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BSN Program
Lincoln University
NUR 230 Principles of Nursing Skills
Course Syllabus
Spring 2017
COURSE DESCRIPTION
This course introduces the skills and concepts required to deliver safe and professional nursing
care throughout the adult life span, utilizing evidence based practice. Students will explore basic
nursing skills ranging from hygiene, vital signs, assessment, mobility, concepts of sterility, IV
therapy and medication administration. This course has 3 hours of theory and 3 hours of
laboratory per week. Prerequisite: Admission to BSN program. Co-requisites: NUR 200, AGR
303A, NUR 220/220H
CREDIT HOURS: 4 hours (48 theory clock hours, 48 lab clock hours)
COURSE OBJECTIVES
1. Utilize concepts from arts and sciences to safely perform clinical skills. [1.230]
2. Demonstrate a culture of safety and caring through teamwork. [2.230]
3. Apply the concepts EBP in selected simulated scenarios. [3.230]
4. Demonstrate competency in skills related to patient care technologies, information
systems and communication devices that support safe practice while upholding patient
confidentiality. [4.230]
5. Demonstrate knowledge of policies that guide the financial and regulatory environments
of healthcare. [5.230]
6. Utilize effective communication techniques with the inter-professional healthcare team.
[6.230]
7. Demonstrate teaching interventions during a simulated scenario. [7.230]
8. Demonstrate professional behaviors consistent with core nursing values as guided by the
ANA Code of Ethics and State Practice Act. [8.230]
9. Demonstrate basic clinical reasoning utilizing the principles of nursing skills within the
simulated environment. [9.230]
The numbering system used in the Department of Nursing and Allied Health is used to link the
end-of- program student learning outcomes to the course objectives and unit objectives. The first
number in 1.220.1 represents the end-of-program student learning outcome and corresponding
course objective. The second number in 1.220.2 represents the course number. The third number
1.220.2 represents the unit of study.
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FACULTY
Dr. Anne Heyen, DNP, RN
105 Elliff Hall
Office Phone: 573- 681-5490
Fax Number: 573-681-5422 (Please use cover sheet with “Attention-Anne Heyen”)
E-mail Address: [email protected]
Michelle Nolph
105 Elliff Hall
Office number: 573-681-5421
Fax Number: 573-681-5422 (Please use cover sheet with “Attention Michelle”)
Email Address: [email protected]
OFFICE HOURS
Dr. Anne Heyen DNP, RN
Mondays 0830-0900; 1300-1530
Tuesdays 0825-0925; 1300-1500
1st 8 weeks
Wednesdays 1300-1500
Thursdays 0830-1100
Mondays 0830-0900; 1300-1530
Tuesdays 0825-0925
Wednesdays 1500-1600 at SSM
Thursdays 0830-1100
2nd 8
weeks
We are here to assist you in being successful with this course. Please feel free to make an
appointment with me any time that you need assistance. We do ask that you make an
appointment so that both your time and the instructors can be spent efficiently.
REQUIRED TEXTS
Deglin, J. & Vallerand, A. (2012). Davis drug guide for nurses (13th ed.). Philadelphia: F.A.
Davis.
Pickar, G., Dosage Calculation: A ratio-proportion approach (3rd ed.). Clifton Park, New
York: Delmar Publishing.
Venes, D. (Ed). (2013). Taber’s cyclopedia medical dictionary (22nd ed.). Philadelphia:
F.A. Davis.
Wilkinson, J. M., & Treas, L.S. (2016). Fundamentals of nursing, (Vol. 1&2), (3rd ed.).
Philadelphia: F.A. Davis.
Wilkinson, J.M. (2016). Fundamentals of nursing skills CD (set of 3). Philadelphia: F. A. Davis.
Lab Supply Kit to be purchased from bookstore
REQUIRED WEB SITE
AACN (2008). The Essentials of baccalaureate education for professional nursing practice.
Retrieved from http://www.aacn.nche.edu/Education/pdf/BaccEssentials08.pdf
APA Writing Style http://www.apastyle.org
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TEACHING/LEARNING METHODS
Teaching/learning methodologies in the theory portion of this class will include: class discussion,
case studies, quizzes and tests. Teaching/learning methodologies in the laboratory portion of this
class will include demonstration of skills, active participation in simulations and debriefing.
GRADING CRITERIA
A student must pass theory and laboratory to receive a passing grade for the course. Students
must achieve 75% of the total points in the course in order to satisfactorily complete the
classroom portion. Each student must satisfy all requirements for all components of each
nursing course. It is not an option to omit turning in an assignment. A grade of “C” or better is
required for progression in the BSN Program. The laboratory is graded on a pass/fail system. A
passing grade must be obtained in all skills performed in order to be successful in this class. A
student who fails theory or the laboratory will receive a failing grade in the course. All
laboratory components must be completed in order to pass the course.
CLASSROOM EVALUATION METHODS
Attainment of the course objectives will be evaluated relative to the following:
Quizzes
20 points
Test #1
50 points
Test #2
50 points
Test #3
40 points
Test #4
40 points
Final (comprehensive)
50 points
Total Points
250 points
Grading Scale
Grades will be determined as following:
90 %- 100% = A (225-250 points)
80%- 89%
= B (200-224 points)
75% - 79%
= C (188-199 points)
60%-74%
= D (150-187 points)
Below 60%
= F (less than 149 points)
Laboratory Evaluation Methods
In order to pass the laboratory portion of the course, the student will successfully meet all
laboratory performance expectations as detailed in skills performance sheets which can be
located in a printed form in the practice lab and electronically in your Canvas course.
Passing (P) performance is defined as practice that is safe, accurate and consistent. The student
needs minimal cues in order to accomplish the skill. Demonstration of successful performance
in laboratory will be evaluated by:
 Safe, accurate and consistent demonstration of all skills.
 Requires minimal verbal cues to complete skills.
 Utilizes available learning opportunities.
 Improves performance with practice.
 Improves performance following constructive feedback.
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


Demonstrates required knowledge base and accurate judgments.
Follows policies and procedures of the course and department.
Completes required laboratory objectives.
Failing (F) performance is defined as practice that is unsafe and/or unsuccessful in
demonstrating desired behaviors. The student needs repeated verbal and/or nonverbal cues from
the instructor and is unable to meet one or more of the laboratory expectations. Failing
performance is validated by:











Unsafe, inaccurate, and/or inconsistent work of below average quality.
Requires repeated verbal cues to meet outcomes.
Fails to engage in learning opportunities.
Fails to demonstrate adequate knowledge base and/or inaccurate judgments.
Fails to improve with practice to expected level.
Lacks appropriate level of self-direction.
Fails to accept responsibility for learning outcomes.
Fails to change behavior following feedback.
Fails to communicate learning needs.
Fails to follow policies and procedures of the course and department.
Fails to complete required laboratory objectives.
The laboratory skills performance is based on a pass/fail. Skills must be successfully completed
by the assigned calendar date. Failure to complete skills by the assigned date could result in a
number of consequences from behavioral contracts, up to course failure dependent upon
discretion of the course instructors. Personal care and hygiene, vital signs, physical assessment,
and medication administration check-offs will be completed face to face with an instructor.
If a student does not pass a skill check off on the first attempt, the student will contact lab staff
for remediation within one day. The student must then complete one hour of practice, in addition
to the required weekly lab practice time. After the required one hour of practice, the student will
arrange a date for a second check off with either practicum or lab faculty. The second check must
occur within one week following the unsuccessful attempt. In the event of a second
unsuccessful attempt, the third and final attempt and will be submitted as a video, following a
second meeting with lab staff and a second additional hour of lab practice. The meeting with lab
staff must occur within one day of the second unsuccessful attempt. The video for the third and
final attempt must be submitted via Canvas within one week of the second unsuccessful attempt.
CLASSROOM REQUIREMENTS
Attendance
Students are expected to attend all lectures, seminars, laboratories and field work for each
registered class and to complete all work assigned by the instructor. Due to the relationship
between class attendance and final course grades, total absences ideally should not exceed twice
the number of time a class meets per week. Therefore, this class meets twice per week; a
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maximum of four absences will be acceptable. If a student exceeds the maximum number of
acceptable absences for a course, the course instructor may choose to lower the student’s grade
by one letter grade. Absences, excused or unexcused, may jeopardize the student’s ability to
meet the course objectives. Coming to class late or leaving early may be counted as an absence.
Absences are required to be documented in our Learning Management System.
Lateness
No late work will be accepted without prior approval from instructor. Students are expected to
be to class on time. If a student demonstrates a pattern of lateness without a call, he/she may not
be allowed to enter the class until break. This sixteen-week course will require students to keep
pace completing the course in the time allowed and in a quality manner. Please keep in mind
that work commitments, personal commitments, or travel commitments do not constitute reasons
for late work.
Quiz Policy
Makeup quizzes will not be given. If a student misses a quiz for any reason, he/she forfeits those
quiz points. Quizzes may be announced and or unannounced.
Test Policy
Tests will be taken on the day they are scheduled. The only reason a test may be given on an
alternate date or time would be for the death of immediate family, personal illness, or military
orders. Prior notification and written documentation is required. Arrangements for makeup
times must be made by the student within one week of the missed exam. If no arrangements are
made, the student will receive a zero for that test.
Cell phones
Cell phones must be placed on silent and put away during class. They must be turned off for
testing and testing review.
Communication/Email
Students are expected to check their LU and Canvas e-mail on a frequent and regular basis in
order to stay current with University related and course related communications, recognizing that
certain communication may be time critical. It is recommended that your email and
announcements be checked at least 2-3 times per week. Checking it on a daily basis is preferred.
The instructor will only communicate through the Lincoln University e-mail and your
Canvas email not your personal e-mail. Please note, as with all computer systems, there may
be occasional scheduled downtimes, as well as, unanticipated disruptions. Students who do not
have internet access at home may use computers in Elliff Hall, Page Library, or MLK. Technical
assistance can be obtained by contacting the Center for Teaching and Learning at 573-681-5777,
the Office of Information Technology at 573-681-5888, the Canvas helpdesk which can be
accessed by clicking the “help” button in the upper right corner of Canvas, or calling Canvas at
855-912-8224.
LABORATORY REQUIREMENTS
Laboratory Portfolio
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Due to the nature of laboratory experiences and the risk of injury in NUR 230L, all nursing
students are strongly encouraged to have health insurance. The cost of treatment for illness or
injury is the responsibility of the individual student.
