course syllabus: course name - university of...

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The University of Jordan

Accreditation & Quality Assurance Center

Course Syllabus:

Course Name: Adult Health Nursing Clinical (2)

Course Number: 0702309

The University of Jordan Course Syllabus Accreditation and Quality Assurance Center

1 Approved by The School Council on September 28th, 2016

SCHOOL OF NURSING

COURSE SYLLABUS

DEPARTMENT: CLINICAL NURSING DEPARTMENT

[SEMESTER ACADEMIC YEARI]

2ND SEMESTER 2016/2017

THE MISSION OF THE UNIVERSITY OF JORDAN

The mission of The University of Jordan is to apply and promote the concepts of quality assurance efficiently and effectively, to control performance and evolve administrative procedures in order to develop distinctive educational, administrative and research system through applying modern quality assurance methodologies that achieve the mission of The University of Jordan and its objectives.

THE VISION OF THE SCHOOL OF NURSING

To be a leading, global school in the areas of nursing education, research, and community service.

THE MISSION OF THE SCHOOL OF NURSING

The School of Nursing dedicates itself to improve health and wellbeing of society through preparing professional nurses to provide quality nursing care, conduct research and provide community service. The school provides a model learning environment that encourages life-long learning, innovation, and professional and personal development.

SCHOOL OF NURSING’S CORE VALUES

Our values are derived from the Islamic Arabic heritage and the nursing profession which include: integrity, equality, and justice; transparency and accountability; innovation and excellence; leadership and teamwork; discipline; response; and most importantly caring.



1 Course title Adult Health Nursing (ii) Clinical

2 Course number 0702243

3

Credit hours (theory, practical) Theory 3hours , practical 6 hours

Contact hours (theory, practical) Practical 12 hours /weekly

4. Class room: University of Jordan Hospital, Prince Hamzeh Hospital, and Al-Basheer Governmental Hospital,School of nursing labs

4 Prerequisites/co-requisites Adult 1

5 Programtitle BS

6 Programcode 07

7 Awarding institution

8 School School of Nursing

9 Department Clinical Nursing Department

10 Level of course Third year BSc

11 Year of study and semester(s) 2016/2017 Second Semester

12 Final Qualification

13 Other department(s) involved in teaching the course

-

14 Language of Instruction English

15 Date of production/revision 26/1/2017

16. Course Coordinator:

Name: Tagreed Osama Shawashi RN, MSc Faculty Member: Officenumber first floor (126) Officehours Sunday 11-1pm, Monday 2-3 pm, Thursday 2-3 pm Phonenumbers (23157 ) Emailaddresses [email protected]

17. Other instructors:

Name: Khaled Waleed , Officenumbers (225) Khaled Waleed Officehours Thursday ( 2-3) pm ,Tuesday(2-3) Phonenumbers (23127) Khaled Waleed Emailaddresses [email protected] Name: Wejdan Younes Officehours Sunday (8-10) Officenumbers (120) Emailaddresses [email protected] Name Malek AL-Najjar Officenumbers (225) Officehours Thursday 2-3 pm ,Tuesday(2-3) Phonenumbers (23127) [email protected] Name Souliman Ahmed Officenumbers (222) Officehours (Thursday 2-3 pm) Emailaddresses [email protected]

mailto:[email protected]





18. Course Description:

As stated in the approved study plan. This course introduces students to conditions that affect the major three systems in the body (Respiratory, Cardiovascular and Cognitive) of critically ill adult client. Emphasis will be placed on the impact of these conditions on an individual's function and responses beside the role of the nurse in providing care for those critically ill clients. These conditions may be acute or long term and the focus will be on selected functional health patterns, including: nutritional-metabolic, cognitive-perceptual and elimination patterns. The nursing process will be used as a framework to formulate nursing diagnosis and identify nursing interventions which promote, maintain and restore the health of adults.

19. Course aims and outcomes: A- Aims: This course is designed to provide the student with the knowledge, psychomotor skills, and professional attitude while providing nursing care for adult with critically ill conditions that affect the major three systems in the body (Respiratory, Cardiovascular and Cognitive) and its impact on their functional health patterns. B- Intended Learning Outcomes (ILOs): Upon successful completion of this course studentswillbeableto…



Intended Learning Outcomes (ILO)

ILO 1: Demonstrate competency in performing and providing the role of a professional nurse in quality care provision for individuals, families, and groups.

Specific Course Objectives 1. Apply comprehensive nursing care for clients in various critical care settings from admission to discharge, according to the learned principles of basic knowledge.

2. Apply comprehensive health assessment for clients with different critical health problems.

3. Demonstrate effectively different nursing skills depending on procedure manual during simulation training & in clinical setting while caring for critically ill clients. 4. Utilize updated evidenced-based practice in caring for critically ill clients with different critical health problems.

5. Formulate Nursing Care Plan (NCP) for critically ill clients in order of priority

Relevant Competency (JNC) Client- centred care, Ethical and accountable practice, Quality improvement, Evidenced-based practice, Safety.

Evaluation Methods Nursing care plan, written exam, clinical performance evaluation, Clinical oral exam, procedure exam.

ILO 2: Apply principles of effective communication with peers, individuals, families, groups, and health care team.

Specific Course Objectives 6. Show professional behaviour in dealing with client, their families' instructor, and health team members.

7. Build health education for clients and their families according to their needs.

Relevant Competency (JNC) Professional communication , Ethical and accountable practice

Evaluation Methods Clinical performance evaluation, Heath education form

ILO 3: Utilize critical thinking and problem solving in planning and implementing nursing care for individuals, families, and groups.

Specific Course Objectives 8. Interpret normal and abnormal ECG (basic and advanced changes) for critically ill clients. 9. Analyse arterial blood gases (ABG) readings for critically ill clients. 10. Combine critical thinking and problem solving approach in nursing care for clients with different critical health problems.

11. Demonstrate effectively different nursing skills depending on procedure manual in caring for critically ill clients

12. Formulate Nursing Care Plan (NCP) for critically ill clients in order of priority.

Relevant Competency (JNC) Safety, Client- centred care, Ethical and accountable practice, Quality improvement, Evidence base practice

Evaluation Methods Nursing care plan, written exam ,clinical performance evaluation ,procedure exam, Clinical assignment

ILO 4: Apply professional standards, values, and behaviours in providing nursing care for individuals, families, and groups.

Specific Course Objectives 13. Show professional behaviour in dealing with client, their families' instructor, and health team members.

