of Surgical Sutures.
This Direct Link explains the importance of cutting the suture very close to the skin in order to prevent the contaminated part of the suture outside to pass through the suture track. Please notice that when the suture is being pulled out, one should always pull it towards the incision line. What is missing in this video is that you should remove the alternate sutures in order to prevent wound dehiscence (splitting open of the incision).
In the first video please note that the Suture cutting scissor has a curved grove close to the tip to easily get under the suture.
The Instructor in the second video does a great job at teaching the how's and whys of suture removal and surgical staple removal.
Thank you for updating your medical knowledge and clinical skills at Online Health Expert. I encourage each one of you to join Online Health Expert (Free and more interactive version) and share your knowledge, ask questions, and leave comments and feedback.
Sincerely,
Dr. Harish Malik
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Thank you once again for updating your medical knowledge at Online Health Expert.
Sincerely,
Dr. Harish Malik
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