Tardiness/Absenteeism
A student who is going to be tardy or absent from practicum must notify his/her instructor prior
to the time practicum is going to start. Each instructor will inform her/his group of the procedure
for contacting her/him. A pattern of lateness and/or absenteeism will lead to a conference with
the instructor, and, if this behavior persists, it may lead to dismissal from the nursing program.
A no call/no show absence on a practicum day may result in a practicum failure.
Dress Code
Students are expected to follow the LU Nursing Science Department dress code while
participating in laboratory and simulations experiences. A copy of the dress code may be found
in the BSN Student Handbook.
Cell phones
Cell phones are not allowed during class time.
Orientation to Laboratory
Please refer to laboratory orientation videos in the Canvas LMS course for the Simulation Lab.
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Units
Points
Topical Outline
Weeks
Unit 1
Week
1
Personal Care and Hygiene
Unit 2
Weeks
2-3
Unit 3
Week
4
Unit 4
Weeks
5-6
Unit 5
Week
7
Unit 6
Weeks
8-9
Assessment/Patient Safety
Check off on hand washing and personal care/hygiene
Test 1 (units 1 and 2)
Mobility
Vital sign check off
Medication Administration
Math quiz (week 6)
Assessment check off (week 5)
Test 2 (units 3 and 4)
Wound Care
Medication Administration check off
GI/GU
Math quiz
Dressing change video due (week 8)
Enema video due (week 9)
Unit 7 Oxygenation and Circulation
Week Urinary catheterization video due
10
Unit 9 Exam #3 (units 5, 6 and 7)
Week Objective 1 Math
11
Suction video due
P/F
45
P/F
5
P/F
45
P/F
5
P/F
P/F
P/F
45
P/F
Unit 8
Week
12
Nutrition
Math quiz
10
Unit 9
Week
13
Unit
10
Weeks
14-15
IV’s
NG tube video due
P/F
Exam #4 (Unit 8 and 9)
Simulation Week
Incorporate all skills
45
P/F
P/F
IV start and removal video due
Week
16
Final
50
Total Points
250
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ACADEMIC INTEGRITY
Lincoln University holds its students to high standards of academic integrity and will not tolerate
acts of falsification, misrepresentation or deception. Such acts of intellectual dishonesty include,
but are not limited to, cheating or copying, fabricating data or citations, stealing examinations,
taking an exam for another student or having another student take an exam intended for oneself,
tampering with the academic work of another student, submitting another’s work as one’s own,
facilitating other students’ acts of academic dishonesty, using internet sources without citation
and plagiarizing. You are responsible for understanding the definition of plagiarism and for
proper documentation of written work. Turnitin, plagiarism software, may be used in this course
and may be an expectation prior to submitting papers as directed. Additional information about
turnitin can be found on the homepage of this course.
Any student guilty of cheating will be reported to the Department Head of Nursing and may be
reported in writing to the Dean of the College of Professional Studies. Discipline could include
course grade reduction, departmental probation, program dismissal, and/or submission of the
matter to the Office of Student Affairs.
Summarizing, Paraphrasing, and Quoting
When you are citing sources in your formal written work, you have three choices of how to
present someone else’s published information. You can summarize the main idea(s) of the entire
text, you can paraphrase a section of the text by putting it into your own words, or you can quote
from the text word for word. Each of these techniques require an in-text citation where you
indicate the last name(s) of the author(s) and the year of publication; if you quote directly from
any source, you also need to include the page or paragraph number where this text can be found.
You need not limit yourself to one of these techniques. In fact, it is encouraged that you use all
three when submitting your responses/written papers. Why do you use any of these techniques in
your academic writing? It’s not enough that you have experienced a trend or that you are aware
of an issue; think of academic writing as investigative reporting and you need someone else’s
writing and ideas to build a foundation for your own insights and observations. Some published
authors seem to have captured exactly what you wish to have written; that is when using a direct
quotation provides strength and support for your theories. Limit the number of quotations, since
the responses/papers are to be your writing, not merely the parroting of published sources on that
topic.
SOCIAL NETWORKING POLICY
Client confidentiality is an integral part of the role of the nurse and described in the Code of
Ethics with Interpretive Statements, (ANA, 2015). We believe the student is responsible for
maintaining patient confidentiality in all aspects of the students’ life. This includes social
networking sites (Twitter, MySpace, Facebook, etc.), as well as, personal conversations, and
written work.
Social networking sites can often reach further than a student might intend but the consequences
are the same, regardless of the intentional or unintentional nature of the breach of confidentiality.
Consequences include probation, departmental dismissal and up to university dismissal. Breach
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of confidentiality agreement will be determined by nursing faculty. The department expects
students to adhere to the ANA’s Principles for Social Networking and the Nurse (2011) as
described in the BSN Student Handbook.
TITLE IX
Lincoln University prohibits discrimination on the basis of sex, including sexual harassment, in
education programs and activities. Title IX protects individuals from harassment connected to
any of the academic, educational, extracurricular, athletic and other programs, activities or
employment of schools, regardless of the location. Title IX protects all individuals from sexual
harassment by any school employee, student, and a non-employee third party. This policy
applies equally to all students and employees regardless of the sex, gender, sexual orientation,
gender identity, or gender expression of any of the individuals involved. No officer, employee,
or agent of the institution participating in any program under this title shall retaliate, intimidate,
threaten, coerce, or otherwise discriminate against any individual for exercising their rights or
responsibilities under any provision of this policy.
SERVICES FOR STUDENTS WITH DISABILITIES
Students are hereby notified that this institution does not discriminate on the basis of race, color,
national origin, sex, age, or disability in admission or access to its programs and
activities. Questions that may arise in regard to the University's compliance with Section 504 of
the Rehabilitation Act and the Americans with Disabilities Act should be directed to the
Coordinator for Access & Ability Services, 304 Founders Hall, Lincoln University, Jefferson
City, Missouri 65102-0029.
For more information, contact the Coordinator of Access & Ability Services at: 304 Founders
Hall; 573-681-5162, email: [email protected].
COURSE EVALUATION
Students will be given the opportunity to evaluate the course and faculty at the end of the
semester (using standardized forms online) to ensure ongoing quality improvement.
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Unit Objectives
Unit 1: Personal Care and Hygiene
Lecture
1. Describe factors that require the use of personal protective equipment[1.230.1a]
2. Describe hygienic care that nurses provide to clients. [2.230.1a]
3. Identify safety and comfort measures underlying the bed making procedures. [2.230.1b]
4. Identify indications for hand hygiene and standard precautions. [3.230.1a]
5. Identify cost saving ability in personal care supplies. [5.230.1]
6. Identify and discuss professional behaviors used in providing patient care. [8.230.1a]
7. Identify clinical reasoning utilizing the principles of nursing skills. [9.230.1]
Lab
1. Demonstrate donning and removing personal protective equipment. [1.230.1b]
2. Demonstrate hygienic care that nurses provide to patients (bath, pericare, oral and hair).
[2.230.1c]
3. Employ skills required to perform an unoccupied and occupied bed linen change. [2.2230.1d]
4. Demonstrate correct hand hygiene and standard precautions. [3.230.1b]
5. Demonstrate professional behaviors in the performance of patient care. [8.230.1b]
Focus
Personal Protective
Equipment
 Donning PPE
 Removing PPE
 Standard Precautions
Hygiene
 Hand hygiene
 Bathing
 Peri care
 Oral care
 Hair care
Bed making
 Occupied bed
 Unoccupied bed
Reading
Assignment:
Wilkinson &
Treas
V. 1 P. 535-538
Learning Experiences
Review of applicable content from
previous/concurrent nursing curriculum
courses
Ch. 23 Vol. 2, Clinical Reasoning:
Thinking and Doing (page 345)
V. 2 Procedures
23-1, 23-2, 23-3
Practicum
insights 23-1; 232; 23-3
V. 1 P. 535
Ch. 25, Vol. 2 Clinical reasoning
Ch. 25
questions 3 and 4 (page 405).
V. 2 Procedures
25-1, 25-2, 25-3,
25-4, 25-5, 25-6,
25-7, 25-8, 25-9,
25-10
V. 1 Ch. 22
V. 2
Procedures 2513, 25-14
Thinking About the Procedure,
answer the following questions:
25-14 #1,2
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Unit 2: Assessment and Patient Safety
Lecture
1.
2.
3.
4.
5.
6.
Discuss anatomy and physiology related to physical assessment. [1.230.2]
Explain fall prevention measures. [2.230.2a]
Identify essential guidelines for safe and efficient body movement. [2.230.2b]
Identify indications and contraindications for the use of restraints. [2.230.2c]
Identify the acceptable range of vital signs for the adult population. [3.230.2a]
Describe the variations in techniques used to obtain vital signs for the adult population.
[3.230.2b]
7. Describe the purpose of the physical assessment. [3.230.2c]
8. Describe normal and abnormal physical findings for the adult population. [3.230.2d]
9. Use the nursing process assessment of pain and pain control. [3.230.2e]
10. Describe how communication can enhance the physical assessment process. [6.230.2a]
11. Demonstrate clinical reasoning utilizing the principles of nursing skills. [9.230.2]
Lab
1. Utilize proper assistive devices when lifting and transferring patient s. [2.230.2d]
2. Demonstrate appropriate use of restraints and reporting of falls. [2.230.2e]
3. Demonstrate accurate assessment of patient ’s vital signs. [3.230.2g]
4. Perform a basic physical assessment of the adult patient. [3.230.2h]
5. Identify ways to collaborate with inter/intra professional team related to assessment findings.
[ 6.230.3b]
Focus
Reading
Assignment:
Wilkinson &
Treas
Learning Experiences
Review of applicable content from
previous/concurrent nursing curriculum
courses
Falls
 Fall prevention
 Bed alarms
 Documentation of falls
 Use of restraints
Mobility
 Safe and effective body
movements
 Assistive devices
 Positioning
 Positioning devices
Vital signs
 Acceptable ranges of
VS for adults
 Variations in
V. 1 P. 552-554;
570
Ch. 24 Vol 2 “Doing” questions 3-4 pg
359.
V. 2 Ch. 24
V. 1 P. 835-842
Chapter 32
V. 2 Practicum
insight 32-1, 322
V1. Ch. 20
Go to Practice Documentation, on the
Student Resource Disk to practice
documentation for a patient
experiencing mobility problems.
Vol. 2 Ch. 20 Clinical reasoning
questions 1-4 (page 207).
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techniques to obtain VS V. 2 Procedures
20-1, 20-2, 20-3,
20-5, 20-6,
Assessment
V. 1 Ch. 22
 Purpose
V. 2 Procedures
 Normal vs. abnormal
22-1, 22-2, 22-3,
findings
 Communication during 22-4, 22-5, 2212, 22-13, 22-14,
assessment
22-15, 22-20.
