Download FR I Skills Guides

NRS 1117
Fundamentals of
Nursing
Skills Guides/ Check Off Forms
(Use this as a guide for skills check offs)
1
PERSONAL CARE SKILLS
*Student Observer will perform check off- use form at end of packet for bed/bath check off
Bed bath
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Ask for patient preferences/check physician orders/explain procedure/check room
temperature
Provide for privacy/offer bedpan or urinal/prepare bath water
WASH HANDS
Put bed in high position/use bath blanket/remove top sheet/put side rails up on
opposite side from work
HOB up/towel over chest and under head
Wash eyes first using different section of mitt-wash inner to outer canthus of eyes
(use water only), then wash face, neck, ears (soap if patient requests)
Offer to shave males (electric razor only if on blood thinner)
Put towel under arm-wash fingers to axilla with stroke upward for venous returnsoak hand- wash axilla (apply deodorant now or at end of bath) - wash opposite
arm
Place towel over trunk- lift & wash chest/abdomen (make sure to wash well under
skin folds) - rinse and dry well- may apply powder in skin folds
Apply clean gown
Place towel under leg- wash leg from ankle upward for venous return- soak feetrinse and dry well (esp. between toes) – wash opposite leg
CHANGE WATER WITH SIDERAILS UP- turn patient to side
Place towel along back/buttocks- USE GLOVES- wash neck to buttocks- offer
backrub (use lotion)
Wash buttocks/anus- wipe front to back- place patient supine
CHANGE GLOVES/WASHCLOTH/WATER WITH SIDERAILS UP
Wash genitalia/perineal area – wipe front to back
Finish dressing/offer lotion/comb hair/mouth care- replace call light
YOU MUST KEEP SIDERAILS UP AT ALL TIMES WHEN NOT CLOSE AT
BEDSIDE
Bed making
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Place bed at waist level- keep at good working height
Keep seams away from patient
Don't fan the covers
Don't touch yourself or floor with linens
Don't forget the toe tuck
Try for neatness-miter corners and eliminate wrinkles
KEEP SIDERAILS UP WHEN APPROPRIATE!!!
PUT BED BACK IN LOW POSITION
2
Nail & Foot Care
Equipment: Washbasin, emesis basin, washcloth, bath towel, orange stick (can use
wooden end of cotton-tipped applicator), emery board and body lotion (if available), paper
towels, clean gloves
 Inspect entire surface of extremities for dryness, inflammation or cracking
 Use towel or waterproof pad to protect linen
 Soak extremity in warm water after checking temperature
 Soak for 10 minutes-rewarm water-soak another 10 minutes (if needed)
 DO NOT SOAK HANDS OR FEET OF DIABETIC PATIENTS!
 STUDENT NURSES DO NOT CUT FINGERNAILS OR TOENAILS!
 Apply gloves if needed
 Clean under fingernails with orange stick (can you wood end of cotton-tipped
applicator)
 Shape nails with emery board or file if available
 For feet-scrub callused areas with washcloth-clean under toenails with orange stick
 Do not file corners of toenails
 Apply lotion to hands and feet if available and patient agrees (DO NOT APPLY
LOTION BETWEEN TOES OF DIABETIC PATIENTS!)
 Record procedure and observations-report any skin breakdown or ulcerations
Oral Care
Equipment: Toothbrush, toothpaste, floss (if available and patient desires), water glass
with cool water, saline or mouthwash, emesis basin, towel, paper towels, clean gloves
 Determine patient’s oral hygiene practices
 Inspect oral cavity
 Set up patient equipment on paper towels at bedside
 Raise the head of bed
 Place towel over patient’s chest
 Apply gloves
 Apply toothpaste to brush holding it over an emesis basin-pour water over
toothbrush
 Assist patient to brush if needed—
 Allow patient to brush tongue lightly, avoiding gag reflex
 Assist patient to rinse mouth and spit into emesis basin several times
 Allow patient to gargle with mouthwash and floss if desired and available
 Clean all equipment and bedside table
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Oral Care for Unconscious or Debilitated Patient
Equipment: Oral care solution (that will loosen crusts), toothbrush or sponge toothette or
tongue blade wrapped in single layer of gauze, tongue blade, towel, paper towels, emesis
basin, water glass with cool water, water-soluble lip lubricant, syringe, suction machine (if
needed) clean gloves
 Check gag reflex with tongue blade
 Have suction set up and ready
 Place patient on side with head of bed elevated
 Wash hands-Apply gloves
 Place paper towels on bedside table-arrange equipment
 Place towel under patient’s head and emesis basin under chin
 Separate teeth with tongue blade or swab-never use your fingers!
