Download Faculty Site Listing - Metropolitan Community College

SYLLABUS HANDOUT
FOR
Summer 2012
Concepts of Health Assessment and Therapeutic
Intervention II
NURS 2520 9A & 9B
INSTRUCTORS:
Alex Winter, RN, MSN
Diana Blum, RN, MSN
WELCOME TO METROPOLITAN COMMUNITY COLLEGE
Metropolitan Community College
1
Metropolitan Community College
Course Syllabus – Summer 2012
COURSE IDENTIFICATION
Title:
Concepts of Health Assessment and Therapeutic Intervention II
Prefix/Section:
NURS 2520 9A
Credit Hours:
1 Credit hours (Class hours 5.5, lab hours 20 for 10 weeks)
Begins/Ends:
Saturdays, June 9, 2012 through Saturdays, August 11, 2012
Meeting Day/Time:
Saturdays
11:30am – 2:00pm
Last Day to Withdraw
Saturday, July 28, 2012
No Class:
N/A
Delivery Type:
Classroom/ Simulation Laboratory/Demonstration
Class Location:
SOC, Mahoney RM 505
Lab Location:
SOC, Mahoney RM 505
Course Web Address:
http://www.mccneb.edu/healthcareers/
CONTACT INFORMATION
Instructor Name:
Office Location:
Office Telephone:
Facsimile:
Office Hours:
Email Address:
Faculty Web Site:
Alex Winter RN, MSN
SOC-Mahoney Bldg, RM 513
402-738-4784
402-738-4552
Posted outside office
[email protected]
http://faculty.mccneb.edu/awwinter
Instructor Name:
Office Location:
Office Telephone:
Facsimile:
Website:
Metro Office Hours:
Diana Blum, RN, MSN
Mahoney Bldg. SOC Room 513
402-738-4651
402-738-4552
Faculty.mccneb.edu/Dblum3
Posted outside Office
Academic Program Area:
Tutoring:
Health Careers
Alice Ludwig, RN – SOC-Mahoney RM 513
COURSE INFORMATION
Course Description: This course is designed to assist the student in developing assessment skills of
the professional registered nurse. It introduces physical assessment skills related to light palpation,
percussion, and the use of the ototscope/opthalmoscope. The therapeutic interventions related to
intravenous therapy are presented. Comprehension of underlying principles and mastery of skills
will be demonstrated in the lab setting.
Course Prerequisites: Successful completion of the LPN program and licensure as an LPN.
Co-requisites: NURS 2410: High Risk Family.
Metropolitan Community College
2
Course Objectives: At the completion of this course, the student will be able to
1.
Demonstrate the safe administration of IV therapies.
2.
Demonstrate total parenteral nutrition administration.
3.
Demonstrate safe blood administration.
4.
Demonstrate chest tube management.
5.
Demonstrate head to toe physical assessment of the adult client.
6.
Demonstrate the use of the ophthalmoscope/otoscope in the assessment of the adult
client.
7.
Demonstrate the proper techniques for light palpation and percussion.
8.
Assess abnormal heart sounds including S3, S4 sounds and murmurs.
9.
Assess neurological reflex activity.
Required & Supplemental Materials:
Berman (2012) Kozier & Erb’s Fundamentals of Nursing, 9th Edition. Pearson.
Osborne, K. et al (2010). Medical-Surgical Nursing Preparation for Practice. Pearson: Boston:
Kaplan: Math for Nurses (2007)
Gahart: IV Medications (2011) 27th edition
Course Structure:
a. Class activities will include lecture, discussion, demonstration, return
demonstration, reading assignments, and application of content in the laboratory
portions of the program.
COURSE ASSESSMENT
Types of Assessment/Assignments
COURSE OBJECTIVES
1. Demonstrate the safe administration of IV
therapies.
ASSESSMENT MEASURES
Lab activities
Return Demonstration
2. Demonstrate total parenteral nutrition
management.
Lab activities
Return Demonstration
3. Demonstrate safe blood transfusion.
4. Demonstrate nursing management of chest
tubes.
Lab activities
Return Demonstration
Lab activities
Return Demonstration
5. Demonstrate head to toe physical
assessment of the adult client..
Lab activities
Return Demonstration
6. Demonstrate the use of the
ophthalmoscope/otoscope in the assessment of
the adult client.
7. Demonstrate the proper techniques for
light palpation and percussion.
Lab activities
Return Demonstration
8. Assess abnormal heart sounds including
S3, S4 sounds and murmurs.
Lab activities
Return Demonstration
Metropolitan Community College
Lab activities
Return Demonstration
3
9. Assess neurological reflex activity.
Lab activities
Return Demonstration
Final Exam
10. Objectives 1-9
EVALUATION:
METHODS OF ASSESSING STUDENT PROGRESS: Classroom assessment techniques will
be utilized periodically to determine the student’s understanding of the materials being studied.
CRITERIA FOR DETERMINING FINAL COURSE GRADE:
Test Out x 4
Final
MNL
(IV) Quiz
Test #1
Test #2
Test #3
Test #4
100 pts.
100 pts
150 pts
25 pts
375 pts
=
=
=
=
70%
20%
5%
5%
100%
Central Line Care
IV start
IVP meds
1o & 2o setup on pump
Final course grades are based on the following letter scale:
93-100 = A
84-92 = B
78-83 = C
70-77 = D
Below 70 = F
There will be NO rounding of grades, i.e., a 75.8 = 75%. A final course grade of C (78%) is
required to continue in the program.
Unit examinations will be administered as indicated on the course calendar.
A comprehensive final examination will be administered at the completion of the quarter.
MAKE-UP TEST PROCEDURES:
If it is necessary to be absent during an assigned test period, the student must make-up that
examination within one week of the original test date (i.e., if the exam is given on Monday, it
must be made up PRIOR to the next Monday). Failure to do so will result in a zero for the
examination. The student may miss one examination without penalty, as long as the test is made
up within the specific time period. If the student misses more than one examination, the exam
may be made up, but the maximum score allowed is 80%. The final examination must be taken
on the scheduled date and at the scheduled time.
Metropolitan Community College
4
Students may not enter the classroom after the testing has begun. If the student is not in the
classroom when tests are being distributed the student must follow the procedure for make up
testing.
When it is necessary to make up an examination, it will be placed in the testing center. It is the
student’s responsibility to make an appointment and take the test within the specified period of
time.
Exceptions to these guidelines may be considered, but only if the student consults with the
instructor in advance.
LATE ASSIGNMENTS:
The assignment for the teaching project is to be submitted at the time indicated. Failure to
submit at the appropriate time will result in a zero.
Maintenance of Student Records
The tests will be reviewed in the following class period. All test papers are to be returned to the
instructor at the completion of the review. Exams will be kept for one academic year.
STUDENT EXPECTATIONS
Required Expectations
METHODS OF LEARNING: Students will be expected to read all assigned material, participate
in the lecture-discussion classes, and participate in small group activities as assigned, and
demonstrate lab skills. Objectives for each unit of study are provided in this syllabus. Students
will be expected to prepare for activities related to the assigned objectives.
ATTENDANCE STATEMENT:
The student is expected to attend all classes. If it is necessary to be absent from class, the student
is responsible for all assignments and materials covered in class. It will be necessary to obtain a
fellow classmate’s notes or have a classmate tape-record the lecture for you. If there are
questions or handouts see the instructor as necessary. Students who attend no class meetings up
to and including the Section Census Date published in the Class Schedule at
www.mccneb.edu/schedule/ may be disenrolled from the class. There is no appeal for this
disenrollment.