 Pain assessment
 Intake and output
Practicum
insights 22-2
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Unit 3: Mobility
Lecture
1. Discuss the musculoskeletal system. [1.230.3]
2. Discuss the use of a gait belt. [3.230.3a]
3. List the steps in assisting a patient to transfer from (A) bed to bed, (B) bed to chair, and (C)
chair to bed. [3.230.3b]
4. Discuss the responsibilities of the nurse when ambulating a patient with and without
assistance. [3.230.3c]
5. Demonstrate technology skills that support safe nursing care of patient s with basic mobility
needs. [4.230.3]
Lab
1. Demonstrate how to effectively support and maintain alignment when positioning and
transferring patients. [3.230.3d]
2. Demonstrate turning of patients in bed and the various methods of transferring patients.
[3.230.3e]
Focus
Reading
Learning Experiences
Assignment:
Wilkinson &
Review of applicable content from
Treas
previous/concurrent nursing
curriculum courses
Mobility
 Safe movements
 Gait belts
 Lifts
 Beds
 SCD’s
Transfer
 Bed to bed
 Bed to chair
 Chair to bed
V. 1 Pages 836846
Positioning
 Maintaining alignment
 Positioning devices
 Moving up in bed
Assisting with ambulation
V. 1 P. 86-846
Vol 2, Ch. 32 “doing” questions 3-4
P. 648
V. 2 Ch. 32
V. 1 P. 836-846
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Unit 4: Medication Administration
Lecture
1. Utilize math principles required to safely administer medications. [1.230.4a]
2. Describe safety measures in relation to medication administration. [2.230.4a]
3. Describe the roles of the prescriber, pharmacist, and nurse in medication administration.
[2.230.4b]
4. Describe the nursing process and EBP related to medication administration. [3.230.4a]
5. Describe the steps in preparing and administering medications. [3.230.4b]
6. Describe appropriate communication when preparing medications. [ 4.230.4a]
7. Discuss economic factors related to medications. [5.230.4]
8. Identify ways to collaborate with primary care providers in the administration of medication.
[6.230.4a]
Lab
1. Use previously learned math skills to compute a correct medication dose. [1.230.4b]
2. Implement safety measures when administering medications. [3.230.4c]
3. Practice setting up medications for administration. [3.230.4d]
4. Demonstrate correct techniques in medication administration. [3.230.4e]
5. Demonstrate operation of an IV pump. [4.230.4b]
6. Use the EHR for documentation and communication of medication administration. [4.230.4c]
7. Utilize effective communication with the inter/intra professional healthcare team. [6.230.4b]
Focus
Math Principles
 Apothecary system
 Household system
 Metric system
 Computing doses
 Reconstitution
Medication administration
 Safety measures
 Oral medications
 Rectal medications
 Topical medications
 Ophthalmic medications
 Drawing from
ampule/vial
 Routes (oral,
subcutaneous,
Reading
Assignment:
Wilkinson & Treas
Learning Experiences
Review of applicable content from
previous/concurrent nursing
curriculum courses
Dosage Calculations
book: chapters 3, 4,
12
Review other chapters on an
individual need basis
V. 1 Ch. 26
Chapter 26, Vol 2. Clinical
reasoning question 3 (page 485)
V. 2 Medication
guidelines;
Procedures
26-1, 26-2, 26-6,267, 26-9, 26-10, 2612, 26-13, 26-14
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intramuscular)
Documentation in the EHR
Communication in medication
administration
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Unit 5: Wound Care
Lecture
1. Discuss the inflammatory process. [1.230.5a]
2. Recognize the difference between clean and sterile technique. [3.230.5a]
3. Identify alterations in skin integrity. [3.230.5b]
4. Discuss the principles of asepsis. [3.230.5c]
5. List the steps used in: (A) assessing wounds and pressure ulcers; (B) performing a dry
dressing change; (C) performing a wet to dry dressing change; (D) applying bandages and
binders; (E) irrigating a wound, and (F) care of wound drains. [3.230.5d]
6. Discuss appropriate wound care treatments. [4.230.5a]
Lab
1. Demonstrate methods of preventing the transmission of microorganisms. [1.230.4b]
2. Perform various methods of dressing changes to include sterile technique and gloving.
[3.230.5e]
3. Apply an abdominal binder. [3.230.5g]
4. Demonstrate setting up a sterile field and gloving. [3.230.5h]
5. Demonstrate competency in management and care of a wound vac. [4.230.5b]
Focus
Inflammation
Clean vs. Sterile technique
 Medical asepsis
 Surgical asepsis
 Sterile fields
 Sterile gloving
Wound Care
 Wound assessment
 Dry dressing change
 Wet to dry dressing
change
 Wound vac
 Irrigation of a wound
 Apply bandages
 Apply binders
 Wound vacs
Wound drains
 JP
 Hemovac
 Penrose
Reading
Assignment:
Wilkinson &
Treas
Learning Experiences
Review of applicable content from
previous/concurrent nursing
curriculum courses
V. 1 P. 247-248
V. 1 P 533-543
V. 2 Procedure
23-7, 23-8
Clinical insight
23-7
V. 1 P. 920-930
V. 2 Procedures
35-3, 35-5, 35-6,
35-7, 35-8, 35-9,
35-10, 35-11, 3513,
Ch. 35 Vol. 2 Clinical reasoning
“thinking, doing, caring” questions
Page 717-718
V. 1 P. 922
V. 2 Procedure
35-15
16
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Unit 6: Bowel and Bladder
Lecture
1. Discuss the anatomy and physiology of the bowel and renal systems. [1.230.6]
2. Verbalize the steps required in delivering catheter and ostomy care. [2.230.6b]
3. Discuss the various types of catheters and their respective care and maintenance. [2.230.6c]
4. List the steps used in: (A) assisting with the bedpan, (B) administering an enema, (C)
removing a fecal impaction. [3.230.6a]
5. Describe nursing interventions to maintain normal urinary elimination, prevent urinary tract
infections, and manage urinary incontinence. [3.230.6b]
6. List the steps used in: (A) applying an external urinary device; (B) performing urinary
catheterization; and (C) performing intermittent and continuous bladder irrigation. [3.230.6c]
7. Describe the methods of obtaining urine samples: clean catch, routine, and sterile. [3.230.6d]
8. Relate the financial impact of hospital acquired infections to urinary catheter use. [5.230.6]
Lab
1. Demonstrate ostomy care. [3.230.6e]
2. Demonstrate the administration of an enema. [3.230.6f]
3. Demonstrate insertion of a catheter on a male and female. [3.230.6g]
4. Demonstrate how to obtain urine samples. [3.230.6h]
5. Demonstrate removal of a urinary catheter. [3.230.6i]
Focus
Bowel Elimination
 Ostomy care
 Bedpan
 Enema administration
 Removing fecal
impactions
Reading
Assignment:
Wilkinson &
Treas
V.1 Ch. 29
Learning Experiences
Review of applicable content
from previous/concurrent nursing
curriculum courses
Ch. 29 Vol 2 Clinical reasoning
question 2 (page 596)
V. 2 Procedures
29-2, 29-3, 29-4,
29-6, 29-8,
17
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Unit 7: Oxygenation and Circulation
Lecture
1. Discuss the anatomy and physiology of the respiratory and cardiac systems. [1.230.7]
2. Discuss safety issues related to oxygen therapy and safe handling of equipment. [2.230.7a]
3. Describe the nursing assessment for oxygenation status. [3.230.7a]
4. Discuss the various mechanisms of oxygen delivery. [3.230.7b]
5. Recognize the importance of trach care and suctioning. [3.230.7c]
6. Describe safety precautions for the patient with a chest tube. [3.230.7d]
7. Identify the purpose of an incentive spirometer. [7.230.7a]
Lab
1. Demonstrate safe handling of oxygen equipment. [2.230.7b]
2. Demonstrate application of appropriate oxygen delivery devices. [3.230.7e]
3. Demonstrate suctioning of airways. [3.230.7f]
4. Perform tracheostomy care. [3.230.7g]
5. Demonstrate use of oxygen monitoring devices. [4.230.7]
6. Apply teaching principles in instructing patients in the use of an incentive spirometer.
[7.230.7b]
Focus
Oxygen therapy
 Safety issues
 Mechanisms of
oxygen delivery
 Incentive spirometer
 Oxygen monitoring
 Airway suctioning
 Nasal and oral
airways
Tracheostomy
 Trach care
 Trach suctioning
 Safety issues
Chest tubes
 Care of chest tubes
 Safety issues
Reading
Assignment:
Wilkinson & Treas
V. 1 Ch. 36
Learning Experiences
Review of applicable content from
previous/concurrent nursing
curriculum courses
Ch. 36 Vol. 2 Clinical reasoning
question 2 (page 769)
V. 2 Procedures 362, 36-4, 36-5, 36-8
Clinical insight 361, 36-3
V. 2 Procedures 366, 36-7, 36-9
V. 2 Procedures
36-11
Practicum insight
36-5
18
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Circulation
 Pulse oximetry
 Cardiac monitoring
 SCD’s
 TED hose
 Peripheral pulses
Vol. 1 Ch. 37
Vol. 2 Procedures
39-2, 39-3
19
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Unit 8: Nutrition
Lecture
1. Discuss nutritional absorption. [1.230.8]
2. List the steps in: (A) assisting an adult to eat, (B) inserting a nasogastric tube; (C) removing a
nasogastric tube; (D) administering enteral and parenteral nutrition (E) administering
medications per tube. [3.230.8a]
3. Discuss the reasons and precautions related to placement of a nasogastric tube. [3.230.8b]
Lab
1. Demonstrate feeding techniques for the adult patient. [3.230.8c]
2. Demonstrate the insertion and removal of a nasogastric tube. [3.230.8d]
3. Demonstrate tube feeding techniques. [3.230.8e]
4. Demonstrate administration of medications per tube. [3.230.8f]
5. Demonstrate operation of an enteric feeding pump. [4.230.8g]
Focus
Nutrition
 Assisting adults to eat
 Enteral nutrition
 Parenteral nutrition
Nasogastric tubes
 Insertion
 Removal
 Safety precautions
 Meds per tube
 Tube feeding
o PEG Tubes
o NE Tubes
o J Tube
o Placement of tubes
o Considerations of tubes
o Nursing care
o Feeding tube placement
o Providing enteral
feedings
Reading
Assignment:
Wilkinson &
Treas
V. 1 P. 705-712
Learning Experiences
Review of applicable content from
previous/concurrent nursing
curriculum courses
Ch. 27 Vol. 2 Clinical reasoning
“thinking” questions 1-2 P. 526
V. 2 Procedures
27-2, 27-3, 274, 27-5, 27-6
Procedure
23-1
Practicum
insights 27-4,
27-7, 27-8, 279, 27-10
20
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Unit 9: Fluids
Lecture
1. Discuss primary functions of fluids to maintain homeostasis. [1.230.9]
2. Discuss use of personal care equipment needed in initiating an intravenous line. [2.230.9a]
3. Discuss possible complications related to intravenous therapy. [2.230.9b]
4. List the steps and equipment required in starting an intravenous line. [3.230.9a]
5. Identify interventions that prevent complications associated with intravenous therapy and
central venous catheters. [3.230.9b]
6. List the correct steps in administering an IVP and IVPB. [3.230.9c]
7. Discuss the purpose and care of central lines. [3.230.9d]
8. Describe the steps to access and maintain a Mediport. [3.230.9e]
9. Discuss the importance of correct infusion times (IV, IVP, IVPB). [3.230.9f]
10. Utilize formulas to calculate intravenous infusion rates. [3.230.9g]
11. List components of fluid intake and output. [3.230.9h]
12. Illustrate knowledge of indications and contraindications of intravenous therapy and central
venous lines. [5.230.9]
