Blood pressure 2

it was not easy to take the blood pressure measurement . I need to practise more. In today practise i just can do 4 out of 20 correctly. it look like a long journey for me.

when talk with patient
let them know
-pulse pressure ( ....beat per min), the pulse is eg : strong and regular
- blood pressure ( ...per .... milimeter per mercury) ,state the position of the patient eg : siting

Blood Pressure - Clinical Lab

here are some video about taking blood pressure

1. http://www.youtube.com/watch?v=tB8nISCEcs8

Ethical class -Confidentiality

It already late today and i already sleepy.

i just summerise what i had learn today.

why we must kept the information confidential? (this the thing that being talked)

1. build up trust between patient and doctor
2. avoid harm escpecially to patient
   
3. information is personal and privacy, everyone own their own information
4. abuse of power
5. reputation
6. protect personal info
7. prevent embaressment
   
   

Go near bridge of the confidentiality? are you?

-will you do that ?

1. when should we tell the confidental ? -well actually it happen without intend to do so

well i need to read more ..it ethic right ? there is no right or wrong..it about our judgement. let build up our own knowledge

reference to be read

• http://www.gmc-uk.org/guidance/currrent/library/confidentiality.asp
• http://www.dh.gov.uk/assetRoot/04/06/92/54/04069254.pdf
• http://www.bma.org.uk/health promotion ethics/confidentiality/index.jsp
• and many more
  

that all ,
jzkk

Sleep again

i fall asleep ...suddenly..
why?
am i tired?
not enough sleep?
that people or even me say it

or it is more about that.. i dont know..

2 cups of coffee do not effect me at all. not even sweet. moving my legs,head and hand also not really effective. i went out to run when the gaps between lecture..still not helping..

i slept most in the lectures and practical class (skin).. quite blurr what i had learned today.
the day that had most of PPD lecture it happen again.

do i need to standing in lecture? how long can i struggle with it?
everyone getting bored to wake me up..hm..me too i guest. (thank for people thank help me to awake)



Ya Allah, please help me. give me strength.. be strong ...help me to cope with it.

Please be ACTIVE......you have to find how to overcome it..not just give reason.

GAmbatee!

any suggestion to overcome sleepness please tell me :)


RIGHT NOW...please see the recap back!!!! make sure you are not left behind..

Gathering Information 2

during yesterday lecture and today seminar about gathering information 2 these is what can i wrote:

type of question involve

1. open question (eg:what make you come to me today...can you tell me what do you feel...)
2. statement
3. clarifying question (get detail eg: you said you feel pain in your chest.can your describe more about it?)
4. problem question (get detail: kind similar too clarifying but it start from problem)
5. close question (usually have one answer eg : yes/no)

we was practising to use open question,close question,and summerising.

1. open question

• the benefit of this type of question it helps a lot for the interviewer get an overview what going on.
• usually interviewer tend to listen carefully and ask open question and statement to initiate interviewee to talk
• interviewee tend to talk more , and the content of the conversation mostly was dominated by the interviewee (she can talk what she want)
• the conversation runs smoothly
• but the interviewer cannot know the detail from the conversation.

2. close question

• interviewer tend to talk more (more question needed to get the information)and will be running out question easily
• interviewee tent to easily answer the question without thinking deeply because the question will be usually one answer (eg: yes/no)
• the conversation not running smoothly

3. summarising

• a powerfull method to show to the interviewee that the interviewer is listening
• help the interviewer get the information correctly and precisely
• interviewee tend to hear back and add the additional point or the missing point.
• tips if the interviewer is running out of the question

the was a video session about patient and doctor. we being discuss together how to responce to the patient.

conversation:

what do you feel? (no matter what do not always express your feeling to patient unless it suitable time)

what the patient feel?

platitudinous response? (dismiss the patient feeling) eg : it ok everthing will be alright.

emphatic response?

eg:

I adknowledge that you are....

I can see you have a very difficult time. what can i do for you?

dont ever say I understand that..........

because we just imaging the feeling ..

look like i must practise more to create open question, platitudinous respons,emphathic respons..

if you all have any example of the question,how to respon or to comment ,i glad to know that .

that all..need to go to my english class :writing this evening .

smile always and stay focus

jazakallahu khairan,

EULA class- listening and speaking ( 1 day)

today were quite buzy as my class finish at 7. hmm

my first class for speaking and listening really good. alhamdulillah i manage to register and be continue for sem 2.

this semester i will learn on how to speak in seminar...talking in small group..well it good for me.
beside my classmates come from different country and most of them doing PHD and Master .hmm probably i can have different point of view then. hopefully this class will going to be work.

General Chest Examination

i do not really know what should i wrote today. just try to summarised chest examination that i practise just now.

1. wash hand while introduce myself
2. ask the name and date of birth of the patient.
3. take letter of consent eg : " can i do chest examination to you today? "

inspection

1. make sure the patient sit 45 degree position in a comfortable way.
2. ask the patient to take out shirt
3. stand opposite of the patient (in front of the bed) and look for the the patient face( look ill or not) and scar( had accident or any surgery before)
4. ask the patient to breath deeply ( see the chest expansion - whether normal heart rate and ,symmetrical )
5. look for any ankle oedema
6. ask the patient to lift up hand and make it straight (show method)- see for any nicotine stain and clubbing + hypercarpnic termors* (eyes in same level of the patient hand)
7. check for palmar erythmia( tgn bwh ) and flapping (tgn 90 darjah)
8. check pulse rate *
   
9. ask patient to turn left- check for JVP raise ask patient to stick out tounge and lift it upward - (see any anemia or central cyanotic*)
10. look for the anemia(pale) and jaundice( yellow) when ask patient to look up and look down while streching it.

palpation

1. check trachea is central or not
   
2. check apex beat (normal- in 5th intercostal space at midclavicular line)
3. check for lymph node*
4. check chest expansion at upper and lower chest
   
5. ask patient to say "99" during palpation of both hand at 8 place of the body ( check vocal fremitus)

percussion

1. percussion the same place like to check vocal fremitus but add with both clavicle ( make it in sequece to compare between both side)

auscultation
1. ask patient to breath deeply through out the mouth when you are put the stethoscope to the patient while open the (6 places)
2. do the same step but ask the patient to say "99". (for bronchial vesicular breath sound, and vocal resonance)



ask patient to sit to the left and make her back of body facing opposite me

1. check for the scar, breathing rate, palpation,percussion, and auscultation again.

say thank you.

then summarise.

p/s: * = indicate (i am not really know what that , not familiar word)

i wrote in before sleeping ..if there are any comment or suggestion or additional information i will happy to hear that, thank you

time to sleep ..zzz , a buzy and adventure day tomorrow.
hope to keep strong ..and still smiling.