Attendance and participation in lab activities is mandatory. Any missed labs must be made up
prior to the next scheduled lab time.
Notice: This syllabus is written as an expectation of class topics, learning activities, and
expected learning outcomes. However, the instructor reserves the right to make changes in this
schedule that may result in enhanced or more effective learning for students. These
modifications will not substantially change the intent or objectives of this course and will be
done within the policies and guidelines of Metropolitan Community College.
WX
WX is an administrative withdrawal/disenrollment of a student who registered by never attended
class. WX is not a grade or other transcript mark; it is only a code used by the instructor or the
College. After the first class meeting and through the Section Census Date, the instructor may
Metropolitan Community College
5
disenroll (WX) students who have not attended any classes. The Section Census Date is listed
under the Important Dates for the course in the official Class Schedule at
http://www.mccneb.edu/schedule/. There is no appeal for this disenrollment.
FX
The FX grade, an attendance-related failure, can be determined at any time during the quarter—
that is, once it is earned according to the attendance policy as specified in the instructor’s
syllabus. The actual posting of the FX grade will take place at the end of the quarter.
Avoiding the FX Grade
When a student has earned the FX grade prior to the end of the quarter, he or she may avoid
receiving the failing grade by withdrawing from the course before the Last Date to Withdraw
from Class. This date is posted under the Important Dates for the course on the official Class
Schedule at http://www.mccneb.edu/scedule/. It is the student’s responsibility to maintain
contact with the instructor to know if he or she may be subject to an FX grade and/or to drop the
course in a timely manner.
LEARNING SUPPORT
Metro's Learning, Math, and Writing Centers can help you achieve educational success. The staff
in these centers provide drop-in assistance with basic math, reading, writing and computer skills.
We offer a friendly, supportive learning environment. Self-paced computer-assisted instructional
support in reading, vocabulary, typing, English as a Second Language, and online course
orientation is also available.
Detailed information about these services are in the Student Handbook, College Catalog, and
online. Links to these resources are located at http://www.mccneb.edu/learningcenter/.
COLLEGE POLICIES
College policies, such as student rights and responsibilities, academic standards, plagiarism, and
etc. are outlined in the College Catalog and Student Handbook. This information can be
accessed via the online catalog at http://www.mccneb.edu/academics/catalog.asp.
STUDENT WITHDRAWAL:
If you cannot participate in and complete this course, you should officially withdraw through
WebAdvisor at http://webadvisor.mccneb.edu or by calling Central Registration at 402-457-5231
or 1-800-228-9553. Failure to officially withdraw will result in either an attendance-related
failure (FX) or failing (F) grade. The last date to withdraw is noted in the CLASS
IDENTIFICATION section of this syllabus.
STUDENT CODE OF CONDUCT: The College has a standard code of conduct that involves
consequences for specific academic and non-academic behavior that may result in a failing
grade, probation, or suspension from the college. More complete information about the code of
conduct is located in the Student Services portion of the online catalog
(http://www.mccneb.edu/catalog/studentinformation.asp).
ACCOMMODATIONS FOR STUDENTS WITH DISABILITIES: If you have a disability that
may substantially limit your ability to participate in this class, please contact a Vocational
Metropolitan Community College
6
Special Needs Counselor, located in the Student Services Office on each campus. Metropolitan
Community College will provide reasonable accommodations for persons with documented
qualifying disabilities. However, it is the student’s responsibility to request accommodations.
For further information, please contact the Student Services Office at your campus.
RECORDING IN THE CLASSROOM: Students may not video or audio record class sessions
without the instructor’s knowledge and permission. If recording of class sessions is authorized as
a reasonable accommodation under Americans with Disabilities Act (ADA), the instructor must
have the appropriate documentation from College Disability Support Services. Permitted
recordings are to be used only for the individual student’s educational review of the class session
and may not be reproduced, posted, sold or distributed to others. Students who violate this policy
are subject to disciplinary procedures as outlined in the Student Conduct Code.
Other pertinent college policies are posted on the CDS website www.mccneb.edu/cds.
Metropolitan Community College
7
2520 Calendar
Summer 2012
SCHEDULE OF ASSIGNMENTS
The schedule of assignments is listed below. The instructor reserves the right to modify this as
necessary. Changes will be announced in class.
DATE
CLASSROOM ACTIVITY
Week 1
June 9
Intro / Central line venipuncture / Lecture Demo
Week 2
June 16
IVP / Pmeds/ PB / Lecture / Demo
Week 3
June 23
Blood Admin, chest tubes / Lecutre / Demo
Week 4
June 30
Head to toe otoscope/opthalmoscope/Lecture/Demo
Week 5
July 7
Abnormal heart tones, lungs/ABD/Lecture/Demo
Week 6
July 14
Checkouts/Quiz/MNL
Week 7
July 21
Checkouts/Quiz/MNL
Week 8
July 28
Checkouts/Quiz/MNL
Week 9
Aug. 4
Checkouts/Quiz/MNL
Week 10
Aug. 11
Final
IMPORTANT DATES see Metro’s Academic calendar at
www.mccneb.edu/academics/calendar.asp?Theme=2
Metropolitan Community College
8
Unit 1-3: Intravenous interventions
Unit Objectives: At the completion of this unit of study, the student will be able to:
1. Explain the legal implications of intravenous therapy.
2. Apply the concepts of standard precautions in infusion therapy.
3. Discuss the risks, complications, and adverse reactions of intravenous therapy.
4. Identify central and peripherally placed vascular access devices utilized for various patient
needs.
5. Identify the pharmacological principles and administration of intravenous medications.
6. Demonstrate peripheral venipuncture and discontinuation of IV push.
7. Demonstrate calculation of IV drip rates and IV dosages.
8. Demonstrate safe administration of medications and IV piggyback medications.
REQUIRED LEARNING ACTIVITIES
Required Readings:
Kozier Chapter 35, 52 (pgs 1455-1471)
Osborn Chapter 22
Lab activities: Demonstrate safety in delivering intravenous therapies.
Complete the unit objectives.
Demonstrate administration of IV medication, venipuncture, spike IV fluid bag and IVPB.
Utilize Gahart 2009 for safe administration of IV medications.
Metropolitan Community College
9
Unit 4-6: Total Parenteral Nutrition/Intralipids/Central Line Care
Unit Objectives: At the completion of this unit of study, the student will be able to:
1. Demonstrate safe administration and discontinuing of TPN.
2. Demonstrate a sterile central dressing change and changing central line caps.
3. Discuss safe administration of intralipids.
4. Demonstrate safety and sterility in discontinuing a central IV line.
5. Identify types of central lines, safety issues, and cares.
REQUIRED LEARNING ACTIVITIES
Required Readings: Kozier Chapter 52; pg. 1277, 1234, Ch. 31 pgs. 700-711
Osborn: pgs 279-321, 515-516, and 526-527.
Demonstrate safety in delivering TPN in simulation manikin IV arm.
Demonstrate a central line dressing change and changing caps on simulation manikin.
Demonstrate discontinuing a PICC line on simulation manikin (only performed by RN and only
with physician order).
Utilize the procedure checklist.
Metropolitan Community College
10
Unit 7: Blood Transfusion
Unit Objectives: At the completion of this unit of study, the student will be able to:
1. Discuss treatment with blood components.
2. Demonstrate safe nursing interventions in blood transfusions.
3. Assess transfusion reaction and safe interventions.
REQUIRED LEARNING ACTIVITIES
Required Readings: Kozier pgs 1472-1478
Osborn, Chapter 23.
Simulation
Utilize the procedure checklist in demonstrating blood administration.