Lab
1. Demonstrate use of personal care equipment during the initiation of an intravenous line.
[2.230.9c]
2. Select an appropriate intravenous site. [3.230.9i]
3. Demonstrate insertion of an intravenous catheter. [3.230.9j]
4. Demonstrate proper techniques in administering intravenous fluids and medications.
[3.230.9k]
5. Calculate intravenous infusion rates. [3.230.9l]
6. Demonstrate care of a central line. [3.230.9m]
7. Demonstrate access and de-access of a Mediport. [3.2309n]
8. Perform accurate calculation of intake and output. [3.230.9o]
9. Demonstrate operation of an infusion pump. [4.230.9p]
Focus
IV lines
 Starting an IV
 Removing an IV
 Saline lock
 Potential
complication
 Indications and
contraindications
 Blood transfusion
considerations
Reading
Assignment:
Wilkinson &
Treas
V. 1 P. 10051009; 1012-1015
V. 2 Procedures
38-1, 38-2, 38-3,
38-4, 38-5, 38-6;
38-7
Learning Experiences
Review of applicable content
from previous/concurrent nursing
curriculum courses
Ch. 38 Vol 2 Clinical reasoning
“doing” question3-4 page 818
Practicum
insight 38-3, 385
21
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IV medications
 IV push (saline lock
versus an existing line)
 IV piggyback
 IV flow rates
Central lines
 Care of central lines
 Access mediport
 De-access mediport
 Maintenance of a
mediport
 Indications and
contraindications
Intake and output
 Calculating I/O
V.1 P. 652-659
V.2 Procedure
26-16; 26-17
Dosage
Calculations Ch.
15
V. 1 P. 10071009
V.2 practicum
insight 38-4
V. 2 Ch. 38
practicum insight
38-2
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Unit 10: Simulation of Skills
Lecture
1. Discuss the physiological changes of the patient during selected simulations. [1.230.10]
2. Discuss the impact of care provided on the patient during selected simulations. [1.230.10]
Lab
1. Demonstrate teamwork in the delivery of care in a simulated environment. [2.230.10]
2. Use nursing informatics and technology for communication and decision making during a
selected simulation. [4.230.10]
3. Demonstrate closed loop communication in a simulation. [6.230.10]
4. Utilize basic teaching methods during a simulation. [7.230.10]
5. Demonstrate professional behavior consistent with core nursing values as guided by the ANA
Code of Ethics and State Practice Act to a patient during a simulation. [8.230.10]
6. Utilize clinical reasoning during a simulation experience. [9.230.10]
Focus
Simulations in class
Reading
Learning Experiences
Assignment: Review of applicable content from
Wilkinson & previous/concurrent nursing
Treas
curriculum courses
Review:
Sim Lab Orientation and Sim Lab
Monitor Videos
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Skill: Administering Feedings through Gastric and Enteric Tubes
Preparation
Assess:
 Assess order for formula, rate, route and frequency
of feeding
 Tube placement
 Elevate HOB at least 30-45 degrees while
administering feedings and for an hour after
feedings are complete
 Check residual volume before feeding for
intermittent feedings
 Continuous feedings should be infused by pump
Assemble equipment:
 Prescribed feeding at room temperature
 Filtered or sterile water
 Tube feeding administration set and bag
 60 mL syringe
 Stethoscope
 Enteral feeding infusion pump
 IV pole
 Linen-saver pad
 Graduated container
 pH strip
Procedure
Ensure tube is correctly placed
Check order and feeding for type, rate and frequency
Prepare formula by shaking
Prepare equipment for feeding: fill tube feeding bag
with a 4-6 hour supply of feeding formula and prime
tubing.
Label bag with date, time and initials. Hang tubefeeding bag on IV pole
Check #1
Comments
Check #2
Comments
Take syringe and remove plunger
Place linen-saver pad under connection of the feeding tube.
Done procedure gloves.
Aspirate and measure gastric residual volume. Use other
confirmatory methods as well at this time
Reinstill aspirate unless the volume is more than the
formula flow rate for one hour or more than 150 mL
Irrigate feeding tube with 30 mL of water using syringe
to ensure tube patency
Thread bag tubing through infusion pump per
manufacturer’s instructions. Set correct rate and
volume to be infused
Begin infusion by attaching tubing to feeding tube
See book for variations of methods
**Critical steps are in bold
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Skill: Administering Medication Through an Enteral Tube
Preparation
Assess:
 If client is receiving a continuous tube feeding,
disconnect it before giving medication. Leave
tube clamped after administering medication,
according to agency protocol
 If enteral tube is connected to suction, you will
usually discontinue suction for 20-30 minutes
after administration, to allow time for drub to
be absorbed.
Assemble Equipment:
 Medication to be given
 Procedure gloves
 Irrigation syringe
 Sterile water
 Stethoscope
 pH strip
 pill crusher and cutter
Procedure
Prepare the medication for administration. Complete
the first two medication checks prior to entering
client’s room
Place medication requiring pre-assessment in separate
cups
If pill is to be given, verify medication can be crushed
and given per tube
Crush each tablet separately and mix with
approximately 20 mL of sterile water, repeat for each
medication to be given
Don non-sterile procedure gloves
Place client in a sitting (high Fowler’s) position
For NG tubes, check for tube placement
Check for residual volume, follow agency protocol
based upon amounts of residual volume found
Flush tube with a piston tip, Luer-Lock, or
irrigation syringe (usually a 30-60 mL syringe) with
20-30 mL of sterile water
Instill the medication (crushed medication dissolved
in sterile water ) into the tube
Flush the medication through the tube by instilling
an additional 20-30 mL of water
If there is more than one medication, give each
medication separately, and flush after each use
Have patient maintain a sitting position for at least 30
minutes after administering medication
Document medication and amount of sterile water given
to flush tube
Check #1
Comments
Check #2
Comments
** Critical steps are in bold
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Skill: Administering PO Medications
Preparation
Assess:
 Patient’s condition to determine patient’s
ability to swallow medication
 Diet status
 Pre-administration assessment (checking
apical pulse and blood pressure prior to
giving a cardiac medication)
Assemble Equipment:
 Desired liquid for swallowing medications
 Drinking straw (if needed)
 Procedure gloves
Procedure
Prepare the medication for administration
Complete first two medication checks prior to
entering client’s room
Place medications requiring pre-administration
assessment into separate cups if giving multiple
medications
Complete third medication at client’s bedside
Open medication containers in front of client,
letting client know which medication they will be
receiving, place medication in medication cup
Don procedure gloves
Cut any scored tablets or check to whether if pill
can be crushed.
Place client in a sitting (high Fowler’s) position
Give client oral medications in cup
Give client a desired liquid
Ensure client safely swallowed medication
Refer to your text regarding variations for liquid and
buccal medications
**Critical steps are in bold
Check #1
Comments
Check #2
Comments
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Skill: Changing a Bowel Diversion Ostomy Appliance
Preparation
Check #1
Comments
Check #2
Comments
Assess:







Stoma color
Stoma size and shape
Stomal bleeding
Status of periostomal skin
Amount and type of feces
Type of ostomy and its placement
Type and size of appliance and barrier substance
applied to skin
Assemble equipment:
 Clean gloves
 Bedpan
 Solvent
 Moisture-proof bag
 Cleaning materials, including tissue, warm water,
mild soap (optional), washcloth and towel
 Gauze pad
 Skin barrier (optional)
 Stoma measuring guide
 Scissors
 New ostomy appliance
 Tail closure clamp
 Deodorant for pouch (optional)
Select an appropriate time to change the appliance
Procedure
Introduce yourself and verify the client’s identity.
Explain to the client what you are going to do, and how
the client can cooperate.
Perform hand hygiene and observe other appropriate
infection control procedures. Apply clean gloves.
Provide for client privacy.
Assist the client to a comfortable sitting of lying
position in bed or, preferably, a sitting or standing
position in the bathroom.
Unfasten belt if client is wearing one.
Empty and remove the ostomy skin barrier.
Empty the contents of the pouch through the bottom
opening into a bedpan or toilet. Do not throw away clamp.
Assess the consistency and the amount of effluent.
Peel the skin barrier off slowly, beginning at the top and
working downward, while holding the client’s skin taut.
Discard the disposable pouch in a moisture proof bag.
Clean and dry the peristomal skin and stoma
Use toilet tissue to remove excess stool.
Use warm water, mild soap (optional), and a washcloth to
clean the skin and stoma. Check agency policy on the use
of soap.
Dry the area thoroughly by patting with a towel.
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Skill: Initiating a Peripheral Intravenous Infusion
Preparation
Check #1
Comments Check #2
Comments
Assess:
 Order to place IV
 Location of potential vein for
insertion site
 Allergies to any equipment used in
procedure
 Check medical record for history of
anticoagulant therapy, bleeding
disorders, or low platelet count
Assemble Equipment:
 IV solution
 IV administration set (IV start kit)
 Extension tubing
 Appropriately sized IV catheter
 Prefilled (0.9% NS) syringe to prime
extension tubing
 Clean, non-sterile procedure gloves
 Scissors
 Antiseptic swabs
 Tourniquet
 sterile catheter stabilization device
or tape
 sterile gauze
 transparent occlusive dressing
 labels
 linen-saver pad
 alcohol pad
Procedure
Place client in comfortable position. Explain
procedure to client, ensure privacy
Prepare IV solution and administration
or for IV lock based upon order
Follow correct medication checks and
rights before beginning to ensure IV
solution with any prescribed additives are
correct
28
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Label IV tubing and solution with client’s
name, date and your initials
Take the administration set and close roller
clamp
Remove protective cover from solution
container ported and spoke IV
administration set. Ensure spike remains
sterile
Prime tubing by opening the roller clamp
and allow the fluid to slowly fill tubing.