14. Adapt clinical training with hospital policies and Jordanian nurses' code of ethics in variance clinical setting.



Relevant Competency (JNC) Professional communication, Ethical and accountable practice

Evaluation Methods Clinical performance evaluation

ILO 5: Demonstrate safety measures to protect self, individuals, families, and groups.

Specific Course Objectives 15.Explain the indications of Emergency drugs & equipment in various critical care settings 16. Apply nursing care for critically ill client pre, during & after cardiac catheterization .

17.Interpret normal and abnormal ECG (basic and advanced changes) for critically ill clients

18. Demonstrate effectively different nursing skills depending on procedure manual in caring for critically ill clients.

19. Apply comprehensive nursing care for clients in various critical care settings from admission to discharge, according to the learned principles of basic knowledge.

20. Apply comprehensive health assessment for clients with different critical health problems.

21. Operate the specialized machines used in various critical care setting.

22. Apply safety measures among critically ill clients

Relevant Competency (JNC) Safety, Quality improvement ,Client cantered care , Ethical and accountable practice

Evaluation Methods Written exam, clinical performance evaluation, Nursing care plan ,procedure exam , clinical exam

ILO 6: Translate organizational, leadership, interprofessional collaboration, and management concepts into nursing care for individuals, families, and groups.

Specific Course Objectives 23. Build health education for clients and their families according to their needs

24. Adapt clinical training with hospital policies and Jordanian nurses' code of ethics in variance clinical setting.

Relevant Competency (JNC) Professional communication, Ethical and accountable practice

Evaluation Methods Clinical performance evaluation, Heath education form

ILO 7: Utilize evidence based practice in providing care for individuals, families, and groups.

Specific Course Objectives 25. Utilize updated evidenced-based practice in caring for critically ill clients in various critical care settings 26. Combine critical thinking and problem solving approach in nursing care for clients with different critical health problems.

27. Demonstrate effectively different nursing skills depending on procedure manual in caring for critically ill clients.

Relevant Competency (JNC) Evidenced-based practice, Quality improvement, Client centred care

Evaluation Methods clinical performance evaluation, Clinical assignment, procedure exam written exam



20. Topic Outline and Schedule:

Topic Week Instructor Achieved ILOs Evaluation Methods for ILOs

Reference Reading and Activities

explanation of the course objectives and papers Infection control Cardiac Catheterization Mechanical ventilators. Arterial blood gases

First تغريد شواشي خالد وليد

22,8,15 Due Date (30/4) Written exam

Smeltzer, S., & Bare, B., Hinkle, J., & Cheever, K. (2014). Brunner and Suddarth's textbook of medical surgical nursing (13th Ed.). Philadelphia, PA.: Lippincott

ECG analysis Emergency drug Hemodynamic

Second مالك النجار وجدان يونس سليمان عبد الحميد

9,3,11,18,27,16 Clinical performance Evaluation Written exam


Orientation to different clinical unites in the hospital According to orientation tool paper Handle client in critical care units

Third مالك النجار تغريد شواشي خالد وليد وجدان يونس سليمان عبد الحميد

1,19,21,22,24 Clinical performance Evaluation Oral clinical exam Written exam

Smeltzer, S., & Bare, B., Hinkle, J., & Cheever, K.

(2014). Brunner and Suddarth's textbook of medical surgical nursing (13th Ed.). Philadelphia, PA.: Lippincott

Case study discussion according to nursing

Fourth Fifth

مالك النجار تغريد شواشي خالد وليد وجدان يونس

,2,3,4,5,6 7,8,9,10,11,12,13,14,19,20,21,22,25,26,2

Clinical performance Evaluation

Smeltzer, S., & Bare, B., Hinkle, J., & Cheever, K.

http://search.barnesandnoble.com/booksearch/results.asp?ATH=Kerry+H%2E+Cheever






process for handled client physical examination demonstration according to jarvas book Handle medications appropriately in critical care Demonstrate different listed nursing skills according to kozeir foundation book ( refer to procedure manual ) .during simulation training & clinical settings Assign case for NCP(27/2) Monday Assign case for NCP (28/2) Tuesday

Oral clinical سليمان عبد الحميدexam Written exam NCP

(2014). Brunner and Suddarth's textbook of medical surgical nursing (13th Ed.). Philadelphia, PA.: Lippincott

Kozier, B.And ERB, G. (2009). Procedures supplement for Fundamentals of Nursing. New Jersey: Person Education, Inc.

Jarvis, C.(2012).Physical Examination & Health Assessment .Saunders

NCP due date(6/3) Monday NCP due date 7/3)Tuesday Provide health education for clients and their families according to their needs Procedure exam

Sixth مالك النجار تغريد شواشي خالد وليد وجدان يونس سليمان عبد الحميد

2,3,4,5,7, 10,11,12, 18 ,27,22

NCP Clinical performance Evaluation Oral clinical exam Written exam NCP Procedure exam





Final oral exam for the first rotation Handle clients' prior, during, and post cardiac catheterization procedure Submit procedure manual checklist

seventh مالك النجار تغريد شواشي خالد وليد وجدان يونس سليمان عبد الحميد

1,2,3,4,5,6,8,9,10,11,12,13,14,16,19,20,21,22,25,26,27

Oral clinical exam Clinical performance Evaluation


Kozier, B., And ERB, G. (2009). Procedures supplement for Fundamentals

of Nursing. New Jersey:

Person

Education, Inc

Beginning of the second rotation and orientation to the new wards. Revision for different achieved skills physical examination demonstration Handle medications appropriately in critical care units

Eighth

مالك النجار تغريد شواشي خالد وليد وجدان يونس سليمان عبد الحميد

3,11,13,14,18,21,27

Clinical performance Evaluation


Case discussion according to nursing process for handled client Demonstrate different listed nursing skills Handle medications appropriately

Ninth مالك النجار تغريد شواشي خالد وليد وجدان يونس سليمان عبد الحميد

1,2,3,4,5,6,8,9,10,11,12,13,14, 19,20,21,22,25,26,27

Clinical performance Evaluation Procedure exam NCP







in critical care units refer to procedure manual

Kozier, B., And ERB, G. (2009). Procedures supplement for Fundamentals of Nursing. New Jersey: Person Education, Inc.


Assign case for NCP (3/4) Monday Assign case for NCP (4/4)Tuesday Provide health education for clients and their families according to their needs

Tenth مالك النجار تغريد شواشي خالد وليد وجدان يونس سليمان عبد الحميد

2,4,5,7,10,12,13,14,22

NCP Clinical performance


Kozier, B., And ERB, G. (2009). Procedures supplement for Fundamentals of Nursing. NewJersey: PersonEducation, Inc.