Utilize the procedure checklist in demonstrating procedure for transfusion reaction.
Metropolitan Community College
11
UNIT 8: Head to Toe Assessment Review
1. Demonstrate head to toe assessment of the adult client.
2. Document findings by narrative charting.
REQUIRED LEARNING ACTIVITIES
Required Readings: Kozier chapter 30
Osborn: Chapters 6-7, Chapter 9, Chapter 14 (pgs 272-276), Chapter 15 (pgs 338-341.)
Lab activities: be prepared to utilize procedure checklist to demonstrate head to toe assessment.
Document by narrative charting.
Complete the unit objectives.
Unit grade evaluated by unit test.
Evaluated by performance of head to toe assessment in lab setting.
SUGGESTED LEARNING ACTIVITIES
View the video on the complete physical assessment.
Metropolitan Community College
12
UNIT 9: Physical Assessment Techniques for the Lungs, and Abdomen
Unit Objectives: At the completion of this unit of study the student will be able to:
1. Demonstrate the assessment technique of light palpation and percussion to abdomen.
2. Demonstrate the assessment technique of percussion of the thorax and abdomen.
REQUIRED LEARNING ACTIVITIES
Required Readings: Kozier pgs 610-618, 631-639
Osborn: Chapters 33 and 44
Lab activities: Utilize procedure checklist.
Complete the unit objectives.
SUGGESTED LEARNING ACTIVITIES
Review anatomy and physiology of thorax and abdomen.
Metropolitan Community College
13
UNIT 10: Physical Assessment Techniques for the Eye, Ear, and Nose
Unit Objectives: At the completion of this unit of study the student will be able to:
1. Demonstrate the proper use of the ophthalmoscope.
2. Demonstrate the proper use of the otoscope.
3. Assess the anatomical structures visible with the ophthalmoscope and otoscope.
REQUIRED LEARNING ACTIVITIES
Required Readings: Kozier pgs 586-601
Osborn: Chapter 69.
Lab activities: Utilize procedure checklist.
Complete the unit objectives.
SUGGESTED LEARNING ACTIVITIES
Practice using the otoscope and ophthalmoscope before the lab activities.
Metropolitan Community College
14
UNIT 11: Assessment of Abnormal Heart Sounds
Unit objectives: At the completion of this unit of study the student will be able to:
1. Identify the events in the heart that create normal heart sounds of S1 and S2.
2. Identify the abnormal heart sounds of S3 and S4 and murmurs.
3. Identify heart murmurs as systolic or diastolic.
4. Demonstrate auscultation of heart sounds.
REQUIRED LEARNING ACTIVITIES
Required Readings: Kozier pgs 619-624
Osborn: pages 1060-1072
Lab activities: Practice the assessment of the various heart sounds.
Complete the unit objectives.
Utilize the procedure checklist.
SUGGESTED LEARNING ACTIVITIES
Review normal and abnormal physiology of the heart.
Metropolitan Community College
15
UNIT 12: Neurological Assessment
Unit Objectives: At the completion of the unit of study each student will be able to:
1. Assess the components of the basic neurological assessment to include pupils, level of
consciousness and mental status, reaction to external stimuli, and the Glasgow Coma Scale.
2. Demonstrate the proper technique for the assessment of reflex activity using a reflex hammer.
3. Demonstrate the assessment techniques employed in the assessment of the cranial nerves.
4. Demonstrate the complete assessment of the neurological system.
REQUIRED LEARNING ACTIVITIES
Required Readings: pgs 642-653 Osborn: pgs 698-711
Lab activities: Utilize the procedure checklist.
Complete the unit objectives.
SUGGESTED LEARNING ACTIVITIES
Complete a neurological assessment on a client in the clinical setting.
Review neurologic system.
Metropolitan Community College
16
Unit 13: Chest Tubes
Unit Objectives: At the completion of this unit of study, the student will be able to:
1. Demonstrate the role of RN in nursing intervention of chest tubes.
2. Perform therapeutic nursing interventions to clients with chest tubes.
REQUIRED LEARNING ACTIVITIES
Required Readings: pgs 1393-1395 Osborn: pgs 680, 990-991.
Assess simulation of chest tube to manikin.
Utilize the procedure checklist.
Metropolitan Community College
17
Metropolitan Community College
Procedure Checklist
Peripheral Venipuncture
Procedure Steps
1. Verify physician order.
2. Assess purpose of IV (Blood
administration or IV fluids and/or
antibiotics) and choose proper IV gauge.
3. Identify patient and explain procedure.
Note any allergies.
4. Hand hygiene.
5. Obtain IV supplies and flush lock with
saline.
6. Assess venipuncture site – use of
tourniquet.
7. Remove tourniquet, put on gloves.
8. Prepare venipuncture with chloroprep.
9. Do Not Repalpate after prepping.
10. Reapply tourniquet.
11. Inform patient of needle stick.
Introduce needle with bevel up. Angle to
enter skin will depend on depth of vein.
Once vein is entered then bring IV device
flush with skin so able to thread into
vein.
12. Observe for blood return in
flash back chamber.
a. When blood returns advance needle
slightly further then hold needle still (do
not advance needle) and advance only
catheter into vein.
b. Immediately release tourniquet.
c. Connect hub of catheter to saline
lock.
d. Apply Tegaderm.
e. Wipe saline lock port with alcohol
and infuse 5-10 mL of sterile saline to
assure patency and no infiltration noted.
f. Discard supplies and sharp
properly.
g. Remove gloves and wash hands.
h. Maintain patient comfort.
Metropolitan Community College
Yes
18
No
Comments
Peripheral Venipuncture – continued
i. Documentation to include:
- gauge used
- how many attempts (limit to 2
per policy)
- location of IV
- saline lock or infusion as
ordered.
- any comments said by patient
that relates to IV.
Recommendation: Pass____________________ Needs more practice_____________________
Student______________________________________________Date______________________
Instructor____________________________________________
Metropolitan Community College
19
Metropolitan Community College
Procedure Checklist
Administering IV Push Medication
Procedure Steps
1. Check physician order.
2. Verify Allergies.
3. Review information on the
medication, including reason for,
effects of proper dilution, rate of
administration, reactions,
compatibility with existing IV
fluids/meds.
4. Explain procedure to patient.
Yes
No
5. Hand hygiene.
6. Select appropriate equipment
needed.
7. Assure 6 rights to safe medication
administrated.
Rt Patient
Rt Drug
Rt Dose
Rt Time
Rt Route
Rt Documentation
8. Perform the 3 checks while
preparing the medication. maintain
sterility and always use alcohol wipe
before accessing on any IV ports.
9. Put on clean gloves. Flush
peripheral saline port with 5-10 mL
normal saline, observing IV site for
infiltration. (Need to perform if port
is locked). If central line capped
port, flush with 10mL sterile saline
and check of Blood return.
10. Give IV push medication
properly diluted (if indicated) at
recommended rate, timing with
watch.
11. Slowly flush with 10 mL saline
when completed. Again observing
IV site for infiltration for peripheral
lines.
Metropolitan Community College
20
Comments
Administering IV Push Medication- continued
12. If IV fluids are infusing, assure
compatibility. May need to stop
infusion (if safe for patient) and flush
with 10 mL saline then give IV
medication then flush with IV 10 mL
saline slowly to clear tubing of
medication.
13. Observe for side effects.
14. Dispose of equipment properly
and hand hygiene.
15. Document med given, dose,
route, time, signature.