Ensure there are no air bubbles in tubing.
Close the clamp.
Take extension tubing and prepare to
prime by scrubbing the hub with alcohol
pad and let it dry. Attach flush syringe
and prime tubing. Leave flush syringe
attached to extension tubing.
Place linen-saver pad under client’s arm
Place client’s arm in dependent position
Apply tourniquet 10-20 cm above the
selected site. Palpate radial pule, If no
pulse, loosen tourniquet and reapply with
less tension.
Locate vein for inserting IV catheter
Loosen tourniquet
Don clean non-sterile procedure gloves
Select IV catheter and open package
Gently reapply tourniquet. And scrub site
using antiseptic swab. Clean site for 30
seconds, using friction. Allow to dry
Inform client you are about to insert the
catheter and educate it may be
uncomfortable
Take catheter and stabilize catheter for
insertion. Bevel of needle should be up.
Grasp catheter by the hub, using your
thumb and forefinger of your dominant
hand
29
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Use your non-dominant hand to stabilize
vein, and pull skin taunt
Hold catheter at a 3-45 degree angle and
pierce skin over the vein site – watch
closely for flashback of blood into change
of catheter
Lower angle of catheter and advance into
vein
While holding the catheter in place with one
hand, release the tourniquet and place light
pressure on the catheter
Quickly connect the extension tubing to
the IV catheter using aseptic technique
and flush line
Stabilize catheter with clear occlusive
dressing and tape. Dress the site according
the agency protocol
Attach IV administration set, if needed and
secure tubing by looping and take the tubing
to the skin
Set IV Pump if fluids are to be administered
Dispose of all supplies, and chart IV
placement
**Critical steps in bold
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Skill: IV Piggy Back
Preparation
Assess:
 Check compatibility of the medication with
existing IV solution
 Assess patency of the IV line
 Site for redness, swelling, tenderness
Assemble Equipment:
 Alcohol prep pad
 Procedure gloves
 IVPB tubing
Procedure
Choose tubing, and close the slide clamp on the tubing
Using IVPB tubing, attach the piggyback tubing to the
medication bag. Do not touch the “spike” of the bag as
this must remain sterile
Open the clamp and prime tubing using sliding clamp
Label tubing and bag per facility protocol
Hang piggyback container on IV pole. Lower the
primary IV container to hang below the level of the
piggyback IV
Scrub hub of primary line and attach piggyback
tubing to hub on primary line, closest to the patient
Set infusion pump to appropriate rate
Unclamp tubing and ensure piggyback is running
correctly
Check #1
Comments
Check #2
Comments
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Skill: IV Push Medication
Preparation
Assess:
 Check compatibility of the medication with
the existing IV solution
 Assess the patency of the IV line
 Site for redness, swelling, tenderess and/or
signs of infiltration or phlebitis
Assemble equipment:
 Syringe appropriate for medication volume
and type of line
 Normal saline flushes if administering
through an intermittent device
 Alcohol prep pad
 Gauze pad
 Procedure gloves
Procedure
Determine push rate for medication to be
administered and whether medication needs to be
diluted
Prepare medication from vial or ampule. Dilute if
needed. Pause infusion pump to administer the
medication
Don procedure gloves
Complete 3rd medication check at bedside
Scrub surface of hub per facility protocol (30
seconds)
NS flush (if needed)
Pinch or clamp IV tubing between IV bag and port
Insert medication syringe into injection port and
give medication over correct amount of time
NS flush (if needed)
Unclamp IV tubing and restart infusion pump
**Critical steps in bold
Check #1
Comments
Check #2
Comments
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Skill: Inserting a Urinary Catheter--Indwelling & In/out
Preparation & Procedure
Assessment of client condition,
catheter size, & method of
catheterization, allergies, last void.
Gather equipment & supplies
Foley kit, supplies for perineal care,
exam gloves, bath blanket for draping,
lighting
Introduce self, & check client’s ID
band, & explain procedure.
Wash hands & provide privacy
Place patient in supine position.,
bend knees with feet flat on bed.
Establish adequate lighting
Don clean gloves and perform
perineum care.
Remove gloves and wash hands.
Procedure
Open the catherization kit. Place
waterproof drape under the
buttocks (female) or penis (male)
without contaminating the center of
the drape with your hands
Apply sterile gloves and set up
sterile field.
Organize remaining supplies:
 Open pack of swabs.
 Attach prefilled syringe &
test according to policy
 Lubricate catheter tip 2”
female
6”
male
Cleanse
 Female: Nondominant hand
spreads the labia to expose
meatus, hand considered not
sterile once it touches the
skin. Maintain position
thoughout procedure.
 Using a swab cleanse far
labia from front to back,
dispose swab.
Check #1
Comments
Check #2
Comments
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

With second swab cleanse
near labia, dispose swab.
With third swab cleanse
directly down the center over
the meatus.

Male: Nondominant hand
holds the shaft just below the
glans of the penis.
 If uncircumcised retract the
foreskin.
 With swab starting at the
meatus, cleanse in circular
motion partially down the
shaft of the penis.
 Repeat cleaning with
remaining swabs.
Ask patient to bear down as if trying
to void.
Hold catheter with your dominant
hand. Ask patient to take slow deep
breaths.
Insert catheter into the meatus
 Female 2-3”
 Male 7-9”
Insert another 2’ after you see urine
flow
**If catheter accidentally slips into the
vagina or contacts the labia then it is
contaminated & a new sterile catheter
must be used.**
Hold catheter in place with nondominant hand & inflate the bulb to
amount noted on the catheter.
Males: Lay the penis down on the
drape, replace foreskin.
**If client complains of pain,
immediately deflate the bulb, advance
the catheter further & re-inflate the
bulb.
Pull gently on catheter until
resistance felt—insures the bulb is
inflated and placed in the trigone of
the bladder.
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Collect urine specimen if needed.
Allow straight catheter to keep
draining until bladder empty if in &
out procedure is done. If necessary,
attach the drainage end of an
indwelling catheter to the collecting
tubing/bag.
Examine & measure urine. In some
cases, only 750-1000ml of urine are to
be drained from bladder at one time.
Check agency protocol.
Remove straight catheter when urine
flow stops.
Remove sterile gloves, wash hands
& don clean gloves.
For indwelling catheter, secure the
catheter tubing to the inner thigh for
females or upper thigh/abd for males,
with enough slack to allow usual
movement.
Secure the tubing to the bed linens &
hang the bag below the level of the
bladder on the bed frame. No loops of
tubing should fall below the top of the
bag.
Document all relevant data:
Date, time, type & size of catheter
used, amount, color & character of
urine obtained and patient response
Critical steps in bold must be completed to pass skill
35
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Skill: Basic Physical Assessment
Preparation/ Procedure
Checked
#1
Comments Checked
#2
State Normal
Findings
Identifies patient with 2 identifiers,
performs hand hygiene, provides
privacy and utilizes good body
mechanics. Explain procedure to
patient.
Neuro: Assess orientation (person,
place &
time). Thought process
Head & Neck :
 Hair (cleanliness,
distribution)
 Eyes (sclera, drainage)
 Ears (drainage, position)
 Mouth (lesions, color,
moisture & dentation)
 Symmetry
 Palpate Carotids (one at a
time)
Chest:
 Inspects (symmetry and
effort)
 Auscultate (anterior, side &
posterior,appropriate
number of areas)
 Auscultate apical pulse(
locate PMI)
Integument: all areas
 Skin color
 Temperature
 Turgor
 Texture
 Nails (clubbing)
 Notes rashes, bruises,
wounds
 Turns patient to check skin
on back
Cardiovascular:
 Palpates pulses (notes: rate,
rhythm,
amplitude and symmetry)
Radial
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Femoral
Popliteal
Posterior Tibialis
Dorsalis Pedis
 Assess capillary refill
(upper & lower)
 Checks for edema
Abdomen:
 Positions patient in supine
position
 Inspects (symmetry, size &
contour)
 Ask pertinent questions
 Auscultate 4 quadrants
 Light palpation ( 1-2cm)
Motor:
 ROM against resistance
upper and lower extremities
 Hand grasp
 Dorsiflex and plantar flex
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Skill: Intramuscular Injection
Preparation
Assess:
 The client for allergies, previous injection
sites, and assess site for injection
Check #1
Comments
Check #2
Comments
Assemble equipment:
 Appropriate syringe & needle
 Alcohol prep pad
 Gauze pad or adhesive bandage
 Medication
 Clean gloves
 Biohazard (sharps) box
Procedure
Introduce yourself and verify client’s identity.
Explain procedure, and why necessary.
Perform hand hygiene and observe other
appropriate infection-control procedures.
Draw up medication
Don procedure gloves
Position patient to expose correct land marks
and injection site.
Provide privacy for client
Complete 3rd medication check at bedside with
client
Prep injection site by cleaning with alcohol swab
With non-dominant hand, spread the skin taut
between your thumb and index finger.
(Preparing for Z-Track method)
Tell patient what you are going to do and that they
will feel a prick
Give injection, and aspirate by pulling back on
the plunger and waiting for 5-10 seconds.
 If blood return present, remove needle,
discard syringe and prepare medication
again
 If no blood return, press slowly down on
the plunger to inject medication (5-10
seconds/mL) and remove needle
Retract needle per facility protocol and dispose
of needle in sharps container
Gently blot site with gauze pad and apply adhesive
bandage.
Document injection
***Critical steps in bold
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Skill: Inserting a Nasogastric Tube
Preparation
Performed Comments
#1
Performed
#2
Comments
Assessment: Hx of nasal
surgery/deviated septum,
patency of nares, gag reflex,
mental status/cooperation level.
Determine the size of tube to be
used.
Gather equipment & supplies:
NG tube, 1 inch tape, clean
gloves, water-soluble lubricant,
tissues, glass of water & straw,
50ml syringe catheter tip basin,
pH paper, stethoscope, towel,
clamp/plug, suction apparatus (if
required), pen light, tongue
blade, safety pin & elastic band.