NCP due date (10/4 ) Monday) NCP due date(11/4 ) Tuesday)

Eleventh مالك النجار تغريد شواشي خالد وليد وجدان يونس سليمان عبد الحميد

2,3,4,5,10,11,12,18, ,22,27

NCP Clinical performance Evaluation Procedure exam

Smeltzer, S., & Bare, B., Hinkle, J., & Cheever, K. (2014). Brunner and Suddarth's textbook of





Submit procedure manual checklist Procedure exam

medical surgical nursing (13th Ed.). Philadelphia, PA.: Lippincott

Final oral exam (committee) Handle clients' prior, during, and post cardiac catheterization procedure

Twelfth مالك النجار تغريد شواشي خالد وليد وجدان يونس سليمان عبد الحميد

1,2,3,4,5,6,8,9,10,11,12,13,14,19,20,21,22,25,26,27 16

Final oral exam


Final oral exam (committee) Handle clients' prior, during, and post cardiac catheterization procedure

Thirteenth مالك النجار تغريد شواشي خالد وليد وجدان يونس سليمان عبد الحميد

1,2,3,4,5,6,8,9,10,11,12,13,14,19,20,21,22,25,26,27 16

Final oral exam


Written exam (30/4)

Fourteenth مالك النجار تغريد شواشي خالد وليد وجدان يونس سليمان عبد الحميد

1,2,3, 5,7,8,9,10,15,16,17, 18, ,20, 22,23,26, 27

Final written exam Clinical performance Evaluation


21. Teaching Methods and Assignments:

Development of ILOs is promoted through the following teaching and learning methods: (Choose from table below)






Teaching Methodologies: The following approaches that are guided by Adult Learning Theory will be used to achieve course and clinical objectives related to the ILOs:

Instructional Methods Learning Activities (Examples)

Direct Instruction Structured orientation lectures

Skills and procedures demonstrations ( procedure manual

Indirect Instruction

Evidence-based articles

NCP

Interactive Instruction Clinical conferences and Case presentations

Group discussion

Experiential Learning

Experiential learning in clinical setting

Simulation

Independent Study Clinical Assignments

22. Evaluation Methods and Course Requirements:

Evaluation Methods

Exams Assigned Points

Clinical performance Evaluation First Rotations Appendix (1) Clinical performance Evaluation Second Rotations

15% 15%

Procedure Exam First Rotations Appendix (4) Procedure Exam Second Rotations

5% 5%

Assignments

Assignment( Nursing care plan) : Appendix 2 (Due Date ): first rotation NCP due date(6/3) Monday , NCP due date(7/3) Tuesday Second rotation NCP due date (10/4 ) Monday) NCP due date(11/4 ) Tuesday)

Rubric: Objective: To improve Quality and safety nursing care for critical ill clients To apply critical thinking and problem solving approach

10%

Clinical Oral Exam First Rotation : seventh week 13/3-16/3

Appendix3 10%

Clinical Oral Exam Second Rotation: Twelfth 17/4-20/4 committee 24/4-27/4 Thirteenth committee

10%

Final written Exam Fourtheenth (week 30/4/2017) 30%

Total 100%



23. Course Policies:

A- Attendance policies:

Students must attend all classes of this course.

Any student with absence of 15% of the classes of any course, will not be allowed to sit for the final exam and will be given the university zero (F grade) in this course.

In the case (b) above, if a student submits an official sick report authenticated by university clinic or an accepted excuse by the Dean of his/her faculty, the student will be considered as withdrawn from the course, and a "W" will be shown in the transcript for this course.

Students are not allowed to come late to classes. Any student coming late will not be allowed to attend the class and he/she will be marked absent.

B- Absences from exams and handing in assignments on time:

Failure in attending a course exam other than the final exam will result in zero mark unless the student provides an official acceptable excuse to the instructor who approves a make up exam.

Failure in attending the final exam will result in zero mark unless the student presents an official acceptable excuse to the Dean of his/her faculty who approves an incomplete exam, normally scheduled to be conducted during the first two weeks of the successive semester.

Assignments and projects should be submitted to the instructor on the due date.

C- Health and safety procedures:

Students should comply with the Faculty of Nursing policies regarding pre-hospital training immunizations. Students should comply with the training areas policies regarding infection control, general precautions, and patient isolation.

D- Honesty policy regarding cheating, plagiarism, misbehaviour:

Cheating, plagiarism, misbehaviour are attempts to gain marks dishonestly and includes; but not limited to:

Copying from another student’s work.

Using materials not authorized by the institute.

Collaborating with another student during a test, without permission.

Knowingly using, buying, selling, or stealing the contents of a test.

Plagiarism which means presenting another person’s work or ideas as one’s own, without attribution.

Using any media (including mobiles) during the exam

The participation or the commitment of cheating will lead to applying penalties according to the University of Jordan Students’ Discipline rules and regulations No. (94, 49, 47,27, 29): http://units.ju.edu.jo/ar/LegalAffairs/Regulations.aspx

E- Examination Instructions for Students

Bring with you full exam requirements (blue pen, pencils, sharpener, eraser, calculator etc.), borrowing from others is not allowed.

Do not bring any material related to the exam

Do not bring your mobile phone to the Exam room

http://units.ju.edu.jo/ar/LegalAffairs/Regulations.aspx



Be in the exam room at least 10 minutes before exam starting time

It’s not allowed to enter the exam room late. In case of coming late you have to contact the course coordinator immediately

It’s not allowed to leave the Exam room before the end of the END OF AT LEAST ONE-THIRD OF THE EXAM TIME.

Write your name and university number on the exam paper and computerized sheet using Blue pen only.

Use pencil ONLY to shade your answers on the computerized answer sheet.

Do not leave examination room except under exceptional circumstances at the discretion of the Senior Invigilator and you should be accompanied by an invigilator, if needed.

For Re-exam issue refer back to the university rules.

F- Grading policy:

A grade of (D) is the minimum passing grade for the course.