 Insert blade or swab gently between back molars-preferably when patient is
relaxed
 Clean mouth with sponge toothettes either pre-moistened with oral care solution or
a solution can be made with equal parts peroxide, mineral oil and mouthwash (if
mineral oil not available-use equal parts mouthwash and peroxide)
 Clean gums, tongue, teeth and upper palate several times, rinsing swab as needed
 Pay particular attention to upper palette, especially if patient is mouth-breathingsecretions can become dry and adhere to the roof of the mouth
 Repeat rinse several times-bulb or piston syringe can be used
 Suction extra water and secretions as they accumulate
 Apply thin layer of water-soluble jelly to lips if available
 Remove gloves-clean equipment-reposition client for comfort-wash hands
Cleaning Dentures
Equipment: Toothbrush, denture cup, emesis basin or sink, dentifrice or toothpaste,
water glass, gauze, washcloth, gloves
 Clean dentures as often as natural teeth
 Fill emesis basin with warm water-if using sink, place washcloth in bottom to
prevent breaking dentures
 Apply gloves-remove dentures
 If patient is unable to remove own dentures, grasp upper plate at the front with
thumb and index finger wrapped in gauze and pull down. Gently lift lower denture
from jaw
 Rotate to one side downward to remove from mouth.
 Place in basin or sink-apply dentifrice or toothpaste and brush
 Rinse thoroughly in tepid water
 Return dentures to patient or store in tepid water in a denture cup
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Care of Contact Lenses
Equipment: Wetting/cleaning solution for hard lenses; sterile disinfecting/enzyme
solution for soft lenses, lens storage container, lens suction cup, clean gloves
 Wash hands
 Put on clean gloves
Removing Hard Lenses:
 Place patient in sitting position, if possible
 Pull upper and lower lid apart and pull toward lateral side
 Have patient blink- lens should pop out into hand
 *May use lens suction cup if available (for hard lenses only)
Removing Soft Lenses:
 Place patient in sitting position, if possible
 Have patient look up
 Pull lower lid down- place index finger on lower edge of lens, moving it onto
white part of the eye
 Gently grasp lens between thumb and index finger to release suction
(lens should fold) and remove
 Gently roll lens (use normal saline if needed) to separate to normal form
 *Do NOT use lens suction cup for removal of soft lenses
Storing Lenses:
 Rinse lenses with recommended rinsing solution
 Place first lens in corresponding cup (left or right) BEFORE removing second lens
and placing in cup.
Hair Care-Shampooing
Equipment: Bath towels, washcloths, shampoo, hair conditioner (optional), water
pitcher, plastic shampoo trough (if available), waterproof pad (if available), comb, brush,
hair dryer (optional)
 Check facility for availability of shampoo and conditioner, comb, brush, hair
dryer-patient may be required to provide these supplies
 Determine that there are no contraindications (head, neck or spinal cord injury,
arthritis)
 Check scalp for dried blood or dandruff-special shampoo or peroxide may be
needed
 Plastic shampoo trough can be used-if not available the headboard can usually be
removed, the patient positioned at the top of the bed and the washbasin held under
the patient’s head
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If the washbasin is used-you will need 2 assistants (to hold the head and obtain
rinse water)
Place waterproof pad under shoulders, rolled towel under their neck and a bath
towel over their shoulders
Have client pour warm water from water pitcher over hair until saturated
Apply shampoo-lather entire scalp-rinse-repeat-apply conditioner-rinse
Have assistants obtain warm rinse water in pitcher & pour out washbasin as needed
One student should stay with client and support their head and neck at all times
Wrap hair and scalp to dry-use second towel as needed
Comb hair-dry with dryer as desired-Complete hair styling
May use “no-rinse” shampoo caps if available…follow manufacturer instructions
Shaving
Equipment: Razor (electric or safety razor blade, washcloth, towel, basin with warm
water, shaving cream or mild soap, clean gloves (optional)
 All razors-electric or blades should be used by only one patient!