Assist client into High
Fowler’s Position. Place
towel/pad across client’s chest.
Introduce self, check ID band,
& explain to the client the
following: procedure, purpose,
how he/she can assist with the
insertion.
Wash Hands & provide
privacy.
Assess client’s nares using a
flashlight to look inside nares.
Select the nares that has greatest
airflow.
Prepare the tube—if a small
bore tube is being used make
ensure the stylet is secured in
position.
Procedure
Determine how far to insert
the tube: Use the tip to mark
off the distance from the tip of
the nose to the tip of the
earlobe to the tip of the
Xyphoid. Mark the length with
tape.
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Prepare tape
Put on procedure gloves.
Lubricate 4 inches of the tube
with water soluble gel.
Insert the tube with curve
pointing downward, along the
floor of the nasal passage
toward the ear on same side.
Ask client to hyperextend
his/her neck, & gently advance
the tube toward the
nasopharynx.
If you meet resistance withdraw
it, relubricate it, & insert it into
the other nostril.
Continue past the nasopharynx
and gently rotate towards the
opposite naris.
Once tube reaches the
oropharynx, have client tilt
head forward & encourage
client to drink & swallow.
Rotate the tube 180
Direct patient to sip and swallow
as you slowly advance the tube.
In cooperation with client,
pass the tube 2-4 inches with
each swallow until reach
marked length.
Temporarily secure the tube
with a piece of tape
Inspect the posterior pharynx for
presence of coiled tube.
Check for placement:
1) Aspirate stomach contents
& check pH &/bilirubin.
2) X-ray per agency policy.
3) Listen over the epigastrum
with a stethoscope for the
wooshing sound from injecting
10-30 ml air into the tube.
If the signs do not indicate
placement in the stomach,
advance the tube another 2
inches & recheck placement.
Secure the tube by taping it to
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the bridge of the nose
*Wipe off oily skin with alcohol
wipe
*Cut 3 inches tape lengthwise at
one end, leaving a 1 inch tab at
the end.
*Place tape over the bridge of
the nose, & bring split ends
either under & around the tube
or under & back over the nose.
Attach tube to Suction Device or
Feeding apparatus, as ordered
OR clamp the end of the tubing.
Secure the tubing to the gown
using a elastic band/tape and a
safety pin.
Document all relevant data:
Insertion of tube, means by
which placement was assessed,
description of output & client
response.
Critical steps in bold must be completed to pass skill
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Skill: Oropharyngeal and Nasopharyngeal and Nasotracheal Suctioning
Preparation
Check #1
Comments
Check #2
Comments
Assess for clinical signs indicating the
need for suctioning:
 Restlessness
 Gurgling
 Adventitious breath sounds
 Change in mental status
 Skin color
 Rate and pattern of respirations
 Pulse rate
 Decreased oxygen saturation
Assemble equipment:
For oral and
nasopharyngeal/nasotracheal suctioning:
 Towel
 Suction with tubing and
receptacle
 Sterile suction kit
 Goggles or face shield, if
appropriate
 Moisture –resistant disposal bag
 Sputum trap, if specimen is to be
obtained
Oral and oropharyngeal suctioning:
 Yankauer
 Clean gloves
Nasopharyngeal or nasotracheal
suctioning:
 Sterile suction catheter kit
 Water-soluble lubricant (for
nasopharyngeal suctioning)
Procedure
Introduce yourself and verify the
client’s identity. Explain to the client
what you are going to do, why it is
necessary, and how the client can
cooperate.
Turn on wall suction; adjust pressure
to 80-120 mmHg for an adult patient.
Don unsterile gloves to test suction by
occluding the connection tube.
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Remove gloves and perform hand
hygiene and other appropriate
infection control precautions.
Provide for client privacy
Prepare the client
Position a conscious person who has a
functioning gag reflex in the semiFowler’s position, with head turned to
one side for oral suctioning, or with
neck hyperextended for nasal
suctioning.
Position an unconscious client in the
lateral position, facing you.
Place the towel over the pillow or under
the chin
Prepare the equipment
For oral suction:
Moisten the tip of the Yankauer
suction catheter with the sterile saline.
Pull tongue forward, if necessary, using
gauze.
Insert Yankauer along side of the
mouth.
For Oropharyngeal Suctioning:
Lubricate the tip of the catheter with
normal saline.
Insert catheter along the side of the
mouth to the oropharynx 3”-4”.
Apply intermittent suction as you
withdraw catheter.
For nasopharyngeal and nasotracheal
suction:
Open the sterile suction kit:
Put on sterile gloves. Open sterile
saline
With dominant hand pick up suction
catheter, and attach it to the suction
tubing.
Measure the distance between the tip
of the client’s nose and the earlobe
(nasopharyngeal), and to base of neck
(nasotracheal).
If needed, increase supplemental
oxygen.
Lubricate the catheter tip with sterile
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saline or lubricant.
Remove oxygen with your
nondominant hand.
Without applying suction, insert the
catheter into either naris, and advance
it along the floor of the nasal cavity.
Never force the catheter against an
obstruction, try other nostril.
Perform suctioning
Apply your finger to the suction port,
and gently rotate the catheter.
Apply suction for 10-15 seconds while
slowly withdrawing the catheter.
Rinse the catheter, and repeat if needed.
Allow sufficient time between each
suction, and limit suctioning to 5
minutes in total.
Encourage the client to breathe deeply
and to cough between suctions.
Dispose of the catheter, gloves and
saline. Wrap the catheter around
your sterile-gloved hand and hold the
catheter as the glove is removed.
Rinse the suction tubing with the unused
saline. Change the suction tubing and
the container daily.
Ensure that supplies are available for the
next suctioning.
Document relevant data.
 The amount, consistency, color,
and the odor of the sputum.
 The client’s breathing status
before and after the procedure.
 Frequency of suctioning
Critical steps in bold print must be completed to pass skill
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Skill: Removing a Nasogastric Tube
Preparation & Procedure
Performed
#1
Comments
Performed
#2
Comments
Assess: Bowel Sounds, absence
of nausea & vomiting when tube
is clamped, and tube feeding has
been stopped at least 3o minutes.
Gather equipment & supplies:
Towel/pad, tissues, clean gloves,
50ml syringe, trash bag
Check the Dr. order to remove
the NG tube
Assist client into sitting position
Place towel/pad on client’s chest.
Give tissues to the client to wipe
nose & mouth after tube
removal.
Introduce self, check ID band,
& explain procedure & how
client can help.
Wash Hands & Don clean
gloves. Provide client privacy.
Detach the tube from: suction
device/client’s gown. Remove
tape from client’s nose.
Put on clean gloves.
Flush tube with 10 mL of
water, normal saline, or air.
Ask client to take deep breath.
Pinch tube with gloved hand.
Smoothly withdraw tube.
Check the intactness of the tube
Place tube in trash bag.
Ensure Client’s comfort by:
Provide mouth care, assist client
with blowing nose.
Dispose of equipment.
Document all relevant data:
Removal of tube, the amount &
appearance of any drainage, if
tube was connected to suction &
any relevant assessments.
Critical steps in bold must be completed to pass skill
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Skill: Subcutaneous Injection
Preparation
Assess:
 The client for allergies, previous injection
sites, and assess site for injection.
 Complete focused assessment pertaining to
medication
Assemble equipment:
 Appropriate needle and syringe
 Alcohol prep pad
 Gauze pad (optional)
Procedure
Introduce yourself and verify the client’s identity.
Explain to the client what you are going to do, and
why it is necessary.
Perform hand hygiene and observe other
appropriate infection-control procedures.
Draw up medication
Select an injection site with adequate
subcutaneous tissue
Position patient so that the injection site is accessible
and the patient is able to relax the appropriate area
Don procedure gloves
Complete 3rd medication check at bedside with
client
Cleanse area with alcohol prep pad. Allow site to
dry before administering injection
With non-dominant hand, pinch tissue at injection
site, and determine the angle at which to inject the
needle.
Holding syringe between thumb and index finger
of your hand (like a dart) and give injection
Remove needle & engage safety device
Gently wipe site with gauze if needed
Document injection
**Critical steps are in bold
Check #1
Comments
Check #2
Comments
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Skill: Wet to Dry Dressing Change
Preparation
Check #1
Comments
Check #2
Comments
Assess:


Pain level; medicate
30 minutes prior to
procedure if needed.
Comfortable position
for patient
wAssembly Supplies:

3 pairs of clean
nonsterile gloves
 Sterile solution
 Water resistant drapes
 Sterile fine-mesh
gauze in a tray
 Sterile ABD or 4X4
 Tape
Introduce self and identify
the patient. Explain
procedure, provide for
privacy
Procedure
Wash hands and apply clean
gloves.
Loosen the edges of the tape;
gently pull up on tape, with
other hand push down on
the skin, pushing the skin off
the tape.
Starting at the top, and from
one side to the other, gently
remove the gauze from the
wound. If dressing is
sticking to the wound,
moisten with sterile normal
saline.
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Assess drainage:
 Type
 Amount
 Odor
Dispose dressing and gloves
in a biohazard container.
Wash hands.
Open package of 4X4,
moisten with ordered
solution.
Apply clean gloves
Using the center of one
gauze cleanse the wound by
gently wiping from the
center of the wound toward
the edge. Discard 4X4 and
repeat until all of wound has
been cleansed.
Applying a Wet-to-Damp
Dressing
Open sterile gauze and
moisten with solution.
Apply clean gloves
Squeeze excess solution from
gauze
Open gauze to single layer
and apply to wound
covering all tissue.
You may use forceps or cotton
tip applicator
Apply a second layer repeat
until the wound is completely
filled.
Do not over pack wound or
allow wet dressing to contact
surrounding skin.
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Cover the wound with a dry
dressing.
Secure dressing with tape in
windowpane fashion.
Critical steps in bold print must be completed to pass skill
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Skill: Implantable Vascular Access Devices
Preparation
Checked Comments
#1
Checked
#2
Comments
Assess:
 Gather pertinent data
 Know the purpose of the
IVAD
 Primary care provider’s order
for the IVAD
Assemble equipment:
 Sterile central line dressing set
 Clean gloves
 Mask for client
 10-mL syringe of normal
saline flush
 5-mL syringe of heparinized
saline(100 units/mL of
heparin) according to agency
policy
 Huber needle
Procedure
Introduce yourself and verify
client’s identity. Explain to the
client what you are going to do, why
it is necessary, and how the client
can participate.
Provide for client privacy.
Assist the client to a comfortable
position, either sitting or lying.