Mark Range Grade

0-34 F

35-46 D-

47-49 D

50-52 D+

53-56 C-

57-60 C

61-64 C+

65-69 B-

70-74 B

75-79 B+

80-83 A-

84-100 A

G- Available university services that support achievement in the course:

24. Required equipment:

Clinical settings equipments procedure manual Stethoscope , note book , torch ( pen light ) , pen & pencil Watch

25. References:

A- Required book (s), assigned reading and audio-visuals: Smeltzer, S., & Bare, B., Hinkle, J., & Cheever, K. (2014). Brunner and Suddarth's textbook of medical




surgical nursing (13th Ed.). Philadelphia, PA.: Lippincott

B- Recommended books, materials, and media: Lewis, S., Heitkemper, M., Dirksen, S., O’Brian, P., &Bucher, L. (2014). Medical surgical nursing: assessment

and management of clinical problems (9th. Ed.). St. Louis, MI: Mosby. Kozier, B., ..., Abdalrahim, M., Abu-Moghli, F., & Saleh, M. (2012). Fundamentals of nursing: Concepts, process, and practice. (Arab World Ed.). UK: Pearson Education Limited. Kozier, B., and ERB, G. (2009). Procedures supplement for Fundamentals of nursing. New Jersey: Person

Education, Inc. Jarvis, C.(2012) Jarvis, C.(2012).Physical Examination & Health Assessment .Saunders C- Electronic resources Electronic resources are available on: http://ju.coe.deep-knowledge.net/resources

*Examples of available resources on the deep knowledge web site of the University of Jordan e-library:

EBSCO host A to Z; Elsevier clinical key; Pub med; Science Direct; Sage Journals, Springer link, Scopus, etc.

* Dear student you are deeply encouraged to log in the http://ju.coe.deep-knowledge.net/resources page and establish your private user name and password and activate your account, so that you shall be able to use all those available knowledge, books and evidence based electronic resources. Relevant Website and Journals

Database Website

26. Additional information:

Students will be divided into groups with two rotations. Clinical settings will be: The University of Jordan Hospital, Prince Hamzeh hospital, and Al-Basheer Governmental hospital. Students will be guided in each area by specific clinical objectives for that area.

Name of Course Coordinator: ---Tagreed Osama Shawashi----------------Signature: ------------------------- Date: ----

26/1/2016--------------------- Head of curriculum committee/Department: ------------------------- Signature: --------------

Head of Department: ------------------------- Signature: ---------------------------------

Head of curriculum committee/Faculty: ------------------------- Signature: ---------------------------------

Dean: ------------------------------------------- -Signature: --------------------------------- Copy to:

Head of Department Assistant Dean for Quality Assurance

Course File

http://ju.coe.deep-knowledge.net/resources

http://ju.coe.deep-knowledge.net/resources



Apendix (1) Adult Health Nursing (2) clinical

Second semester Semester 2016/2017

Clinical Evaluation Tool

Student name : ………………………. instructor name :……………………...... Clinical area /rotation :…………………

Evaluation mark (15 )……………. Evaluation Grade System:

zero: objectives met 0-20% of time, unsafe, continuous assistance . 1: objectives met 21-40% of time, occasional unsafe, occasional assistance 2: objectives met 41-70 % of time, frequently unsafe, frequently assistance.

3: objectives met 71-100% of time, safe, rarely assistance

I Knowledge Base and cognitive skills score

0 1 2 3

A) Define disease process

B) Summarize pathophysiology of the disease process

C) Interpret diagnostic criteria

D) List risk factors and manifestations

E) Explain the rationale for therapy e.g., medication; its action, side effect, nursing implications.

F ) Compare the client's condition/pattern of recovery with that associated with the diagnosis

G ) Interpret changes in the client's condition:

Laboratory data.

Diagnostic (CT SCAN, ERCP….).

H) List the potential complications associated with the patient's diagnoses and describe preventive measures.

I ) Relate the patient's condition to the evidence-based practice



Evaluation Grade System:



II . Nursing Process Score

0 1 2 3

A) Formulate a complete nursing data via Subjective and

objective data

B) Formulate nursing diagnoses a according to NANDA using PES (problem related to etiology evidenced by

signs and symptoms

C) Prioritize nursing diagnoses according to ABC system (airway, breathing, circulation

D) Formulate short-term goal for each nursing diagnosis. Using SMART criteria

E) List an appropriate planned nursing intervention for his/her client with rationale.

F) Implement actual nursing intervention.

G) Record the patient’s response to care using appropriate medical terminology.



Evaluation Grade System


3: objectives met 71-100% of time, safe, rarely assistanc

III . Interpersonal Relationships Score

0 1 2 3

A) Build a therapeutic relationship with patient and family.

B) Adhere to clinical training rules (see attached papers

Appendix ( )

C) Prepare weekly clinical objectives using SMART criteria, including 3 domains of learning (physical exam, knowledge and

skills)

Appendix ( )

D) Apply patient health education related to disease process, therapeutic regimen, life style modification.

Appendix ( )

E) Build a collaborative relationship with instructor, peers, and health care members.

F) Control emotions despite stressful situations.







IV . Professional behavior and sense of responsibility

Score

0 1 2 3

A) Show evidence of preparation for clinical assignments.

B) Prove initiatively for independent learning activities

C) Identify strengths, weakness and learning needs with the instructor.

D) Discuss and participate in learning activities during bed side discussions and conferences.

E) Apply all of the delegated responsibilities.

F) Improve performance according to suggested instructions and accept instructor notes

G) Show commitment to notify instructor in advance about tardiness or absenteeism

H). Adhere to hospital policies and Jordanian nurses' code of ethics. ( CPR ,Client Confidentiality

I). Show ability to participate in activities during simulation lab





V . Psychomotor skills Score

0 1 2 3

A) Show adequate environment preparation

(privacy, clean surrounding, proper lights, patient

positioning

B) Verified the correct patient using two identifiers.

C) Introduce your self to the client

D) Explain the procedure for the client

E) Prepare equipment correctly and adequately

F) Adhere to safety measures such as infection

control (hand washing, sterility, proper disposal of

equipment)

G) Demonstrate competent and safe performance of the procedures

H) Document procedures appropriately.

I) Discuss and Report abnormal findings to assigned staff.