Recommendation: Pass____________________ Needs more practice_____________________
Student______________________________________________Date______________________
Instructor____________________________________________
Metropolitan Community College
21
Metropolitan Community College
Procedure Checklist
Primary IV Fluid and Tubing
Procedure Steps
1. Check physician order.
2. Verify Allergies.
3. Assess if IV fluid appropriate for
this patient.
4. Gather equipment.
5. Explain procedure.
6. Hand hygiene.
7. Assure 6 rights to safe medication
administrated.
8. Spike IV bag to primary tubing.
fill drip chamber approximately ½
full. Prime this tubing carefully.
Remove all fluid, even in parts along
tubing, inverting these ports so fluid
will fill and air will move out.
9. Place tubing in pump (if using)
assure proper mL/hour and volume
setting into pump.
10. Flush a peripheral saline lock or
central heparin lock to assure
patency. Then attach aseptically
with gloves on. Always wipe lock
connector with alcohol before
attaching.
11. Assure clamps open; proper rate,
proper volume are set in pump.
12. Maintain patient comfort.
Yes
No
Comments
Recommendation: Pass____________________ Needs more practice_____________________
Student______________________________________________Date______________________
Instructor____________________________________________
Metropolitan Community College
22
Metropolitan Community College
Procedure Checklist
Administering IV Piggy Back Medication with Existing IV Line and Without
Procedure Steps
1. Check physician order.
2. Wash your hands.
3. Verify any allergies.
4. Review information on the
medication, medical reason for,
effects of proper dilution, rate of
administrating, reactions,
compatibility with existing IV
fluids/meds.
5. Assess IV access. If IV fluids are
infusing, assure compatibility. May
need to stop infusion if safe for
patient and flush with 10 mL saline,
then attach IV piggyback tubing then
flush with 10 mL saline slowly to
clear tubing of medication. Always
use alcohol wipe prior to accessing
any IV port.
6. Explain procedure to patient.
7. Select appropriate equipment.
8. Assure the 6 rights and 3 checks:
Rt Patient
Rt Drug
Rt Dose
Rt Time
Rt Route
Rt Documentation
* With piggyback meds assess the
label attached by pharmacy as well as
the label on the bag itself to assure
proper dilution and proper med.
9. If using pump and existing IV line
a. Assure compatibility
b. Spike piggyback IV bag to
secondary tubing (clamp is closed at
this time)
c. Fill drip chamber
approximately ½ full
d. Slowly open clamp and flush
secondary tubing so do not waste any
medication.
e. Prime tubing
Metropolitan Community College
Yes
No
23
Comments
Administering IV Piggy Back Medication with Existing IV Line and Without – continued
f. Attach to existing tubing above
pump. Remember to hang what you
want to be infusing the highest.
g. Enter correct infusion rate and
volume into pump and start (make
sure clamp is open or pump will
alarm “occlusion”).
h. Always date tubing. Good for
24-48 hour (check policy)
10. If using pump but no existing IV
line
a. Some agencies use long
Continu-flo tubing for piggyback
medication. But medication is
wasted in this long tubing. Best to
prime Continu-flo with saline (or
compatible fluid) then spike
piggyback med with secondary
tubing and run through pump (follow
the steps in #8 above).
11. Tubing may be revised for 24
hours (check policy).
Recommendation: Pass____________________ Needs more practice_____________________
Student______________________________________________Date______________________
Instructor____________________________________________
Metropolitan Community College
24
Metropolitan Community College
Procedure Checklist
Changing IV Fluid With Existing IV Tubing
Procedure Steps
1. Check physician order for type of
fluid and infusion rate.
2. Hand hygiene.
3. Select correct fluid IV bag.
4. Examine solution for clarity.
5. Assemble supplies.
6. Perform 6 rights to safe
medication administration.
Rt Patient
Rt Drug
Rt Dose
Rt Time
Rt Route
Rt Documentation
7. Close regulator on tubing. Verify
existing tubing date (tubing change
usually every 72 hours)
8. Remove cover from entry port of
new IV bag.
9. Remove old IV bag from
connector and insert connector into
new solution IV bag without
touching the portion of connector
that is going into the bag.
10. Invert new container and hang it
up.
11. Fill drip chamber approx. ½ full.
12. Open clamp, start, and regulate
flow rate through IV pump as
ordered.
13. Secure client’s environment and
comfort.
14. Dispose of used IV bag.
15. Reassess entire IV, including rate
and IV site.
16. Hand hygiene.
17. Document the procedure.
Yes
No
Comments
Recommendation: Pass____________________ Needs more practice_____________________
Student______________________________________________Date______________________
Instructor____________________________________________
Metropolitan Community College
25
Metropolitan Community College
Procedure Checklist
Changing the Central Intravenous Dressing
Procedure Steps
1. Check date and time of last
dressing change. PICC lines 7 days
(Check policy)
2. Wash your hands.
3. Assemble supplies.
4. Check clients’ identification.
5. Explain procedure to patient.
6. Clean overbed table and allow to
dry.
7. Place client in supine position if
patient can tolerate, with head turned
away from site.
8. Put on face mask and also on
patient if necessary. (PICC line
patient does not need to put on mask
(unless patient is watching the
procedure.)
9. Set up supplies on overbed table.
Open sterile field. Maintain sterile
field. Do not contaminate during
procedure.
10. Put on clean gloves and remove
old dressing.
11. Dispose of dressing in plastic
bag or contain in glove.
12. Remove gloves and wash hands.
(make sure patient is safe if moving
away from patient)
13. Visually inspect site carefully.
14. Put on sterile gloves. Maintain
sterility.
15. Cleanse area with chloroprep,
moving in a spiral direction moving
inside to outside. Keeping both
gloves sterile. Cleanse area the size
of the dressing that will cover the
site.
16. Dispose of used articles away
from sterile field.
17. Allow antiseptic solution to dry.
18. Apply new dressing and secure
tube if needed.
Metropolitan Community College
Yes
No
26
Comments
Changing the Central Intravenous Dressing- continued
19. Remove gloves and mask.
20. Label dressing with date and
time. Do not cover site, place on
edge of dressing.
21. Reposition client for comfort and
safety (call light, side rails up).
22. Dispose of packages and wastes.
23. Wash your hands.
24. Assure proper IV flow rate.
25. Document site appearance and
procedure.
Recommendation: Pass____________________ Needs more practice_____________________
Student______________________________________________Date______________________
Instructor____________________________________________
Metropolitan Community College
27
Metropolitan Community College
Procedure Checklist
Changing the Central Line Caps (this is usually done with Central Line Dressing)
Procedure Steps
1. Hand hygiene.
2. Explain procedure to patient.
3. Assemble supplies: If triple
lumen, need:
3 sterile caps
sterile saline syringe
alcohol pads x 3
4. Use 1 saline syringe to remove air
from each cap.
5. Put on clean gloves and place
patient in supine position.
6. Assure all lumens are clamped.
Yes
No
Comments
7. Wipe around existing central caps
with alcohol prior removal to
decrease bacteria count.
8. Make sure line is clamped or
kinked prior to removing cap so air
will not enter.
9. Remove 1 cap and quickly and
keeping end sterile, apply new cap
that has been flushed with saline.
10. Continue these steps until all 3
lumens have new caps.
11. Keep lumens clamped when not
in use to decrease incidence of air
emboli. Assure caps are secure.
12. Heparin flush 100 units is
infused once a day for each lumen to
keep these lumens from clotting.
(Power Piccs are flushed with saline)
complete all the 6 safe administration
rights if infusing the Heparin flush.