 If electric razor is used (make sure it has been checked by maintenance for
electrical hazards)
 Patients on anticoagulants or high doses of aspirin should only use an electric
razor!
 If a razor blade is used, the skin must be softened with a warm cloth for a few
seconds, followed by application or shaving cream or a lathering of mild soap.
 Gently pull the skin taut and use short, firm strokes in the direction the hair grows
 Short downward strokes work best to remove hair over the upper lip
 Mustache and beard-Keep these clean-never shave off with the client’s consent
Assisting with Bedpan/Urinal
 Please refer to Craven (Fundamentals textbook) to review procedures (“Hygiene
and Self-Care” chapter)!
6
VITAL SIGNS CHECK OFF
*Instructor will perform check off
Temperature
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Patient should not drink hot or cold beverages for 20-30 minutes.
Electronic Thermometer: Attach disposable probe cover and place under tongueleave in until thermometer beeps. Give reading in F° (for adult). Discard cover.
Manual (non-mercury) thermometer: You will state temperature reading from a
picture of a non-mercury thermometer. Reading must be EXACT.
*Thermometers available in the nursing lab for practice- you must cover them with
plastic sheath protectors & clean with alcohol afterwards.
Radial Pulse
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30 seconds X 2 (if regular rhythm; full minute if irregular)-must be within 2
Use tips of first 2 fingers (no thumb)
Respirations
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30 seconds X 2 (if regular pattern; full minute if irregular)-must be within 2
With actual patient, do immediately after pulse without letting go of wrist
Apical Pulse
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Must count for full minute and be within 1
Must locate apex correctly (fifth intercostal space, left mid-clavicular line)
In females, move breast tissue upward
Keep the earpieces of the stethoscope pointed toward your nose
Blood pressure
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Palpate brachial artery. Place cuff approx. 2 cm above antecubital space
Don’t let cuff touch stethoscope (may create noise)
Palpate brachial or radial pulse- slowly inflate BP cuff until pulse disappearsNOTE THIS NUMBER- fully deflate cuff and wait 1-2 min.
Use diaphragm (large/flat surface) side of stethoscope-place over brachial artery
Inflate cuff 30 mm Hg above where brachial pulse disappeared
Open valve- pressure should drop 2-3 mm Hg per second
Note 1st Korotkoff sound (systolic) and last Korotkoff sound (diastolic) *If hear
sounds all the way down, diastolic will be when sound significantly
dampens/muffles
PRACTICE…PRACTICE…PRACTICE (including on lab machines)
Must be within 2 mmHg for systolic (top) and diastolic (bottom) numbers
Peripheral pulses
Must be able to name and locate the following pulse sites:
Carotid (palpate low and separate; others palpate R and L together); Brachial; Radial;
Femoral; Popliteal; Posterior tibial; Dorsalis pedis
7
MEDICAL ASEPSIS CHECK OFF
*Instructor will perform check off
Dressing Change (wound)
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Explain procedure/wash hands/expose wound, while maintaining pt’s privacy.