Instructor comments …………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… (Student score -----*15 /120)

Instructor signature : ………………. Student signature : …………

Appendix (2) Adult Health Nursing (2) clinical

Second Semester 2016/2017



Nursing Care Plan

Instructions 1. This is the form of Nursing care plan in Adult (2) course & is the only allowed form for this

course 2. Only hand writing using dark ink pen , allowed Don’t type Nursing care plan ( you will get zero

mark) 3. Using abbreviations not allowed 4. Using symbols not allowed (- ,_ ,/ , X ) 5. Heath assessment describe finding don’t use normal , good bad ,abnormal terminology 6. Diagnostic Evaluation (Lab results, MRI, CT, ECG, etc….) according to the hospital polices 7. Add References for medications profile 8. Write at least (5) nursing diagnosis completely with Functional Health Pattern, Evidenced

By/Defining Characteristics, goal planned interventions ,actual interventions &out com 9.Only one week allowed for filling Nursing care plan 10. Attach Evidance Base Research Article related to Client Critical Health Problem 11.Submit in the due date as mentioned in the time table *First rotation Nursing care plan due date(6/3 ) Monday Nursing care plan due date (7/3 )Tuesday *Second rotation Nursing care plan due date (10/4 ) Monday) Nursing care plan due date( 11/4) Tuesday) 11.Submission late from due date student will lose marks ( one mark out of ten for each late day ) 12. Submission late for more than three clinical days not allowed you will get (zero mark )



Adult Health Nursing (2) clinical

Second Semester 2016/2017 Nursing Care Plan

Student Name : Date : Clinical Area /rotation no. : Evaluator: Student mark out of 10 ( ) ***************************************************** Nursing Admission Data Base (5%) Client ........................................... Age : ................ Sex: .......................... Date of Admission (Transfer) : ..........................Via : ................................. Condition on arrival : Wheelchair.............. Walking............ Stretcher.......... Source of Data: Spoken language: Patient education: (1 Mark) Reasons for Hospitalization : (0 . 5 mark) Confirmed Diagnosis : ( 1 Mark ) Medication taken at home : ( 0.5 Mark) Past medical history : (0 .75 Mark) Past surgical history : ( 0 . 75 Mark) Family history ( genogramfor 3 generations ) : (0 . 5 Mark) ASSESSMENT ( Describe ) (10 Marks) 1. Health Maintenance - Perception Pattern . ( 0 . 5 Mark ) A : Smoking : B : Alcohol : C : Allergies (drugs, food, tape, dyes): 2. Activity / Exercise Pattern (Describe activity, feeding, bathing, dressing, toileting, mobility, & using assistive devices): - ( 1.5 Mark) 3. Nutrition / Metabolic Pattern (Describe): ( 2 Mark) A : Typical diet at home : Prescribed diet : B : Appetite : C : Nausea : D : Vomiting : F : Dysphagia: G : Weight changes within last 6 months: H : Dentures : 4. Elimination Pattern : ( 2 Mark) A : Bowel habits, ostomy, bleeding, assistive devices etc.. :



B : Urinary Habits :- 5. Sleep / Rest Pattern: ( 1 Mark) 6. Cognitive / Conceptual Pattern :- ( 2 Mark) A : Hearing : B : Vision : C : Vertigo : D : Discomfort / pain : 7. Coping Stress/ Self Perception Pattern: ( 1 Mark) A : Major concerns regarding hospitalization of illness : B : Major loss / change : No ............., Yes (specify) C : Coping mechanisms :-



PHYSICAL EXAMINATION : ( OBJECTIVE DATA) :- (15%)

1. A) General Survey: ( 2 Marks )

Level of consciousness: Orientation: Height Weight Temperature General Appearance:

1. B) Vital signs : (2 Marks) 2. Nutritional - Metabolic Pattern (Describe) : ( 4 Mark ) A : Skin : (1 mark) B : Oral Cavity : (1 mark) C: Neck: (1 mark) D: Abdomen: (1 mark) 3. Activity- Exercise Pattern: ( 5 Marks )



A: Lung and Thorax ( 2 Marks) B: Cardiovascular: ( 2 Marks ( C: Musculoskeletal: (1 Mark) 4. Cognitive- Perceptual Pattern:- (2Marks ) A: Mental status: (able to calculate, thinking abstractly, memory, etc..): B: Neurological status: MEDICATION PROFILE ( 10% ) Allergies : ................................................................................................



Drugs and Classification ( 1 Mark )

Indication for my Patient ( 2 Mark )

Dose /Route/ Frequency (1 Mark )

Contra-Indications ( 1 Mark )

Expected side effects ( 2 Mark )

Nursing Implications ( 3 Marks )

References:

Date Test Performed ( 1 Mark )

Normal Value ( 2 Marks )

Patient Value

( 2 Marks )

Interpretations & Nursing Implications

(5 Marks)



Diagnostic Evaluation (Lab results, MRI, CT, ECG, etc….) References: Nursing Care Plan

Functional Health Pattern

Nursing Diagnosis ( 10 Marks)



Evidenced By/Defining Characteristics ( 10 Marks )

Short-Term Goals (5 Marks)

Planned Intervention

(With Rationale )

(15 Marks)

Actual Intervention (5 Marks)

The Outcome

(With Rationale) ( 5 Marks)

References:



Appendix (3) Adult Health Nursing (2) clinical

Second Semester 2016/2017 Oral Clinical Exam

Name of Student: ………………………………… Evaluator:…………………………... Clinical Area / rotation no. :……………………………………... Date: / /20 Rating Scale * 3. Exceptional performance - consistently exceeds expectation 2. Performs as expected for this level 1. Needs Improvement 0. Unsafe clinical practice N/A Not applicable or Performance Criteria not appropriate for this clinical setting Student score *10/69 = student scor out of 10

Items Student Score

0 1 2 3 NA

I Medical diagnosis and Pathophysiology

1 Discusses the client's medical diagnoses, Verbalizes accurate information regarding Medical Diagnosis and/or surgical procedure

2 Discusses the Pathophysiology involved

3 Relates Pathophysiology of disease(s) to patients’ assessment findings, medications, diagnostic test results, and medical interventions

II Assessment

1 Perform comprehensive client assessments including history, subjective and objective data. in a systematic manner

2 Demonstrates correct techniques for physical assessment based on patient characteristics

3 Recognizes abnormal client data

4 Clusters data to identify patient/nursing problems

III Medication

1 Recall client medication information including classification, indication, dosage, side effects.

2 States the nursing implications of the medications

3 Discusses the rationale for therapy e.g., medication procedures (Relate clients’ medications to their health status)

4 Calculate drug dosages correctly

5 Perform appropriate assessments prior to, during, and after medication administration

IV Diagnostic tests

1 Recognize normal and abnormal data

2 Interprets significance of lab and diagnostic tests

3 States the nursing implications of the diagnostic tests

V Needs and diagnosis

1 Formulates appropriate ND (Psychosocial, Developmental, Nutritional, Values & Beliefs) for client needs (Develops comprehensive list of ND)

2 Writes ND correctly, Supports ND with problem statement and appropriate etiology (NANDA approved)

3 Establishes priorities of care in meeting identified needs of patients

VI Client Goal

1 Goal stem congruent with problem



2 Goal stem contains all components (SMART criteria)

VII Nursing interventions

1 Prepare clients for interventions

2 Interventions are appropriate, specific and related to parameters or lab & diagnostic tests

3 Gives rationale for intervention

Comments:………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………

Clinical Instructor’s Signature:………………………………………….



