NVQ evidence

Peak Flow
Peak Flow

Peak Expiratory flow rate is the measurement of the rate at which air is exhaled from the lungs through the mouth.

It is recommended that Peak Flow readings are taken morning and evening pre and 30 minutes post nebuliser/inhalers.



Factors affecting Peak Flow
• Age
• Sex
• Ethnic group
• Underlying aetiology [asthma, COPD, emphysema]
Procedure guidelines for recording Peak Flow
Equipment
• Peak Flow meter
• Clean mouth piece
• Chart for recording the result
Procedure
• Explain the procedure to the patient and obtain consent to ensure that the patient understands and has the information to make a valid consent.
• Establish patient’s current and best or predicted peak flow to provide a benchmark and make a comparison.
• Wash and dry hands to minimize cross infection.
• Collect and assemble equipment. Ensure that a new mouthpiece that is client specific so that cross infection risks are minimized
• Position client as is usual for them to have reading taken. Research recommends sitting where possible. This helps towards consistency of readings
• Zero meter for accuracy of readings.
• Ask client to breath through meter as hard as possible
• Note results
• Repeat twice more and record the results
• Return client to comfortable position
• Discard used mouthpiece and wash and dry hands to minimize cross infection.
• Return peak flow meter to storage for next use
• Determine highest reading. Note results in correct part of the client’s care plan (ie Peak Flow Chart)
• Report results as necessary







Pelvic floor exercises.
Life events, such as trauma and child birth, can cause the muscles at the base of the bladder to become weaker thus causing urine to be lost with normal activity or sneezing.
With specific exercise over an amount of time, these muscles can be strengthened.
The following exercises should be attempted for as much as 5 minutes three times a day to help strengthen the pelvic floor muscles.
It is important that the correct muscles are located. These are the muscles that are associated with starting and stopping micturition.
Also, imagine that you are trying to prevent the passing flatus. If there is a pulling feeling then the correct muscles are being used.





Aseptic technique
Equipment
Sterile Dressing pack
0.9% Normal saline
hypo-allergenic tape
Appropriate dressings


1 Explain and discuss the procedure with the patient to ensure that patient understand the procedure and is then able to give informed consent
2 Wash and dry hands and apply gloves and apron to prevent cross-infection
3 Clean trolley with hot water and detergent and clean paper towels to provide a clean working surface.
4 Place all the equipment required for the procedure on the bottom shelf of the clean dressing trolley to maintain the top shelf as the clean working surface.
5 Prepare client as necessary. Optimize comfort whilst ensuring that the treatment site is accessible. If the client is in an open ward setting, close curtains around bed space. Maximise client dignity as much as possible. Screening the area allows any airborne pathogens to settle before any sterile supplies are opened.
6 Wash and dry hands and apply gloves and apron to reduce cross-infection risk
7 Take the trolley to the patient, disturbing curtain/fixtures a little as possible to minimize airborne contamination.
8 Loosen the dressing tape of any dressings that are already in situ to facility their full removal later.
9 Remove gloves and wash and dry hands again and clean hands with a bacterial alcohol hand rub to reduce the risk of wound infection.
10 Check the pack is sterile in that the packet is not damaged, wet and opened to ensure the use of sterile products only.
11 Open the sterile dressings pack and open it out, touching the corners of the pack as little as possible to keep the risk of transfer of infection minimized
12 Open out all other required sterile products, ensuring that they are all intact, unopened and undamaged prior to opening.
13 Re-cleanse hands with alcohol rub as they can become contaminated by touching the outer rappings of the products.
14 Use the inverted disposable bag in the dressings pack like a glove to re-arrange the sterile field as required and use the bag to remove the old dressings if required. Stick the bag on the trolley.
15 Where appropriate, poor open the normal saline and poor into galipot provided. The normal saline should be warmed prior to use as this speeds up the time for the healing process to recommence. The heeling process only works when the wound is at body temperature. Removing the dressings and cleaning the wound with cold normal saline stops the healing process.
16 Apply the sterile gloves, touching only the inside wrist end to reduce infection risk. The use of gloves is preferred over forceps as the allow more precision as well as reduce the risk of trauma
17 Where wounds need irrigating, clean from centre of wound to outside so that infected material from the outside to the wound contaminated the epithelialising bed of the wound.
18 Use a wipe then discard method as to reduce infection risk.
19 Dry around the area and apply the required dressings fixing them on as necessary
20 Ensure that the patient is returned to a comfortable position.
21 Dispose of all clinical waste in that they yellowed clinical waste bag, includes gloves and apron to reduce infection risk.
22 Wash and dry hands
23 Apply gloves and clean trolley with detergent and dry as before.
24 Wash and dry hands
25 Record any information that is required in the client’s care plan such as:-
• What was carried out
• What material was used
• Any reference numbers of any surgical equipment used.

Mouth care,

Skin care

Client’s condition

Tube feeding