Take outside cover off kit and make trash bag
Put on clean gloves
Remove dressing away from patient
Note drainage-amount/color/consistency/odor
Remove clean gloves-glove to glove and skin to skin; Wash hands/use alcohol foam
Open kit away from you on bedside table- remember your one inch border
Remember to keep your hands above your waist and don’t turn your back on your field
Apply sterile gloves
Clean wound-CENTER/FAR SIDE/NEAR SIDE
Drop in garbage from a distance and don’t reach across field
Pick up sterile dressing from center
Do not let forceps touch skin when putting down dressing
Lay dressing in direction of incision with blue side up
Tape dressing
Donning STERILE GLOVES
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Glove NON-dominant hand first- pick up by the cuff/keep your hand up and away from
package
 Glove dominant hand- put fingers of non-dominant hand under cuff and keep thumb
abducted-don’t manipulate cuff (below thumb level) after it is on your hand- may adjust
gloves on fingers if necessary
*ANY BREAK IN STERILE TECHNIQUE WILL RESULT IN RECHECK
Donning/Removing Isolation Gear
PUT ON
 Gown-don’t let bottom touch floor
 Mask
 Goggles/face shield (if applicable)
 Gloves LAST- make sure pull over cuffs of gown
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TAKE OFF
 Gloves FIRST- glove to glove and skin to skin
 Goggles/face shield (if applicable)
 Gown- don’t touch outside- roll up away from you
 Mask LAST- don’t touch on front
Handwashing
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Remove rings (except plain wedding band); push up watch above wrist
Turn on faucet-warm water
Keep hands over sink with hands lower than elbows
Rinse hands and lower arms
Apply soap until good lather (rinse off bar soap before/after use)
Wash palms, back of hands, and 1 inch above wrists; interlace fingers and thumbs
Use friction rub 15 – 30 sec per hand (total hand washing 1-2 minutes)
Clean under fingernails
Rinse-don’t rub together, keeping hands lower than forearms
Dry with clean paper towel, fingertips toward forearm (wipe one time or use different
part of towel)
Turn off faucet using clean ,dry paper towel
9
ENEMA CHECK OFF
*Instructor will perform check off
Administering a cleansing enema
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Assess patient/check order/wash hands prepare enema bag (clamp tubing-add
warm water first, then soap)- raise bag and release clamp and allow solution to
flow into sink long enough to fill tubing (“priming” the tubing) and re-clamp
Provide for privacy/adjust bed height
Identify patient/explain procedure/apply gloves
Place patient in left side-lying (Sims’) position with right knee flexed
Place waterproof pad
Have bedpan or commode accessible
Cover patient/expose buttocks
Remove cap from tip-apply more lubricating jelly if desired-should be
lubricated 2-3 inches
Gently separate buttocks and locate anus
Insert tip slowly toward umbilicus-for adult insert 3-4 inches
Hold tubing at all times
Open clamp and allow solution to flow at hip level
Raise bag slowly 3-18 inches-NEVER higher than 18 inches
*If cramping occurs-lower container,
*If cramping continues, clamp tubing
*If cramping does not subside, remove tubing
After solution instilled, clamp tubing
Withdraw tubing, wiping with toilet tissue while removing
Ask client to hold solution as long as possible
Assist client to bathroom or position on bedpan (lower bed and leave call light
within reach if you leave room)
Properly dispose of contents (observe character of feces)
Remove waterproof pad/clean patient
Ensure bed is in low position
Remove gloves/wash hands
Document procedure/results/how patient tolerated
10
NASOGASTRIC TUBE (NGT) CHECK OFF
*Instructor will perform check off
Large-Bore Nasogastric Feeding Tube Intubation
*Steps in bold are critical-if not done correctly, failure will result
 Check physician’s order
 Assess patient (swallowing, past surgeries, patency of nares, anticoagulants, gag reflex)
 Prepare patient (explain procedure, provide for privacy)
 Wash hands
 PLACE PATIENT IN HIGH FOWLER’S POSITION
 Cover patient’s chest with drape or towel
 Measure tube (traditional method-measure tip of nose to earlobe to xyphoid process of
sternum). Mark the tube with tape or Sharpie.