Appendix(4)

Adult Health Nursing (2) clinical Second Semester 2016/2017

Procedure Manual List

Student Name: …………………………………….. University No.: ……………………..........

Skill Instructor Name and signature

Date Student

Signature

1. Perform comprehensive physical assessment ( health assessment checklist)

2. Enteral Nutrition via a Nasogastric Feeding Tube

3. Oral Hygiene

4. Eye Care

5.Measuring and Monitoring Central Venous Pressure

6. Arterial Catheter Measuring and Monitoring )

7. Suctioning

8. Preparation & Administration of continuous infusion drugs

References: 1.American Association of Critical – Care Nurses procedure manual for critical care by Debra J.Lynn- McHale, Karen K. Carlson .4th edition 2.Kozier & Erb’s Fudamentals of nursing concepts , process, and practice 8th edition ,Audrey Berman, Shirlee J.Snyder , Barbara Kozier , Glenora Erb.2008




Second Semester 2016/2017 Procedure Evaluation

Student Name: …………………………………….. Day/Date: ……………………............

Course Name: ……………………………………… Section: ……………….……………...

Instructor Name: ………………………………….. Evaluator Name:…………………….

Procedure: Enteral Nutrition via a Nasoenteric Feeding Tube Procedure: Evaluation Grade System:

0: constant assistance, unsafe 1: occasional assistance, occasionally unsafe 2: rare assistance, usually safe Note: *point (safety point) if it is not done 25% of the total mark will be subtracted.

Task Score

Comments 0 1 2

1. Assemble equipment and supplies

2. Introduce self and verify the client’s identity using agency protocol

3 . Explain to the patient what you are going to do, why it is necessary , how she or he can cooperate .inform the client that feeding should not cause any discomfort but may cause a feeling of fullness.

4. Provide privacy for this procedure if the client desires it .Tube feeding is embarrassing to some people.

5. perform hand hygiene and observe appropriate infection control procedures (e.g,clean gloves )

*6. Assess tube placement Attach the syringe to the open end of the tube and aspirate check the PH (1 to 5) Position of nasogastric tube can be confirmed by X-ray Place stethoscope over the client`s epigastrium & inject 10to 30 ml of air into the tube while listening for whooshing sound

*7. Help the client to assume high fowler`s position

8. Assess residual feeding content

If the tube is placed in the stomach, aspirate all contents and

measure the amount before administering the feeding .

If 100 ml (or more than half the last feeding ) is withdrawn ,

check with the nurse in

9. Before administering feeding :

Check the expiration date of the feeding.

Provide formula at room temperature.



When an open system is used, clean the top of the feeding

container with alcohol before opening it.

Feeding bag (open system ):

10. Hang the labeled bag from an infusion pole about 30cm (12in.) above the tube’s point of insertion into the client .

11.clamp the tubing and the formula to the bag

12.open the clamp , run the formula through the tubing and re clamp the tube . 13. attach the bag to the feeding tube and regulate the drip by adjusting the clamp to the drop factor on the bag (e.g 20drops /ml) If not placed on pump .

14 . Dispose of equipment appropriately

15. Document all relevant information

16. Monitor the client for possible problems

17. Hand hygiene post procedure

TOTAL

Syringe (open system): Repeat steps from (1-9)

1.Remove the plunger from the syringe and connect the syringe to a pinched or clamped nasogastric .

2.Add the feeding to the syringe barrel .

3.Permit the feeding to flow in slowly at the prescribed rate .Raise or lower the syringe to adjust the flow as needed .Pinch or clamp the tubing to stop the flow for a minute if the client experiences discomfort .

4. Ensure client comfort and safety.

5. Dispose of equipment appropriately


7. Monitor the client for possible problems


TOTAL

Prefilled bottle with drip chamber (closed system)

1. Remove the screw –on cap from the container and attach the administration set with the drip chamber and tubing .



2. Close the clamp on the tubing.

3. Hang the container on the intravenous pole about 30cm (12in.) above the tube’s insertion point into the client .

4. Squeeze the drip chamber to fill it to one- third to one – half of its capacity .

5.Open the tubing clamp , run the formula through the tubing and re clamp the tube .

6. Attach the feeding set tubing to the feeding tube and regulate the drip rate to deliver the feeding over the desired length of time or attach to a feeding pump.

7. Clamp the feeding tube

8. Ensure client comfort and safety.

9. Dispose of equipment appropriately


11.Monitor the client for possible problems


TOTAL Out Of 24




Second Semester 2016/2017 Procedure Evaluation




Procedure: Oral Hygiene for Unconscious or Debilitated Patient. Evaluation Grade System:

0: constant assistance, unsafe

1: occasional assistance, occasionally unsafe 2: rare assistance, usually safe

Note: *point (safety point) if it is not done 25% of the total mark will be subtracted

Task Score

Comments 0 1 2

*1.Perform hand hygiene before patient contact.

2.Verify the correct patient using two identifiers.

3.Provide privacy for the patient.

4.Explain the procedure to the patient, even if he or she is unconscious.

5.Place paper towels on the over-bed table, and arrange supplies.

6.If needed, turn on suction machine, and connect tubing to suction catheter.

7.Raise bed to appropriate height for the nurse; lower side rail.

8.Unless contraindicated, position the patient on side (Sims position) with head turned well toward dependent side and head of bed

lowered.

9.Place a towel under the patient’s head and an emesis basin under the chin.

*10.Perform hand hygiene and don gloves while remaining at the bedside.

11.Remove the patient’s dentures or partial plates, if present.

12.Insert an oral airway if the patient is unable to cooperate. Insert it when the patient is relaxed, if possible. Insert it upside down, then

turn it sideways and position it over the tongue to keep the teeth apart. Do not use force.

13.Clean the mouth/teeth using a small, soft-bristle toothbrush moistened in water if the patient can tolerate brushing. Use a water-

moistened foam stick applicator if the patient has sensitive gums a.Apply toothpaste or use antiinfective solution first to loosen crusts. b.Clean chewing and inner tooth surfaces first, outer surfaces next,

using an up-and-down gentle motion. c.Use toothbrush or foam stick applicator to clean roof of mouth,

gums, and inside of cheeks. Gently brush tongue but avoid stimulating gag reflex.

d.Rinse with water and repeat as needed.



e.Moisten toothbrush with antimicrobial mouth rinse and cleanse oral cavity, ensuring contact of the antimicrobial rinse with all oral cavity

structures. f.Repeat antimicrobial rinsing several times if needed.

g.Use toothbrush or foam stick applicator to apply water-based mouth moisturizer. Do not use lemon and glycerin swabs.