13. Document.
Recommendation: Pass____________________ Needs more practice_____________________
Student______________________________________________Date______________________
Instructor____________________________________________
Metropolitan Community College
28
Metropolitan Community College
Procedure Checklist
Blood Administration
Procedure Steps
1. Verifies blood administration
consent has been signed.
2. Verifies physician order, note type
of blood, number of units, rate of
infusion, any premedication orders.
3. Verify that the patient has been
typed and cross matched.
4. Notify lab if patient has not been
typed/cross matched.
5. Inquire to blood bank as
availability of blood.
6. Explain procedure to patient.
7. Obtain blood tubing and IV of
normal saline.
8. Assess IV administration site, state
proper gauge of peripheral IV catheter
appropriate for infusion.
9. Wash hands, put on gloves.
10. Prime blood administration
tubing with IV saline, squeeze drip
chamber to ½ full, prime tubing, so no
air in tubing including “Y” tubing to
where blood unit will be connected.
(make sure clamp closed to “Y”
tubing awaiting blood product).
11. Flush IV lock with saline first to
assure patency.
12. Use aseptic technique and
connect to IV.
13. If using pump, or gravity, turn
rate to keep open – usually 20
ml/hour.
14. Remove gloves – wash hands.
15. Administer any pretransfusion
medications if prescribed depending
on the order (make sure the 6
administration rights have been
completed for any pretransfusion
meds)
Metropolitan Community College
Yes
No
29
Comments
Blood Administration - continued
16. Obtain the blood product from the
blood bank according to agency policy.
May need to take a form that has the
patients infusion number from wrist
band to take to blood band.
17. Put on gloves when handling blood
products.
18. Recheck physician order for any
possible changes.
19. Obtain pre-transfusion vitals.
20. Verify the patient and blood product
with another nurse following agencies
policy/procedure.
a. Have patient state name/birthdate
and nurse compares to blood bank form.
b. Compare patient name and
hospital ID number to patient name and
hospital ID number on blood bank form
attached to blood product.
c. Compare blood unit ID number
located on blood bank form with the ID
number printed on blood product.
d. Compare patient’s blood type on
the blood bank form with blood type on
blood product.
e. Obtain signatures of both nurses if
no discrepancies to blood bank form
attached to blood product.
f. Document on blood bank form the
date/time transfusion began.
g. Keep blood bank form attached to
blood product until administration is
complete.
21. Observe blood bag for bubbles,
cloudiness, clots, sediment, and if
present, notify blood bank, then gently
invert blood product several times.
22. Carefully spikes blood product
through blood port “Y”. Do not touch
the connector that is going inside the
blood bag. Open clamp.
Metropolitan Community College
30
Blood Administration - continued
23. Using roller clamp, adjust to
prescribed drip rate (blood
administration sets have drop factor
of 10 drops/mL) or set pump.
24. Remain with patient the first 15
minutes (or according to
policy/procedures) and then obtain
vitals, assess for signs/symptoms of
transfusion reaction.
25. Assure patient has call light.
26. Then vitals hourly until
transfusion is complete, always
assess for transfusion reaction and
fluid status.
27. After infusion is complete, close
rollerclamp to “Y” transfusion bag
and allow normal saline to flush the
administrator set.
28. State tubing is used for no more
than 2 units and blood unit/tubing
not hanging longer than 4 hours.
29. Discard empty blood bag and
tubing per policy.
30. Obtain post transfusion vitals.
Recommendation: Pass____________________ Needs more practice_____________________
Student______________________________________________Date______________________
Instructor____________________________________________
Metropolitan Community College
31
Metropolitan Community College
Procedure Checklist
Transfusion Reaction
Procedure Steps
1. Upon assessment of reaction,
stops transfusion immediately.
2. Do not flush blood administration
set with saline.
3. Disconnects administration set
from IV catheter.
4. Obtains vitals, assesses patient
including auscultating heart and
lungs.
5. Notify physician.
6. Hang new IV 0.9% with primed
new tubing TKO or saline lock IV
catheter.
7. Administer prescribed
medications as ordered.
8. Places administration set and
blood product with blood bank form
attached and place all inside
biohazard bag, notify blood bank,
and return it to blood bank regarding
policy.
9. Obtain blood and urine specimen
according to policy.
10. Continue to assess patient and
monitor vitals frequently – notify
physician of any changes
immediately.
11. Complete transfusion reaction
record.
Yes
No
Comments
Recommendation: Pass____________________ Needs more practice_____________________
Student______________________________________________Date______________________
Instructor____________________________________________
Metropolitan Community College
32
Metropolitan Community College
Procedure Checklist
Head-to-Toe Assessment
Procedure Steps
1. Hand hygiene.
2. Introduce self. Explain procedure
to patient, provide privacy.
3. Demonstrate therapeutic
communication during assessment.
4. The following are to be noted:
-Appears stated age
-Level of consciousness
-Oriented to person, place, time
- Skin color
- Obvious physical deformities
- Mobility, gait
- ROM
- Facial expressions
- Mood and affect
- Speech
- Vision (glasses?)
- Hearing (hearing aid?)
- Personal hygiene
- Pain assessment
- Allergies
- Unexplained weight loss
5. Skin
-Inspect nails
-Inspect for presence of dryness,
rashes, discolorations, any
abnormalities
-Note general texture and color
-Inspect in regions as exam
progresses
6. Vital Signs
-Radial pulse/apical pulse
-Respirations
-Blood pressure
-Temperature
- Pulse ox if necessary
Metropolitan Community College
Yes
No
33
Comments
Head-to-Toe Assessment – continued
7. Head
- Inspect face, scalp, hair, cranium
- Observe facial expression for
symmetry, appropriate affect
- Test pupils for size, reaction to
light and accommodation
- Note sclera, conjunctiva, cornea,
any redness, drainage, swelling.
- Palpate sinus areas for
tenderness if appropriate.
-Inspect outer ear
- Observe hearing ability
- Note presence of hearing aides
-Inspect nose for symmetry,
drainage, lesions.
-Inspect mouth for moist mucous
membranes, note any abnormalities,
any difficulty swallowing.
- Note presence of dentures,
lesions, loose teeth
- Inspect neck, note any swelling,
limited range of motion.
- Palpate for tenderness, nodules.
8. Lungs assessment: Cough
present, difficult breathing?
Posterior chest:
- Inspect, note symmetry,
configuration
- Palpate for symmetrical
expansion, fremitus, tenderness
- Auscultate over all lung field in
a consistent pattern
Anterior chest:
-Inspect respiratory pattern,
symmetry, symmetry of breasts
-Palpate, note fremitus, lumps
-Auscultate over all lung fields in
a consistent pattern.
Metropolitan Community College
34
Head-to-Toe Assessment – continued
9. Cardiovascular
-Inspect precordium, note any
pulsations or heaves
-Auscultate apical rate and
rhythm,
- Capillary refill
- Listen to all areas of precordium
with diaphragm, including traditional
valve areas. Note S1 and S2, as well
as other sounds (murmurs).
-Assess for peripheral edema,
assess peripheral pulses, assess
capillary refill, assess Homan’s sign
or any tenderness to calves.
10. GI
-Inspect
-Auscultate all four quadrants
-Palpate all quadrants, noting
tenderness/guarding.
-Soft, firm, distension, flat
11. Extremities
-inspect, noting any swelling,
lesions, discoloration, hair pattern
-palpate for swelling, tenderness
-palpate pulses, compare quality
side to side
-test hand grasp strength and foot
push strength. Note equality
12. GU: Assess voiding changes or
problems
13. Maintain patient comfort.
14. Hand Hygiene
15. Document – report any abnormal
findings to physician.