 Prepare tape
 Put on clean gloves
 Coil end that will be inserted into nose
 Lubricate tube 3-5 inches
 Hyperextend the head
 Insert tube gently through nostril to back of throat (posterior nasopharynx)
 Flex head toward chest
 Encourage patient to swallow
 Advance tube to desired length as patient swallows, rotating tube 180 degrees while
inserting
 Do not force tube. If resistance is met, or coughing, choking occurs, pull back (if
continues, pull tube out)
 Check for position of tube in back of throat with tongue blade
 CHECK PLACEMENT OF TUBE- Aspirate stomach contents with syringe-return
aspirate to stomach
 Secure tube with tape
 Clamp end of tubing or attach to suction, as ordered
 Rinse syringe/plunger (may leave at bedside for future use), dispose of trash
 Remove gloves/wash hands
 Document procedure
Tube Feeding/Irrigation
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Check order/explain procedure to patient/gather supplies
Wash hands/don clean gloves
Critical Element- Place head of bed in High Fowler’s position
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Continuous feeding:
 Keep HOB up 30-40 degrees at all times while feeding is running
 Measure residual (which also checks placement) as ordered (usually every 4-6
hours). Stop feeding if residual is > 2 hours’ worth of feeding (or > than amount
stated on health provider order). Return residual to stomach.
 Change bag/bottle, syringe and tubing every 24 hours or per facility policy
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Bolus feeding:
 Measure residual (which also checks placement) as ordered (usually every 4-6
hours). Hold feeding if residual is > 50% of previous feeding (or > than amount
stated on health provider order). Return residual to stomach.
 Disconnect syringe and remove plunger
 Reconnect syringe and pour feeding into syringe barrel, letting it flow in via
gravity. Follow formula with water to flush tubing til clear
 Clamp tubing off for 30 minutes-1 hour /Keep HOB up during this time
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PATIENT TRANSFER
*Student Observer will perform check off- use form at end of packet for patient transfer check off
Transfer
 Assess strength/get equipment/explain procedure
 Remove pillows
 Put client in sitting position
 Rock up on 3 with back straight
 Have client hold to arm rests on chair to sit
 MAKE SURE WHEELS ARE LOCKS AND BED IS IN LOW POSITION
USE GOOD BODY MECHANICS
RANGE OF MOTION (ROM)
*Instructor will observe check off- bring form at end of packet for ROM check off
Range of Motion (passive)
See Fundamentals of Nursing (Craven, 7th ed.) text, Chapter 24, Table 24-1 (pp. 669 – 671)
13
FOLEY CATHETER CHECK OFF
*Instructor will perform check off
Inserting an Indwelling Catheter
*Steps in bold are critical-if not done correctly, failure will result
 Assess patient (allergies, last urination, distended bladder)
 Check physician’s order
 Prepare patient (explain procedure, obtain help if needed, provide for privacy)
 Wash hands/Clean perineum if needed/Position and drape patient/Make garbage bag from
package
 Open catheterization kit-Away from student/sides/toward student
 Apply sterile gloves
 Allow drape to form cuff over both hands-Slip cuffed edge under buttocks/Apply
fenestrated drape to perineum/Organize supplies on sterile field
 Check integrity of balloon *Optional* (text does not recommend; however, facilities
may require- check facility policy and procedure manual)
 Open packet of swabs OR pour antiseptic solution over cotton balls; Lubricate tip of
catheter (1-2 inches for females/5-7 inches for males)
 Cleanse urethral meatus-keeping dominant hand sterile
 Female-With nondominant hand retract labia- maintain this position (until advanced
additional 1-2 inches after urine obtained)
 With dominant hand, pick up swab OR cotton ball with forceps and clean perineal area,
wiping from front to back-use new swab/cotton ball for each wipe-FAR labial
fold/NEAR labial fold/ OVER meatus (middle)- If more than 3 swabs/cotton balls with
antiseptic available, wipe meatus first, far side, near side, then meatus again last