14.Suction secretions as they accumulate, if necessary.

15.Apply a thin layer of water-soluble moisturizer to the patient’s lips

16.Inform the patient that the procedure is completed.

17.Reposition the patient comfortably; return the bed and side rail to original positions.

18.Clean equipment and return it to its proper place.

19.Report any unusual findings to the practitioner.

20.Assess, treat, and reassess pain.

21.Discard supplies, remove gloves, and perform hand hygiene.

22.Document the procedure in the patient’s record

Total 44




Procedure Evaluation Student Name: …………………………………….. Day/Date: ……………………............



Procedure: Eye Care for Unconscious Patients Evaluation Grade System:

0: constant assistance, unsafe 1: occasional assistance, occasionally unsafe 2: rare assistance, usually safe Note: *point (safety point) if it is not done 25% of the total mark will be subtracted.

Task Score

Comments 0 1 2

*1.Perform hand hygiene before patient contact.


3.Assess the eye for swelling, drainage, and pain during each shift. Facial trauma, facial surgery, administration of large amounts of fluids, and prone positioning increase a patient’s risk for orbital eye swelling.

4.Assess for blink reflex, which lubricates the eye. If the blink reflex is absent, the patient is at risk for eye injury.

*5.Perform hand hygiene and don gloves.

6.Position patient in supine position, unless contraindicated.

*7.Use clean washcloth or cotton balls moistened with water or saline solution, and gently wipe each eye from inner to outer canthus. Use a separate, clean cotton ball or corner of the washcloth for each eye.

8.Cover the eye with the appropriate product or administer the appropriate ointment or drops as prescribed. (Artificial tears and LACRI-LUBE are two common lubricants.)

9.If the blink reflex is absent, gently close the patient’s eyes and apply eye patches or pads. Secure each patch or pad, being careful not to tape onto the surface of the patient’s eyes as that may cause further irritation and skin breakdown.

10.Assess, treat, and reassess pain.

11.Discard supplies, remove gloves, and perform hand hygiene.

12.Document the procedure in the patient’s record.

Total 24




Procedure Evaluation




Measuring and Monitoring Central Venous Pressure (CVP)


0: constant assistance, unsafe 1: frequent assistance, usually unsafe

2: rare assistance, usually safe Note: *point (safety point) if it is not done 25% of the total mark will be subtracted

Preparation

Score Comments

0 1 2

1.Assemble equipment and supplies:

2.Preparation a.Check physician’s order. b.Identify client using two descriptors. c. Explain procedure to client. d. Provide privacy. e. Determine client’s previous CVP parameters. _

Procedure

3.Perform hand hygiene.

4.Review the patient's medical record for a history of coagulopathies, vascular abnormalities, peripheral neuropathies.

.5Review the patient's medication profile for current anticoagulation therapy and the laboratory profile, including complete blood count (CBC), platelet count, prothrombin time (PT), bleeding time, international normalized ratio (INR), and partial thromboplastin time

6..Use a catheter checklist, standardized supply cart or kit, and standardized protocol for insertion.

7..Comply with Universal Protocol. Use a standardized list to verify that all required items, including informed consent, are available.

8.. Prepare and prime a single-pressure disposable transducer system. -When preparing the flush solution, follow organization practice for adding heparin to the IV bag, if heparin is not contraindicated. Label the flush bag, indicating the date and time the solution was hung and the nurse's initials.



-Turn the stopcock toward the port. Place an occlusive sterile cap or a sterile needleless cap on the top port of the stopcock. -Label the tubing, indicating the date, time, and nurse's initials

9..Record position so that same position can be used each time a CVP reading is made. _

10. Performed hand hygiene and donned sterile gloves, head covering, gown, and face-shield mask or eye protection.


12.Comply with Universal Protocol: Perform a time-out to verify correct patient, correct site, and correct procedure.

13..Place the patient in the supine position for cannulation.

14. Administer sedation as prescribed if the patient is restless or combative or if the extremity cannot be stabilized sufficiently.

15.Use sterile barrier precautions during insertion.

16.Cleanse the area of insertion. a. If the skin needs cleansing, use soap and

water first, then allow it to dry. b. Prepare the insertion site with chlorhexidine-

based antiseptic 0.5% or higher using a back-and-forth motion for at least 30 seconds.2,12 i. If chlorhexidine is contraindicated,

use tincture of iodine, an iodophor, or 70% alcohol.12

ii. When using povidone-iodine for children younger than 2 months of age or for children with compromised skin integrity, allow it to dry and then remove it with sterile normal saline wipes or sterile water.5

17.Assist the physician with inserting the CV catheter as needed

17.When the catheter is in place, connect the primed line pressure tubing to the catheter.

a. Trace tubing or catheter from the patient to point of origin (1) before connecting or reconnecting any device or infusion, (2) at any transition (e.g., new setting), and (3) as part of the hand-off process.9

b. Label the tubing at a site close to the patient and at a site close to the source when there are different access sites or several bags.9 Rationale: Tubing should be labeled to reduce the chance of misconnection, especially in circumstances where multiple IV lines or devices are in use.

c. Check vital signs immediately after making any connection per organization practice.9

d. Do not force connections, and avoid workarounds per organization practice.9

http://mns.elsevierperformancemanager.com/NursingSkills/ContentPlayer/SkillContentInIFrame.aspx?KeyId=71&Id=CC_059&IsConnect=False&bcp=SearchOp%7e0%7earterial+line%7eFalse&Section=7










Hold the catheter in place while the connections are made.

18.Secure the catheter in place with tape or adhesive strips and apply an impregnated sponge and an occlusive sterile dressing over the site.

a. Apply a sterile dressing to the site. Use either a transparent, semipermeable dressing alone or a gauze dressing with tape. If the patient is diaphoretic or if the site is bleeding or oozing, a gauze dressing is preferred.5,12

b. Label the dressing per organization practice with the date and time of application and the nurse's initials.

c. Apply an arm board and joint stabilization device, as appropriate.

19.Connect the transducer cable to the bedside monitor.

20.Leveled the CVcatheter air-fluid interface (zeroing stopcock) to the phlebostatic axis, or the practitioner performed this step.

