Clinical: Preparation, Procedures, Diagnostics, Pharmacology, Infection Control
Prepare, perform, protect
Clinical questions combine sequencing and safety. Vital signs anchors: adult pulse 60–100, respirations 12–20, oral temperature about 98.6 °F (37 °C), blood pressure near 120/80. Positions: Fowler/semi-Fowler for dyspnea, dorsal recumbent and lithotomy for pelvic exams, Sims for rectal procedures, Trendelenburg for shock, prone for back procedures, knee-chest for rectal or vaginal access.
Infection control: chain of infection, medical versus surgical asepsis, hand hygiene as the single most effective measure, Standard Precautions for all patients, and transmission-based precautions - airborne (N95 or higher, negative-pressure room), droplet, contact. Spaulding classification: critical items (sterile, enter tissue), semicritical (high-level disinfection), noncritical (low-level). Autoclave standard cycle is about 121 °C (250 °F) at 15 psi for 15–30 minutes; packaging, load density, and chemical/biological indicators must be monitored.
Pharmacology: the rights of medication administration, routes, common drug classes and side effects, dosage calculation by weight, prescription elements, and DEA schedules. Injection angles: intramuscular 90°, subcutaneous 45° (90° for some sites/needle lengths), intradermal 10–15°, typically on the inner forearm.
Diagnostics: venipuncture order of draw (blood cultures, light blue citrate, serum red/gold, green heparin, lavender EDTA, gray fluoride-oxalate), capillary puncture technique, specimen labeling at the bedside, CLIA-waived testing, ECG lead placement, and spirometry coaching. Sharps go in rigid containers immediately; never recap by hand.
Trap: angle, tube order, and "which precaution" questions. Rule of thumb: 90/45/10–15 for IM/subcutaneous/intradermal, and when in doubt, a blood culture tube precedes everything.