 Male- With nondominant hand-retract foreskin-grasp penis at shaft below glans, retract
meatus between thumb and forefinger- maintain this position (until advanced additional
1-2 inches after urine obtained)
 With dominant hand, pick up swab/cotton ball with forceps and clean penis. Move in
circular motion from meatus down to base of glans penis. Repeat 2-3 more times, using
new swab/cotton ball each time
 While discarding cotton balls-go around sterile field-drop cotton balls from a distance
into garbage bag-after last cotton ball is discarded-drop forceps into garbage bag
 Pick up catheter with dominant hand, holding 3-4 inches from tip-insert catheter
o Slowly insert catheter through meatus
o Females-Advance 2-3 inches (until urine flows)
o Males-Lift penis to position perpendicular to patient’s body
o Advance catheter 7-9 inches
 After urine appears, advance another 1-2 inches- Do not force against resistance
 May now use contaminated, nondominant hand to anchor catheter
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Inflate balloon- if sudden pain-aspirate back solution and advance catheter further
Disconnect syringe from balloon port without allowing fluid to backflow into syringe
Pull gently to feel resistance/Make sure catheter is connected to drainage bag
Tape catheter-Allow for slack to prevent tension with movement
o Females-Tape/secure catheter to inner thigh
o Males-Tape/secure catheter tubing to top of thigh or lower abdomen-with penis
directed toward chest
Hang drainage bag on bed frame/Be sure there are no obstructions in the tubing
Dispose of equipment/Wash hands
*ANY BREAK IN STERILE TECHNIQUE IS A FAILURE
Catheter Irrigation
*Steps in bold are critical-if not done correctly, failure will result
(Sterile procedure using clean technique)
 Assess patient (allergies, last urination, distended bladder)
 Check physician’s order
 Prepare patient (explain procedure, obtain help if needed, provide for privacy)
 Wash hands/Clean perineum if needed/Position and drape patient
 Gather equipment/Open sterile irrigation tray
 Maintain sterility around mouth of container and syringe (only touching plunger tip
and wings of barrel)
 Pour required amount of sterile solution into sterile container
 If opened previously-lip the bottle
 Replace cap
 Apply clean gloves (can use sterile-according to facility policy)
 Place waterproof drape under catheter
 Aspirate 30-60 ml of solution into syringe
 Move sterile collection basin close to patient’s thigh
 Clean junction of catheter with alcohol-keeping port away from junction
 Disconnect catheter from drainage tubing- holding both ends in nondominant hand
maintaining sterility
 Insert tip of syringe into catheter and gently instill solution
 Withdraw syringe, allow solution to drain into basin-Repeat if needed
 Clean each end of connection with separate alcohol preps-reconnect
 Measure urine and record appropriately on I&O sheet
 Discard urine and supplies
 Wash hands
*ANY BREAK IN STERILE TECHNIQUE IS A FAILURE
15
MEDICATION ADMINISTRATION CHECK OFF
*Instructor will perform check off
Students will be given a medication card with several medications to calculate and prepare. If
the student is unsuccessful with either dosage calculation or dosage preparation, a failure will
result for that component. Students need to use dimensional analysis in all calculations.
Make sure your answer makes sense! Always recheck decimals. There are many different types
of insulin and medications that are similar. ALWAYS check labels carefully with the
medication order.
Preparing Oral Medications
To prepare tablets or capsules from a bottle, pour correct number into bottle cap and transfer to
medicine cup. Place all tablets into same cup except those requiring pre-administration
assessments.
To prepare unit-dose, place unopened doses in cup.
To prepare liquids, remove bottle cap from bottle and place upside down. Hold bottle with label
against palm of hand while pouring. Hold medicine cup at eye level and fill to desired level on
scale. If the dosage amount is not a multiple of 5, is less than 5mL, or is a fraction of a mL, use a
syringe without a needle to draw it up.