Recommendation: Pass____________________ Needs more practice_____________________
Student______________________________________________Date______________________
Instructor____________________________________________
Metropolitan Community College
35
Metropolitan Community College
Procedure Checklist
Physical Assessment of Lungs
Utilizing Light Palpation and Percussion
Procedure Steps
1. Explain Procedure to patient.
2. Lung Visual:
a. Sitting position if patient can
tolerate.
b. Inspect shape of thorax:
1. Estimate visually transverse
diameter of thorax then anteroposterior diameter.
2. Inspect for superficial veins
on thorax.
3. Estimate angle at which
ribs articulate with sternum.
4. Assess for retractions, use
of accessory muscles.
5. Assess rate of respirations,
depth, pattern, audibility, mode of
breathing (nose or mouth breathing).
6. Any sputum.
7. O2 needed? Trach tube?
Any other assistive devices?
3. Lungs: Light palpation: posterior
a. Carefully palpate any area
where pain is reported or lesions
evident as last portion of exam, for
patient comfort.
b. Place your thumbs at level to
10th ribs, your hands grasping the
lateral rib cage. Slide hands
medially slightly to raise loose skin.
fold between thumbs and spine.
Have patient inhale deeply and
feel for symmetry of respiratory
movement.
c. Palpate posterior for fremitus
with ball of hand (palm side of hand
at base of fingers); ask patient to
repeat words “ninety nine”. Can use
both hands at once comparing
bilaterally.
d. Identify, describe, and localize
any areas of increased or decreased
fremitus.
Metropolitan Community College
Yes
No
36
Comments
Physical Assessment of Lungs - continued
4. Lungs: Percussion Posterior to
determine underlying tissues are airfilled, fluid-filled, or solid.
a. Press only distal phalanx and
joint of middle finger firmly on
surface.
b. Quick strikes (one or two)
when move on with opposite hand,
middle finger to the distal phalanx
that has firm pressure on surface.
Compare one part chest to another.
5. Assess and identify 5 percussion
notes:
a. Flatness: soft intensity, high
pitch, short duration (thigh).
b. Dullness: medium intensity,
medium pitch, medium duration
(fluid in lungs)
c. Resonance: Loud intensity,
low pitch, long duration (example
normal lung)
d. Hyper Resonance: Very loud
intensity, lower pitch, longer
duration. (emphysematous lung,
hyperinflated)
e. Tympany: loud intensity.
(gastric air bubble, puffed out chest.)
6. Percussion lungs: Posterior:
Percuss across top of each shoulder –
to identify lung apex with arm folded
across chest.
a. Percuss symmetrical areas of
lung moving down chest.
b. Below scapulae, percuss areas
along sides of chest and medially.
7. Identify level of diaphragmatic
dullness bilaterally during
respiration.
a. Slightly higher level on right
than left. (sound is dull below
diaphragm.)
b. Abnormally high “dull”
suggests pleural effusion or a high
diaphragm from paralysis or
atelectasis.
Metropolitan Community College
37
Physical Assessment of Lungs - continued
8. Lungs: Anterior Light Palpation
a. Identify areas of tenderness.
b. Respiratory symmetry.
- place thumbs along each
costal margin
- hands along lateral rib cage.
- slide in to raise loose skin
fold between thumbs.
- ask patient to inhale deeply
c. Tactile Fremitus:
compare symmetrical areas of
lungs using ball of hand. Have
patient say “ninety-nine”. Fremitis is
decreased or absent if bronchus
obstructed or fluid in pleural space.
Fremitus is increased near large
bronchus and over consolidated lung
such as pneumonia.
8. Lungs: Anterior: Percussion:
a. Compare symmetrical points.
- supraclavicular (above
clavicle)
- infraclavicular (below
clavicle)
move down chest wall. Heart:
dullness to left of sternum from 3rd to
5th interspaces.
b. Dullness replaces resonance
when fluid or solid tissue replaces
air.
c. Only large pleural effusion
detected anteriorly since pleural fluid
displaces posterior in supine patient.
d. Identify upper border of liver
dullness to right.
e. Identify tympanic gastric air
bubble to left.
Recommendation: Pass____________________ Needs more practice_____________________
Student______________________________________________Date______________________
Instructor____________________________________________
Metropolitan Community College
38
Metropolitan Community College
Procedure Checklist
Physical Assessment of Abdomen
Utilizing Light Palpation and Percussion
Procedure Steps
1. Explain procedure to patient.
2. Provide for privacy.
3. Hand hygiene.
4. Assess abdomen using light
palpation.
a. Identify abdominal tenderness,
superficial masses.
b. Use pads of your fingertips
with finger together in a light, gentle
motion.
c. Move smoothly in all 4
quadrants.
d. Identify involuntary rigidity of
abdominal muscles (indicates
peritoneal inflammation.)
5. Percussion :
a. Percuss lightly in all 4
quadrants.
b. Tympany most prominent.
Dullness over distended bladder.
c. Percuss liver for dullness in
right, midclavicular line.
d. Percuss stomach: identify
tympany of gastric air bubble of left
lower anterior rib cage.
e. Percuss spleen: small oval
area of splenic dullness near left 10th
rib posterior to mid axillary line.
Yes
No
Comments
Recommendation: Pass____________________ Needs more practice_____________________
Student______________________________________________Date______________________
Instructor____________________________________________
Metropolitan Community College
39
Metropolitan Community College
Procedure Checklist
Assessing Eye With Use of Opthalmoscope
Procedure Steps
1. Explain Procedure to patient.
2. Darken room
3. Switch on opthalmoscope light
and turn lens disc to zero. Keep your
index finger on lens disc so as to be
able to refocus the scope during
examination.
a. Large round beam (0) for large
pupils
b. Small round beam for small
pupils the green (or red) beam used
to detect small red lesions)
4. Use right hand for patient’s right
eye. Use left hand for patients left
eye.
5. Place thumb of opposite hand on
patients eyebrow to give guidance as
you move in closer and may use
thumb to gently elevate patients
upper lid if necessary.
6. Ask patient to look straight ahead
and look at a specific point on the
wall.
7. Hold scope firmly against your
face with your eye directly behind
the sight hole.
8. From about 15 inches away and
about 15 degrees lateral to patient’s
line of vision, shine the light beam
on the pupil, keep both your eyes
open.
a. Note orange glow (red reflex)
b. Absence of red reflex
suggests:
- cataract
- detached retina
- artificial eye
9. Keep the light beam focused on
red reflex as you move
opthalmoscope very close to pupil.
Your forehead is on or very close to
your thumb.
Metropolitan Community College
Yes
No
40
Comments
Procedure Checklist – continued
10. Identify optic disc, note:
yellowish orange, oval or round, may
need to follow a blood vessel
centrally until visualized. There is
much branching away from optic
disc and progressive enlargement of
vessel size as approach disc.
11. Identify arterioles and veins:
Arterioles are light red, smaller,
bright light reflex, veins are dark red,
larger, absent light reflex.
12. Adjust lens disc to focus on
optic disc.
a. Normal patient eye usually
“O” diopters (clear glass)
b. Near sighted patient: use lens
with longer focus – rotate lens disc
counterclockwise (red numbers
indicates minus diopters)
c. Farsighted patient or lens has
been removed: rotate disc clockwise
to plus diopters (black numbers).
13. Assess for normal white or
pigmented rings or crescents around
disc. Disc outline clear.
14. Note abnormalities of retina.
a. Flame-shaped hemorrhages
(may indicate hypertension)
b. Tiny red spots (may indicate
diabetic retinopathy)
c. Small, slightly irregular red
spots (diabetes)
d. Large, horizontal line
(preretinal hemorrhage)
15. Identify macular area
(responsible for central vision).
