catheterisation - points i tend to miss

- explain why to do it
- wash hands
- maintain dignity as far as possible.
- double gloving
- not 'dropping the penis in to the sterile field'
- retracting foreskin before and after
- cleaning clockwise from centre out, each time, from twelve, from 3, from 6 from 9
- making sure the catch tray is there at the end of the catheter to catch the urine
- asking the patient if they feel pain at any point in time- especially at point of distending the balloon to hold in bladder trigone area...cos if ur blowing it up in the middle of the urethra u'll end up with trouble and major pain - do not want that!!

-Note size of catheter and volume of water used for ballooning to document in notes.
- making sure that you wait for 2-3 mins for anaesthetic to work, some say hold tip closed/massage down, but im not sure how to do that effectively

- clean sterile trolly down maintain clean area with alcohol, then open up pack so not touching inner sterile area. Drop everything in inner sterile area.

- make sure that the sterile solution is in the sterile bit filled already by yourself

- tear up the main bit of paper for passing over the penis area..clear field

- clearing everything away
- waiting for 3-4 mins while bag fills, chekcing urine for discolouration, blood, general appearance, and remember to put bag on the end of the tube.

-document in the notes : date, size of catheter, patient name, amount of water used for blowing up balloon, for colour and appearance of urine, any probs etc. sign ur name.

Obs and Gynae pocket doctor template

this is the gynae history from the POCKET DOCTOR booklet:

INTRO

CHECK
Patient name and age

PRESENTING COMPLAINT

HISTORY OF PRESENTING COMPLAINT

1. BLEEDING
menarche
period regularity
heavy? if yes: pad changing per day/flooding/clots/tiredness
LMP
IMB/PCB/PMB
Discharge: if yes: colour, smell

2. FERTILITY
Sexual contacts
STI's
contraception: barrier and birth control
HRT if post-menopause
Pregnancy attempts
Smears: last date and result
Breast screening

3. PAIN
Painful periods? at what part of cycle
Painful sex? On penetration/during

4. UROGYNAE
Prolapse: dragging sensation/something 'coming down'. Back pain.
Urinary: incontinence? relation to coughing/sneezing/straining
Urinary symptoms: freq, noct, dysuria, strangury, hameaturia, unable to interrupt stream.
Bowel habits: esp change in habits.

OBSTETRIC HISTORY
Pregnancies: date delivered, mode, weight, problems.
Miscarriages: gestation?
Termination: gestation, reason?
ectopics

PAST MEDICAL HISTORY
esp gynae operations

DRUG HISTORY

FAMILY HISTORY

SOCIAL HISTORY

summary
address pesky concerns

[Kindly written up by a friend]

'Explanations' Template for OSCE's or in life.

A friend of mine said:

real simple template:
egs are for endoscopy

1. WHAT it is and WHY we do it (camera test to look for ulcers/bleeding)
2. HOW we do it (spray at back of throat, thin camera tube in mouth)
3. SIDE effects and RISKS (sore throat and infection/perforation)
4. RESULTS: when and how you get them
5. PREPARATION and AFTER the procedure (eg starve 6hrs before endoscopy, have a lift home organised)

its quite basic, but covers most things!

In essence its, why what how, side effects, risks, complications, results, preparation, afterwards [immediate, short term, longterm]