Preparing Parenteral Medications
To prepare injection, wipe off surface of vial with alcohol or break neck of ampule with alcohol.
If vial, insert air equivalent to dosage amount into vial. Insert needle into vial or ampule and
invert keeping needle below fluid level. If drawing from an ampule, use filter needle if
available. Draw up correct volume and remove air bubbles. Remove needle from container.
Recap and change needle.
When drawing from a vial and an ampule, draw medication from the vial first and then the
ampule.
When drawing from two vials, change the needle between vials except when second vial is a
single-dose vial.
If drawing from two insulin vials, insert air into intermediate-acting (N or NPH) insulin first but
draw up short-acting (Regular or R) first since needle cannot be changed. Rotate the
intermediate-acting insulin between hands to disperse suspension prior to drawing up. Double
check prepared insulin syringe with another nurse prior to administering.
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Intramuscular
Sites:
1. Deltoid – Draw an imaginary upside down triangle with the base 2-3 fingerbreadths
below the acromion process. The apex of the triangle is in line with the axilla. Give in
the middle of the triangle in the thickest area of the muscle. No more than 1 mL is
usually recommended for this site.
2. Vastus lateralis – Place one handbreadth below the greater trochanter and one
handbreadth above the knee. Give the injection in the middle third of the muscle between
the anterior and lateral midlines of the thigh. Lift muscle away from the bone. No more
than 2 mL is usually recommended for this site.
3. Rectus femoris- Located midway between the patella and the superior iliac crest, the
center of the anterior thigh. Lift muscle away from the bone. No more than 2 mL is
usually recommended for this site.
4. Ventrogluteal - Place non-dominant hand over or just below the greater trochanter. Point
fingers up towards waist, then move a finger forward toward the anterior superior iliac
spine and extend adjacent finger(s) posteriorly along the iliac crest toward the buttocks.
Give in the middle of the “V”. No more than 3 mL is usually recommended for this site.
5. Dorsogluteal – According to the text, routine use is not recommended. To locate the
dorsogluteal muscle, imagine a line from the posterior superior iliac spine (near the small
of the back) to the greater trochanter. Give the injection above the imaginary line but
below the iliac crest. No more than 3 mL is usually recommended for this site.
Angle: 90 degrees
Technique: Locate correct site. Cleanse with alcohol. Unless lifting muscle away from bone,
use the Z-track method. Insert needle quickly. Aspirate for blood return. If no blood return,
inject medication slowly and withdraw needle quickly.
Syringe: 3 mL
Needle Length: 1- 3 inch; usually 1 – 1 ½ inch for average adult client
Needle Gauge: 19 – 25, usually 21- 23
1. Always rotate injection sites to avoid tissue injury with subsequent scarring.
2. Always select a site that has no scars, bruising, sores, or wounds.
3. Always determine needle gauge and length according to the size of patient and how
viscous (thick) and irritating a medication is.
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Subcutaneous
Sites: No more than 1 mL is usually recommended for these sites.
1. Posterior aspect of upper outer arms
2. Abdomen – below the costal margins of the ribs to the iliac crest, 2 inches away from the
umbilicus
3. Anterior thighs
4. Upper back near the scapula
5. Upper buttocks
Technique: Locate correct site. Cleanse with alcohol. Pinch/bunch skin depending on amount
of subcutaneous tissue. Insert needle quickly and release skin (if pinched). Inject medication
slowly, and withdraw needle quickly.
Angle: 45 or 90 degrees depending on amount of subQ tissue
Syringe: 0.5 mL – 2 mL syringe, insulin syringe (for insulin), or tuberculin syringe
Needle Length: ½ inch - 5/8 inch
Needle Gauge: 25 – 30
1. Use abdominal site for heparin. Anticoagulants may cause local bleeding and bruising
when injected into arms and legs because of muscular activity.
2. Rotate all injection sites to prevent tissue damage.
3. On the abdomen, avoid the area 1-2 inches on either side of the umbilicus when
administering heparin or low-molecular weight heparin (Lovenox).