Shine light beam laterally or have
patient look directly into light.
a. A vascular area, somewhat
larger than disc, has no distinct
margins. Shimmering light
reflection common in younger
patients.
Metropolitan Community College
41
Procedure Checklist - continued
16. Rotate lens disc progressively to
+10 to +12 diopters to focus on
anterior structures of eye.
a. Lens: should be transparent
- cataract symptoms of
impaired vision, annoying glare from
bright lights, distortion of vision.
Recommendation: Pass____________________ Needs more practice_____________________
Student______________________________________________Date______________________
Instructor____________________________________________
Metropolitan Community College
42
Metropolitan Community College
Procedure Checklist
Assessing Ears With Use of Otoscope
Procedure Steps
1. Explain Procedure to patient.
2. Obtain otoscope and use correct
size speculum (the largest speculum
that the canal will accommodate).
3. Have patient tilt head to side not
being examined.
4. For adult: pulls Helix up and
back.
For preschool child: Pulls Helix
down and back.
Assess for ear pain with this
movement (maybe painful with acute
otitis externa)
5. Inserts speculum slowly, only into
outer 1/3 of canal.
6. Identify if wax, discharge, or
foreign bodies, redness or edema in
ear canal.
7. Identifies location of cone of light
and bony landmarks.
a. Normal drum is pearly
grey/with good cone of light.
b. The handle and short process
of the malleus are readily
identifiable.
8. Gently move speculum to observe
entire drum.
9. Examine bilaterally.
10. Dispose of speculum used.
11. Hand hygiene.
Yes
No
Comments
Recommendation: Pass____________________ Needs more practice_____________________
Student______________________________________________Date______________________
Instructor____________________________________________
Metropolitan Community College
43
Metropolitan Community College
Procedure Checklist
Assessing the Nose With Use of Otoscope
Procedure Steps
1. Explain Procedure to patient.
2. Assess nose for deformity,
asymmetry, inflammation.
3. Using otoscope, use wide, short
nasal speculum.
4. Assess lower portions of nose
then upper portion.
5. Move your own head and
otoscope to view upper nasal cavity.
6. Assess:
a. Nasal mucosa: note color
(normally slightly redder than oral
mucosa) edema, exudates, bleeding.
b. Nasal septum: note any
bleeding, deviation.
c. Inferior and middle turbinates
and middle meatus: note color,
edema, exudates, polyps.
7. Dispose nasal speculum after use.
8. Hand hygiene.
Yes
No
Comments
Recommendation: Pass____________________ Needs more practice_____________________
Student______________________________________________Date______________________
Instructor____________________________________________
Metropolitan Community College
44
Metropolitan Community College
Procedure Checklist
Assessment of Abnormal Heart Sounds
Procedure Steps
1. Explain Procedure to patient.
2. Position patient supine or sitting.
3. Provide privacy.
4. Hand hygiene.
5. Identify head piece of the
stethoscope
a. Diaphragm transmits highfrequency sounds
b. Bell transmits low – pitched
sounds (rest only lightly on skin or
will act like the diaphragm.)
6. Identify S1: Use diaphragm of
stethoscope
a. S1 loudest in mitral area (left
5th ICS at midclavicular line) “lub”
sound from “lub-dub”.
b. Caused by closure of mitral
and tricuspid valves.
c. Palpate carotid lightly as you
will hear S1 with each carotid pulse
beat.
7. Identify S2: Use diaphragm of
stethoscope
a. S2 loud in aortic area (identify
angle of Louis, move your finger
laterally to right of sternum, this is:
2nd ICS to right of sternum)
b. “Dub” in “lub-dub”
c. Caused by closure of
semilunar valves.
Metropolitan Community College
Yes
No
45
Comments
Assessment of Abnormal Heart Sounds - continued
8. Identify S3: Use bell of
stethoscope
a. Auscultate mitral and tricuspid
area (Tricuspid area left of sternal
border with 5th ICS)
b. “Gallop” or extra heart sound
just after S2.
c. Indicated rapid ventricular
filing, CHF and fluid overload.
S1 S2 S3
Ken tuc ky
d. Use mitral landmark for left
rapid ventricular filling.
e. Use tricuspid landmark for
right rapid ventricular filling.
9. Identify S4 heart sound: Use bell
of stethoscope.
a. Best in mitral or tricuspid area.
b. Late diastolic filling and
occurs right before S1.
c. S4 (left-sided) louder on
expiration. S4 (right-sided) louder
on inspiration.
S4
S1
S2
Ten
nes
see
d. Increased resistance to filling
from poorly compliant ventricle from
MI, CAD, CHF, cardiomyopathy,
HTN, aortic stenosis.
10. Auscultate patient for the
following concerning murmurs:
a. Location: Note area where
murmur is loudest. Aortic and
pulmonic areas, with diaphragm of
stethoscope. Mitral and tricuspid
areas, with diaphragm and bell of
stethoscope.
b. Timing: Systolic murmur:
between S1 and S2. Diastolic
murmur: between S2 and S1
c. Intensity:
Grade I very faint.
Grade II faint, heard immediately.
Grade III moderate intensity.
Grade IV loud, may be associated
with palpable thrill.
Grade V loud, thrill palpable, audible
with stethoscope partially off chest
Metropolitan Community College
46
wall.
Grade VI very loud, heart with
stethoscope off chest wall, thrill
palpable.
d. Identify quality: harsh,
rumbling, blowing, musical.
e. Identify pitch: high, medium
or low. Low pitched with bell of
stethoscope. High pitched with
diaphragm of stethoscope.
f. Identify configuration:
Crescendo: soft to loud.
Decrescendo: loud to soft.
Plateau: sound is sustained.
g. Identify if murmur radiates to
another area such as neck, axilla.
Recommendation: Pass____________________ Needs more practice_____________________
Student______________________________________________Date______________________
Instructor____________________________________________
Metropolitan Community College
47
Metropolitan Community College
Procedure Checklist
Neurological Assessment
Procedure Steps
1. Explain Procedure to patient.
2. Provide privacy.
3. Hand hygiene.
4. Consider patient’s language,
education and culture during
examination.
5. Assess behavior, facial
expression, posture, affect,
grooming.
6. Determine level of arousal, as
needed, in this order: verbal stimuli,
tactile stimuli.
7. Correctly describe altered level of
consciousness using Glasgow Coma
Scale.
8. Determine level of orientation.
a. Checks orientation to time,
person, and place.
7. Assess recent memory – “How
did you get to the hospital?”
8. Assess remote memory – “What
is your birth date?”
9. Checks cranial nerves.
a. CN I – identify the smell of
common substances.
b. CN II – tests visual acuity and
visual fields.
c. CN III, IV, and VI
Tests Extraoculor movement by
having patient move eyes through the
6 cardinal fields of gaze with the
head held steady. Tests papillary
reaction to light and accommodation.
d. CN V – motor function –
move jaw from side to side,
clenching jaw, and biting down on a
tongue blade.
e. CN V – sensory function –
close eyes and identify when nurse
touches patients face at forehead,
checks, and chin bilaterally.