Perform hand hygiene and observe
other infection control procedures.
Put on clean gloves and palpate for
the IVAD, and expose area.
Put mask on patient or have them
turn head away from site.
Remove clean gloves.
Set up sterile field
 Open sterile dressing change
kit
 Put on mask
 Set up sterile field
 Add Huber needle to sterile
field
 Add cap to sterile field
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

Put on sterile gloves
Maintain dominant hand
sterile and connect syringe
with normal saline to Huber
needle and flush, clamp.
Cleanse site
Clean the site with CHG-based skin
prep in a vertical and horizontal
back-and-forth motion, and
circular, using plenty of friction.
The prepped area will be
approximately 5-10 cm (2-4 in.) Let
the skin dry. Check agency policy.
Insert the Huber needle.
Grasp the base of the IVAD
between two fingers of your nondominant hand to stabilize it.
Using your dominant hand, insert
the needle at a 90-degreee angle to
the septum, push it firmly through
until it contacts the base of the
IVAD chamber.
Avoid tilting or moving the needle.
Aspirate for blood return. If no
blood is obtained, have the client
move the arm and or change position.
If no blood return, remove the needle
and repeat the procedure.
Secure needle
 Support needle with a 2x2
dressing and apply an
occlusive dressing.
 Loop and tape the tubing.
 Attach an intermittent
infusion cap.
Begin infusion or flush.
 If infusion is ordered, attach
tubing and begin infusion.
 When infusion is complete
flush with 10 ml of normal
saline followed by the heparin
flush.
 Flush with heparin if no
infusion is ordered.
 When flushing, maintain
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positive pressure, and clamp
the tubing immediately
before the flush is finished.
How to deaccess an IVAD.
Assemble equipment:
 Clean gloves
 10 mL syringe of sterile
normal saline flush
 Heparin flush according to
policy
Prepare client as per procedure for
IVAD access.
Wash hands and put on clean
gloves.
Cleanse port with swab rubbing for
15 seconds, let dry.
Attach syringe with normal saline,
aspirate for blood, flush with saline,
clamp tubing and remove syringe.
Cleanse port with swab rubbing for
15 seconds, let dry.
Attach syringe with heparin and
flush using positive pressure, clamp
tubing.
Stabilizing Huber needle pull
dressing off of skin and work
inwards toward Huber needle.
Grasp Huber needle and pull out in
a straight motion.
Inspect the skin for signs of irritation
or infection.
Document procedure and assessment.
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Skill: Assessing Blood Pressure
Preparation
Check #1
Comments
Check #2
Comments
Assess:
 Signs and symptoms of
hypertension/hypotension.
 Factors affecting blood pressure.
 Client for allergy to latex.
Assemble equipment:
 Stethoscope
 Blood pressure cuff of the
appropriate size
 Sphygmomanometer
Procedure
Identify yourself and verify the
client’s identity. Explain to the client
what you are going to do, why it is
necessary, and how the client can
cooperate.
Perform hand hygiene and observe
other appropriate infection control
procedures.
Provide for client privacy.
Position the client appropriately.
The adult client should be sitting unless
otherwise specified. Legs uncrossed.
The elbow should be slightly flexed, the
palm facing up, and the forearm
supported at heart level.
Wrap the deflated cuff evenly around
the upper arm. Locate the brachial
artery. Apply the center of the
bladder directly over the artery.
For an adult, place the lower border of
the cuff approximately 2.5cm (1 inch)
above the antecubital space.
Procedure
If this is the client’s initial
examination, perform a preliminary
palpatory determination of systolic
pressure.
Palpate the radial artery with the
fingertips.
Close the valve on the bulb.
Pump up the cuff until you no longer
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feel the radial pulse. Note the
pressure on the sphygmomanometer
at which pulse is no longer felt.
Release the pressure in the cuff, and
wait 2 minutes before taking further
measurements.
Position the stethoscope
appropriately.
Insert the ear attachments of the
stethoscope in your ears so that they tilt
slightly forward.
Ensure that the stethoscope hangs freely.
Place the diaphragm over the brachial
artery. Hold the diaphragm with the
thumb and index finger. (Bell of
stethoscope can also be used).
Auscultate the client’s blood pressure.
Pump up the cuff until the
sphygmomanometer is 30 mm Hg
above the point where the radial pulse
disappeared.
Release the valve on the cuff carefully
so that the pressure decreases at the
rate of 2-3 mm Hg per second.
Listen for the Korotkoff sounds as
you deflate
Note when you hear the first sound
(systolic)
Note when sound disappears
(diastolic)
Wait 1-2 minutes before taking more
readings.
Document reading
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Variation: Taking a Thigh Blood Pressure
Procedure
Check #2
Comments
Check # 2
Comments


Help the client to assume a
prone position. If the client
cannot assume the position,
measure the blood pressure
while the client is in a supine
position with the knee slightly
flexed. Slight flexing of the
knee will facilitate placing the
stethoscope on the popliteal
space.
Expose the thigh, taking care
not to expose the client.
Locate the popliteal artery.
Wrap the cuff evenly around the
midthigh with the compression bladder
over the posterior aspect of the thigh
and the bottom edge above the knee.
If this is the client’s initial
examination, perform a preliminary
palpatory determination of systolic
pressure by palpating the popliteal
artery.
In adults, the systolic pressure in the
popliteal artery is usually 20-30 mm
Hg higher than that in the brachial
artery, the diastolic pressure usually is
the same.
Critical steps in bold must be completed to pass skill
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Skill: Administering an Enema
Preparation
Check #1
Assessment:
 When the client last
had a bowel
movement, and the
amount, color, and
consistency of the
feces.
Comments
Check #2
Comments

Whether the client
can use a toilet,
commode, or must
remain in bed and
use a bedpan.
Assemble Equipment:
 Disposable linensaver pad
 Bath blanket
 Bedpan or
commode
 Clean gloves
 Water-soluble
lubricant
 Paper towel
 Enema bag or
prepackaged enema
Procedure Preparation
Close clamp of enema
tubing and fill with 5001000ml of warm water.
Hang bag on an IV pole
and prime tubing over
sink or wastebasket. Do
not touch tip of the
tubing to the surface of
sink or trash can.
Procedure
Introduce yourself and
verify the client’s
identity. Explain the
procedure to the client
and how the client can
cooperate.
Perform hand hygiene
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and observe other
appropriate infection
control procedures.
Don clean gloves
Provide for client
privacy.
Assist the client to a left
lateral position, with the
right leg as acutely flexed
as possible.
Place waterproof pad
under the patient’s
buttocks.
Drape patient with bath
blanket.
Lubricate the tip of the
tubing.
For clients in the left
lateral position, lift the
upper buttock.
Insert the tube smoothly
and slowly into the
rectum, directing it
toward the umbilicus.
Insert the tube 7-10 cm
(3-4 inches).
If resistance is encountered
at the internal sphincter,
ask the client to take a deep
breath, and then run a
small amount of solution
through the tube.
If resistance persists, end
the procedure and report
the resistance to the
primary care provider and
the nurse in charge.
Remove the bag from the
IV pole and hold at hip
level. Slowly administer
the solution.
Slowly raise the level of
the container; do not hold
higher than 12-18 inches
above the hip.
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If the patient complains
of fullness or pain, lower
the container or use the
clamp to stop the flow for
30 seconds, and then
restart the flow at a
slower rate.
If you are using a
commercial container, roll
it up as the fluid is
instilled.
After all the solution has
been instilled, or when
the client cannot hold any
more and feels the desire
to defecate, close the
clamp, and remove the
tube. Place the tube in a
disposable towel as you
withdraw it. Remove
gloves, wash hands
Encourage the client to
retain the enema.
Ask the client to remain
lying down. Place call bell
within reach.
Request that the client
retain the solution for 515 minutes.
Assist the client to
defecate.
Assist the client to a sitting
position on the bedpan,
commode, or toilet.
If a specimen is required,
ask the client to use a
bedpan or commode.
Document solution used,
amount instilled, and how
client tolerated procedure.
Document results of
enema, consistency,
amount and color.
Reassess abdomen.
Critical steps in bold must be completed to pass skill
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Skill: Assessing a Peripheral Pulse
Preparation
Assess:
 Clinical signs of cardiovascular
alterations.
 Factors that might alter pulse rate.
 Site most appropriate for
assessment
Check #1
Comments
Check #2
Comments
Assemble equipment:
 Watch with a second hand
 If using Doppler assemble
necessary equipment
Procedure
Introduce yourself and verify the client’s
identity. Explain to the client what you
are going to do, why it is necessary, and
how the client can cooperate.
Perform hand hygiene and observe other
appropriate infection control procedures.
Provide for client privacy.
Select the pulse point, normally the radial
pulse is taken.
Assist the client to a comfortable resting
position.
Palpate and count the pulse. Place two
fingertips lightly and squarely over the
pulse point.
Count for 30 seconds and multiply by 2.
Record the pulse in beats/minute. If taking
a client’s pulse for the first time, obtaining
baseline data, or if the pulse is irregular,
count for a full minute. An irregular pulse
also requires taking the apical pulse.
Assess the pulse rhythm and volume.
Document the pulse rate, rhythm, and
quality, record.
Critical steps in bold must be completed to pass skill
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Skill: Assessing Respirations
Preparation
Check #1
Comments
Check #2
Comments
Assess:
 Skin and mucous membrane color.
 Position assumed for breathing.
 Signs of cerebral anoxia.
 Chest movement.
 Activity tolerance.
 Dyspnea.
 Chest pain.
 Medications affecting respiratory rate.
Assemble equipment:
Watch with a second hand
Procedure
Identify yourself and verify the client’s
identity.
Perform hand hygiene and observe other
appropriate infection control procedures.
Provide for client privacy.
Place patient’s arm across chest
Palpate radial pulse; keeping hand on wrist
count respirations.
Count the respiratory rate for 30 seconds if
the respirations are regular. Count for 1
minute if they are irregular.
Observe the respirations for depth by watching
the movement of the chest.
Observe the respirations for regular or irregular
rhythm.
Observe the character of respirations-the sound
they produce and the effort.
Document the respiratory rate, depth,
rhythm, and character.
Critical steps in bold must be completed to pass skill
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Skill: Donning and Removing Sterile Gloves (Open Method)
Preparation
Check #1
Comments
Check #2
Comments
Check client record and ask the client about
latex allergies.
Assemble equipment:
Package of sterile gloves.
Procedure
Open the package of sterile gloves
Place the package of gloves on a clean and dry
surface.
Fully open the package flaps so they do not
fold back and contaminate the gloves.