Intradermal
Sites: Inner aspect of forearms, upper arm, and scapular area of upper back
Technique: Spread skin taut. Hold bevel of needle up. Insert bevel only. While injecting
medication, notice that a small bleb/wheal resembling a blister appears on the skin’s surface.
Assess the site at the recommended time. If the result is positive, then induration will be present.
Angle: 5 to 15 degrees
Syringe: 1mL tuberculin syringe
Needle Gauge: 26 – 28
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Medication Practice Guidelines (for Lab Practice)
1. Please do not open the pills – we reuse these each semester. If the pills are in a bottle, it is ok
to take the pills out- just put them back in the bottle when finished.
2. Your Medication Administration Records (MARs) are in the books. All liquid meds (meds
ordered as mLs) are on top of the med cart- they won’t fit in the drawers. Look and see what
med you need and measure it- then put it back in the bottle when finished.
3.
Each MAR will tell you how to practice- for example: it will say practice giving pt’s 0800
meds, 1000 meds etc.
4. Needles- We do not recap needles in the lab. If you are using a needle- use the same one for
the time you are practicing and then when you leave, put it in the sharps containers (these are
red containers scattered throughout the lab).
5.
There are needles, syringes, and needles with pre-attached syringes in the lab- practice with
both. Each needle has a gauge and length on it. Be sure you are getting the right gauge and
length that you need.
6. There are injectable pads for you to use- you can inject liquids into these.
7. There are also cards with different medications for you to practice doing calculations and
drawing up different amounts. Just get a card and the bottle or vial of medication and
practice with it. Be sure to return the bottles/vials when you are finished.
8. When you do Medication check off you will be doing:
 PO tablet
 PO liquid
 IM injection (using Z-track method)
 Subcut insulin injection (will mix 2 types of insulin)
 Injection sites (IM, subcut, ID- will tell/show instructor- MUST know
landmarks)
* Be sure you are comfortable being able to go the station and decide what gauge, length and
type of needle/syringe you need.
*You will be given a medication card at check-off. You will have to locate the meds,
calculate dosages as needed (show your work using dimensional analysis), prepare the
meds, and demonstrate administration of injections.
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BED AND BATH CHECK OFF FORM
Name of student:________________________________________________________________
Name of student observer:________________________________________________________
Date:_________________________________________________________________________
Comments, issues or problems with BATH:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Comments, issues or problems with BED:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
For Instructor Use:
Please circle one:
PASS
FAIL (needs recheck)
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PATIENT TRANSFER CHECK OFF FORM
Name of student:________________________________________________________________
Name of Student Observer: _______________________________________________________
Date:_______________________________________________________________
Please circle one:
PASS
FAIL (needs recheck)
Comments, issues or problems
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
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ROM CHECK OFF FORM
Name of Student: ____________________________________________________________________________
Neck
______Flexion
______Extension
______Hyperextension
______Lateral Flexion
______Rotation
Thumb
______Flexion
______Extension
______Abduction
______Adduction
______Opposition
Shoulder
______Flexion
______Extension
______Hyperextension
______Abduction
______Adduction
______Internal Rotation
______External Rotation
______Circumduction
Hip
______Flexion
______Extension
______Hyperextension
______Abduction
______Adduction
______Internal Rotation
______External rotation
______Circumduction
Elbow
_____Flexion
_____Extension
Knee
______Flexion
______Extension
Forearm
_____Supination
_____Pronation
Ankle
______Dorsal Flexion
______Plantar Flexion
Wrist
_____Flexion
_____Extension
_____Hyperextension
_____Abduction (radial flexion)
_____Adduction (ulnar flexion)
Foot
______Inversion
______Eversion
Fingers
_____Flexion
_____Extension
_____Hyperextension
_____Abduction
_____Adduction
Toes
_____Flexion
_____Extension
_____Abduction
_____Adduction
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