Metropolitan Community College
Yes
No
48
Comments
Neurological Assessment - continued
f. Tests corneal reflex by puffs
air from a syringe over cornea.
g. CN VII motor function – make
faces such as smile, frown, whistle.
h. CN VII taste – test taste on
anterior portion tongue by placing
sweet (sugar) salty (salt) or sour
(lemon) substance on tip on tongue.
i. CN VIII use – watch: the tictoc for hearing; Weber and Rinne
test for air and bone conduction;
Romber test for balance.
j. CN IX and X observe ability to
talk, swallow and cough.
k. CN IX and X motor function:
patient to say “ah” while depressing
tongue with tongue blade and
observing soft palate and uvula rise.
l. CN IX and X sensory function:
induce gag reflex (we will not
perform but be aware these nerves
responsible for this reflex).
m. CN IX and X taste: (sweet,
salty, sour) tests on posterior portion
of tongue.
n. CN XI place hands on
patient’s shoulders and patient to
shrug his/her shoulders against
resistance. Have patient turn head
from side to side against resistance.
o. CN XII
- Say “d, l, n, t”.
- Protrude tongue and move it
from side to side.
10. Tests superficial sensations:
a. Begin with most peripheral
part of limb, test with light touch.
b. If patient does not perceive
touch, determine boundaries by
testing about every inch to determine
sensory loss area.
Metropolitan Community College
49
Neurological Assessment - continued
11. Use correct procedure to test
each reflex: Uses the following scale
to grade reflexes:
O – no response detected
+1 – Diminished response
+2 – Response normal
+3 – Response somewhat stronger
than normal
+4 – Response hyperactive with
clonus.
a. Biceps reflex (spinal cord level
C5 and C6) Rests the patients elbow
in nondominant hand, with thumb
over the biceps tendon. Strikes the
percussion hammer to own thumb.
b. Triceps reflex (spinal cord
level C8 and C8) abducts patient’s
arm at the shoulder and flexes it at
the elbow. Supports the upper arm
with non dominant hand, letting the
forearm hang loosely. Strikes the
triceps tendon about 1-2 inches
above the olecranon process.
c. Brachioradialis reflex (spinal
cord level C-3 and C-6) Rests
patients arm on patients leg. Strikes
with the percussion hammer 1-2
inches above the bony prominence of
the wrist on the thumb side.
d. Patellar reflex (spinal cord
level L-2, L-3, L-4) Patient sits with
legs dangling. Strikes the tendon
directly below the patella.
e. Achilles reflex (spinal cord
level S1, S2) Patient lies supine or
sits with legs dangling. Holds the
patients foot slightly dorsiflexed and
strikes the Achilles tendon about 2
inches above the heel with the
percussion hammer.
f. Test Plantar superficial reflex
with end of reflex hammer. Strokes
sole of foot in an arc from the lateral
heel to medially across the ball of the
foot.
Metropolitan Community College
50
Neurological Assessment - continued
Recommendation: Pass____________________ Needs more practice_____________________
Student______________________________________________Date______________________
Instructor____________________________________________
Metropolitan Community College
51
Metropolitan Community College
Procedure Checklist
Preparing for Chest Tube Insertion
Procedure Steps
1. Insertion: Assure consent signed.
2. Reinforce procedure explanation
to patient.
3. Obtain pre-insertion vitals and
inquire as to pre-procedure pain
medication.
4. Obtains prescribed chest tube
drainage system.
- Water seal
- Dry seal
5. Hand hygiene
6. Prepare water seal system without
suction as prescribed
a. remove cover on water-seal
chamber and fill the second chamber
with sterile water or normal saline to
2 cm mark, then replace cover on
water-seal chamber.
7. Prepare water seal system with
suction as prescribed.
a. remove cover on water-seal
chamber and fill second chamber
with sterile water or normal saline to
2 cm mark.
b. Add sterile water or normal
saline to suction – control chamber.
Add amount of fluid as specified by
physician – usually 20 cm.
c. Attach tubing from suction –
control chamber to connecting tube
to suction source.
8. Position patient to semi-fowlers
to high fowlers according to
indicated insertion site.
9. Assist physician with mask,
sterile gown, sterile gloves and put
on mask to self.
10. Provide support to patient while
physician prepares sterile field, local
anesthetic is administered and
insertion and suturing of chest tube.
Metropolitan Community College
Yes
No
52
Comments
Patient with Chest Tubes – continued
11. As soon as CT inserted, attach to
drainage system using a connector
(from sterile field).
12. Assist physician with occlusive
dressing around C.T., physician may
use petroleum gauze,
- pre-cut drain-dressing over
petroleum gauge
- Abd (lg dressing) over the 2
precut drain dressings
- Secure dressing with 2 inch silk
tape or elastoplast to cover dressing
site completely. Must be air
occlusive dressing.
13. If suction is prescribed, adjust
suction source (on wall) until gentle
bubbling occurs in suction – control
chamber. If suction not prescribed,
leave the suction tubing on the
drainage system open.
14. Assure drainage tube has no
kinks and no dependent drainage
tube. (tubing coiled up on bed).
15. Post insertion x-ray
16. Place Vaseline type dressing to
bedside in case chest tube becomes
dislodged.
17. Make sure chest tube unit is
cleared from bed and make sure
there will be no damage when bed
changes position.
18. Position patient for comfort.
19. Assess lung sounds/vitals.
20. Chart procedure.
21. Assure drainage system is
located below insertion site.
Recommendation: Pass____________________ Needs more practice_____________________
Student______________________________________________Date______________________
Instructor____________________________________________
Metropolitan Community College
53
2012 Summer Quarter Important Dates
Classes Begin for 10-week/first five-week sessions ................................................ June 6 W
***Census Date/Tenth Day* Date for first-five week session .................................. June 12 W
***Census Date/Tenth Day* Date for 10 week session ........................................... June 19 Tu
Student Withdrawal Deadline to “drop” a class ............................................ Varies by Class**
Independence Day Recess/College Closed ................................................................... July 4 W
Classes end: First-five week session ....................................................................... July11 W
Classes begin for Second five week session ........................................................... July 12 Th
Summer grades for first five week session due and posted by 11:59 p.m ................. July 18 W
***Census Date/Tenth Day* Date for second five week session ............................... July 18 W
Spring Quarter Term Incomplete “I” Grades Due ................................................... August 1 W
Classes end for second five week/10 week sessions .......................................... August 15 W
Summer grades for second five week/10 week sessions due and posted by 11:59 p.mAugust 17 F
* Tenth Day is the date on which your enrollment level is checked.
**To view the last day to withdraw “drop” a class, go to the class schedule found on line at
http://www.mccneb.edu/schedule/classschedule.asp . Then, find the course section and click on
the Important Dates link on the same line as the course title. The refund dates for each course
section are automatically calculated based on the start and end dates and the number of sessions
for a course. A student must withdraw by this date to avoid an “F” grade.
Note: Schedule changes may have implications for students on Financial Aid. Check with the
Financial Aid Office prior to any schedule changes at 402-457-2330. The Census Date*** is the
date on which Financial Aid Student’s enrollment is checked to determine the type and amount
of funds authorized for the quarter. Payment is based on enrollment as of that date.
REFUND POLICIES for Credit Courses
A student is responsible for withdrawing “dropping” from a course(s) if unable to attend. Nonattendance or non-payment does not relieve a student from the obligation to pay. To withdraw
“drop” from a course, log on to WebAdvisor https://webadvisor.mccneb.edu and click “Register
and Drop Sections”.
An official schedule change that reduces or terminates a student’s academic credit load may
entitle the student to a refund. The eligibility and amount of a refund is automatically calculated
by the date of the withdrawal.
A student may see the refund percentage received through midnight of the same day by logging
into WebAdvisor and clicking on the Tuition Refund Calculator
A link to the Student Information Calendar is available once logged in on WebAdvisor.
Metropolitan Community College
54