Put the first glove on the dominant hand.
Grasp the inner surface of the glove for the
dominant hand, lift glove up and away from
the surface of table, hold away from body.
Insert the dominant hand into the glove and
pull the glove on. Keep the thumb of the
inserted hand against the palm of the hand
during insertion.
Leave the cuff in place once the non-sterile hand
releases the glove.
Pick up the other glove with the sterile gloved
hand, inserting the fingers under the cuff and
holding the gloved thumb close to the gloved
palm.
Pull on the second glove.
Adjust each glove so that it fits smoothly.
Maintain hands in front of body and above waist.
Removing gloves
Remove first glove by grasping the outside
cuff and pull down. Place removed glove in
palm of gloved hand.
Use 2 ungloved fingers inside the cuff of
second glove. Pull the glove off and over the
other glove and dispose.
Critical steps in bold must be completed to pass skill
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Skill: Assessing Body Temperature
Preparation
Checked
#1
Comments
Checked
#2
Comments
Assess:
 Clinical signs of fever.
 Clinical signs of hypothermia.
 Site most appropriate for
measurement.
 Factors that might alter core
body temperature.
Assemble equipment:
 Thermometer
 Thermometer sheath or cover
 Water-soluble lubricant for a
rectal temperature
 Disposable gloves
 Towel for axillary temperature
 Tissues/wipes
Procedure
Introduce yourself and verify the
client’s identity. Explain to the client
what you are going to do, why it is
necessary, and how the client can
cooperate.
Perform hand hygiene and observe
other appropriate infection control
procedures.
Provide for client privacy.
Place the client in the appropriate
position.
Apply a protective sheath or probe
cover.
Lubricate a rectal thermometer.
Axillary: Dry axilla, place the
thermometer tip in the middle of the
axilla, lower patient’s arm.
Oral: Place the the thermometer tip
under the tongue in the posterior
sublingual pocket (right or left of
frenulum). Ask patient to keep mouth
closed.
Rectal: Put on clean gloves, lubricate
thermometer and insert 2.5-3.7 cm (11.5 in.) in an adult; 2.5 cm (0.9 in.) for a
child, and 1.5 cm (0.5 in.) for an infant.
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Do not leave client unattended.
Tympanic Membrane: Position client’s
head to one side and straighten the ear
canal.
For an adult, pull the pinna up and
back.
For a child, pull the pinna down and
back.
Electronic and tympanic thermometers
will indicate that the reading is complete
via a light or tone.
Remove the thermometer and discard
the cover, or wipe with a tissue.
Read the temperature
If the temperature is obviously too high,
too low, or inconsistent with the client’s
condition, recheck it with a thermometer
known to be functioning properly.
Document the temperature.
Critical steps in bold must be completed to pass skill
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Skill: Establishing and Maintaining a Sterile Field
Preparation
Check
#1
Comments
Check #2
Comments
Determine:
 What procedure will be performed
that requires a sterile field.
 The client’s presence of or risk for
infection.
 The client’s ability to cooperate
with the procedure.
Assemble equipment:
 Package containing a sterile drape
 Sterile equipment as needed
Check the sterilization expiration dates
on the package, and look for any
indication that is has been previously
opened.
Introduce yourself and verify the
client’s identity.
Clean surface of area you will be
working on.
Perform hand hygiene and observe
other appropriate infection control
procedures.
Provide for client privacy
Procedure
 Place the package in the center
of the work area.
 Reaching around the package
pull the flap open away from
you laying it flat on the far
surface.
 Repeat for the side flaps, use the
right hand for the right flap, and
the left hand for the left flap.
 Pull the fourth flap toward you
by grasping the corner that is
turned down.
The area 1” from the edge of the wrapper
and 1” from the table is not considered
sterile.
Establish a sterile field by using a
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drape.
Open the package containing the drape as
described above.
With one hand, lift the corner of the
drape that is folded back.
Lift the drape out and allow it to open
freely without touching any articles.
With the other hand, carefully pick up
another corner of the drape, holding it
well away from you.
Lay the drape on a clean and dry
surface, placing the bottom (the freely
hanging side) farthest from you.
Add necessary sterile supplies.
If the flap of the package has an
unsealed corner, hold the container in
one hand, and pull back on the flap
with the other hand.
If the package has a partially sealed edge,
grasp both sides of the edge, one with
each hand, and pull apart gently.
Hold the package 15 cm (6 inches)
above the field, and allow the contents
to drop on the field. Recall that 2.5 cm
(1 inch) around the edge of the field is
considered contaminated.
Document that sterile technique was used
in the performance of the procedure.
Adding Solutions to a Sterile Field
Check sterility of solution, and the
expiration date
Hold bottle 4-6 inches above the bowl
and pour into solution bowl.
Critical steps in bold print must be completed to pass skill
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Applying Wet-to-Damp Dressing
Preparation
Check 1
Comments
Check2
Comments


Check order and gather supplies
Place client in comfortable
position
 Wash hands and apply clean
gloves.
Loosen tape edges of tape
Hold skin taunt while removing tape
Lift dressing from one end towards
center of wound, if adhered to wound
moisten with normal saline.
Assess dressing for drainage type and
amount.
Holding dressing in gloved hand, pull
gloves over dressing and discard in a
biohazard container
Open 4x4-sponge tray, pour sterile
saline or water to moisten.
Apply clean gloves.
Cleanse wound with wet gauze
starting at center and working
towards edge of wound.
Assess wound for location, exudates,
odor and tissue color.
Remove gloves in same manner as
above.
Apply Dressing
Open sterile gauze add ordered
solution.
Apply clean gloves
Squeeze excess solution from gauze.
Apply a single layer og gauze starting
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at corner of wound and working down
to opposite end.
Repeat until wound is covered, do not
allow wet gauze to touch skin.
Apply dry dressing over wound and
tape.
Remove gloves and discard.
Document procedure.
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Skill: Suctioning a Tracheostomy or Endotracheal Tube
Preparation
Check
#1
Comments
Check #2
Comments
Assess:
 The client for the presence of
congestion on auscultation of
the lungs.
 Note the client’s ability to
remove the secretions through
coughing.
Assemble equipment:
 Resuscitation bag connected to
100% oxygen (if needed)
 Sterile suction catheter kit
 Goggles, mask and gown (if
necessary)
 Moisture-resistant bag
 Towel
Procedure
Introduce yourself and verify the
client’s identity. Explain to the
client what you are going to do, and
why it is necessary.
Perform hand hygiene and observe
other appropriate infection-control
procedures.
Provide for client privacy
Place the client in semi-Fowler’s
Prepare the equipment
Place a towel across the chest below
the tracheostomy.
Turn on suction and set pressure to
80-120 mm Hg or per agency policy.
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Put on goggles, mask, and gown if
necessary.
Hyper-oxygenate the patient by
adjusting the oxygen flow to the
highest level.
Open sterile suction kit, apply
sterile gloves and prepare supplies.
Holding the catheter in your
dominant hand and the suction
tubing in your non-dominant hand,
attach the suction catheter to the
suction tubing.
Using the dominant hand, place the
catheter tip in the normal saline.
Using the thumb of the non-dominant
hand occlude the thumb control, and
suction a small amount of the
solution.
Have client take 3-5 deep breaths,
then with non-dominant hand
remove oxygen source.
With your non-dominant thumb off
the suction port, quickly but gently
insert the catheter into the trachea
through the tracheostomy tube or
endotracheal tube.
Insert the catheter about 12.5 cm (5
inches) for adults, or until the
patient coughs or you meet
resistance. To prevent damaging
the mucous membrane at the
bifurcation, withdraw the catheter
about 1-2 cm. before applying
suction.
Perform suctioning
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Apply intermittent suction over 1015 seconds by placing the nondominant thumb over the suction
port.
Rotate the catheter by rolling it
between your thumb and forefinger
while slowly withdrawing it.
Reassess the client’s oxygen status,
and repeat suctioning if needed.
Observe the patient’s respirations.
Check pulse, if necessary, using the
non-dominant hand.
Allow 30 seconds to one minute
between suctioning when possible.
Limit suctioning attempts to 5
minutes.
Flush the catheter and suction tubing.
Turn off the suction and disconnect
the catheter from the suction tubing.
Wrap the catheter around your
sterile hand, and peel the glove off
so that it turns inside out over the
catheter. Discard the glove and the
catheter.
Be sure that oxygen and ventilator
are returned to presuctioning
settings.
Provide for patient safety and
comfort.
Document relevant data.
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Record the suctioning, including the
amount and description of suction
returns, and any other assessments.
Variation: If client cannot take deep
breaths, and does not have copious
secretions, hyperventilate the lungs
with a resuscitation bag.
Attach the resuscitator to the
tracheostomy or endotracheal tube.
Compress the bag 3-5 times, as the
client inhales.
Observe the rise and fall of the chest.
Remove the resuscitation bag utilizing
your non-dominant hand. Continue
with suctioning as stated above.
After each suction, ventilate the client
with the resuscitation bag with no
more than 3 breaths.
Variation: Using the Ventilator to
Provide Hyperventilation.
If the client has copious secretions, do
not hyperventilate. Instead:
Keep the client connected to the
ventilator, push the 100% button
(will deliver for 2 minutes). Allow
for 3-5 breaths.
Follow steps as described above.
Variation: Inline Closed System
If a catheter is not attached. Put on
clean gloves, aseptically open a new
closed catheter set, and attach the
ventilator connection on the T piece to
the ventilator tubing. Attach the
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client connection to the endotracheal
or tracheostomy tube.
Attach one end of the suction tubing
to the suction connection port of the
closed system, and the other end to
the suction cannister.
Turn suction on, occlude tubing,
and depress the suction control
valve to set suction to the
appropriate level. Release the
suction control valve.
Use the ventilator to hyperoxygenate and hyperventilate the
patient as described above.
Unlock the suction control
mechanism.
Advance the suction catheter
enclosed in plastic sheath with the
dominant hand. Steady the T piece
with the non-dominant hand.
Depress the suction control and
apply suction for no more than 1015 seconds, while gently
withdrawing the catheter.
Assess client as per open suctioning
method.
Repeat as needed, remembering to
provide hyperoxygenation and
hyperventilation as needed.
When done suctioning, withdraw
the catheter into its sleeve and close
the access valve.
Flush the catheter by instilling
normal saline into the irrigation
port and applying suction.
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Close the irrigation port and close
the suction valve.
Return ventilator setting to presuction settings.
Provide for client safety and
document as mentioned above.
Critical steps in bold must be completed to pass skill.
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