21.Zeroed the system connected to the CVcatheter by turning the stopcock off to the patient, opening the stopcock to air, and zeroing the monitoring system. opening the stopcock to air, and zeroing the monitoring system. To confirm that the system is zeroed, take off the cap

squeeze the transducer, and look for fluid coming out of the port.

22.Observe the waveform and perform a dynamic response test (square wave test)

23 .Set the alarm limits according to the normal range of CVP and organization practice

24 .Run a waveform strip and record the patient's baseline CVP pressure.

25. Discard supplies, remove personal protective equipment (PPE), and perform hand hygiene.

26 .Document the procedure in the patient's record.

Total 52










Procedure: Arterial Catheter Insertion: Assisting with Insertion& measuring


0: constant assistance, unsafe 1: occasional assistance, occasionally unsafe

2: rare assistance, usually safe Note: *point (safety point) if it is not done 25% of the total mark will be subtracted.

Task

Score Comments

0 1 2

1. *Performed hand hygiene before patient contact.

2. Verified the correct patient using two identifiers.

3. Reviewed the patient’s medical record for a history of coagulopathies, vascular abnormalities, peripheral neuropathies, and the presence of atrioventricular fistulas or shunts.

4. *Reviewed the patient’s medication profile for current

anticoagulation therapy and the laboratory profile, including

CBC, platelet count, PT, bleeding time, INR, and PTT.

5. Assessed the neurovascular and peripheral vascular status of the extremity to be used for arterial cannulation, including an assessment of color, temperature, presence and fullness of pulses, capillary refill, presence of bruit (in larger arteries such as the femoral artery), and motor and sensory function (compared with the opposite extremity).

6. Used a catheter checklist, standardized supply cart or kit, and standardized protocol for insertion.

7. Complied with Universal Protocol.

8. Prepared and primed a single-pressure disposable transducer system. Considered using a blood conservation system.

9. Performed hand hygiene and donned sterile gloves, head covering, gown, and face-shield mask or eye protection.

10. Complied with Universal Protocol: Performed a time-out to verify correct patient, correct site, and correct procedure.

11. Placed the patient in the supine position for cannulation. Padded the pressure points.

12. Used sterile barrier precautions during insertion.

13. Cleansed the area of insertion.

14. Assisted the practitioner with inserting the arterial catheter as needed.

15. *When the catheter was in place, connected the primed pressure tubing to the catheter.



16. Secured the catheter in place with tape or adhesive strips and applied an impregnated sponge and an occlusive sterile dressing over the site.

17. Connected the transducer cable to the bedside monitor.

18. Set the scale.

19. *Leveled the arterial air-fluid interface (zeroing stopcock port) to the phlebostatic axis at the midaxillary line and fourth intercostal space just above the nipple line.

20. *Zeroed the system connected to the arterial catheter by turning the stopcock off to the patient, opening the stopcock to air, and zeroing the monitoring system.

21. Set the alarm limits according to the patient’s current blood pressure and organization practice.

22. Ran a waveform strip and recorded the patient’s baseline arterial pressure.

23. Recorded the manual (noninvasive) blood pressure and compared it with the arterial (invasive) blood pressure.

24. Assessed, treated, and reassessed pain.

25. Discarded supplies, removed PPE, and performed hand hygiene.

26. Documented the procedure in the patient’s record.

Total 52








Procedure: suction open and closed technique. Evaluation Grade System:

0: constant assistance, unsafe

1: occasional assistance, occasionally unsafe 2: rare assistance, usually safe


Task Score

Comments 0 1 2

1. Performed hand hygiene before patient contact.

2. Verified the correct patient using two identifiers.

3. Assessed the patient for signs of airway compromise or inadequate oxygenation.

4. Ensured that the patient understood the pre procedure teaching. Answered questions as they arose and reinforced information as

needed.

5. Assisted the patient to a comfortable position, generally a semi-Fowler or Fowler position.

6. Enlisted additional staff to assist in the procedure as needed.

7. Determined the appropriate depth to advance the suction catheter.

Closed-Suction Technique *8 .Performed hand hygiene and donned gloves, eye protection, and mask, or mask with eye protection and gown if necessary.

9. Turned the suction apparatus on and set the vacuum regulator to less than 150 mm Hg. Used only the amount of suction necessary to remove secretions effectively

10. Checked the negative pressure of the suction apparatus by occluding the end of the suction tubing before attaching it to the suction catheter. Followed the manufacturer’s directions for suction pressure levels when using a closed-suction catheter system.

11. Connected the suction tubing to the suction port or unlocked the thumb valve, according to the manufacturer’s directions.

*12. Hyper oxygenate the patient for 30 to 60 seconds.

13. With the dominant hand, gently but quickly inserted the catheter into the artificial airway with the control vent of the suction catheter open. Used shallow suctioning.

14. Using the dominant thumb, depressed the control vent of the suction catheter to apply continuous suction while completely withdrawing the catheter into the sterile catheter sleeve within 10 to 15 seconds. Using the nondominant thumb and forefinger, stabilized the airway while withdrawing the catheter

15. Performed one additional pass of the suction catheter if secretions remained in the airway and the patient was tolerating the procedure. Provided 30 to 60 seconds of preoxygenation before and hyperoxygenation after each pass of the suction catheter. Did not exceed two passes per suctioning procedure.

16. Performed oropharyngeal suctioning after the lower airway had been adequately cleared of secretions. Used a separate suction catheter for this step.

17. Rinsed the catheter and connecting tubing with sterile normal saline solution or sterile water until clear.



18. Turned the suction device off and locked the thumb control.

19. Ensured the FIO2 was returned to the baseline level.

20. Assessed the volume, consistency, and color of the airway secretions. Notified the practitioner of any changes in the airway secretions.

21. Maintained the suction collection tubing and canisters for subsequent suctioning episodes. Followed the organization’s practice for discarding and removing multiuse sterile solution containers and equipment.




Total Open Suction Technique Repeat steps (1-7)

26.Performed hand hygiene and donned gloves

27. Turned the suction apparatus on and set the vacuum regulator to less than 150 mm Hg. Used only the amount of suction necessary to remove secretions effectively.

28. Checked the negative pressure of the suction apparatus by occluding the end of the suction tubing before attaching it to the suction catheter.

*29.Using aseptic technique, opened the sterile catheter package on a clean surface, using the inside of the wrapping as a sterile field; opened the package just enough to expose the connecting end and connected the catheter to the suctiontubing.

30.Obtained sterile normal saline solution or sterile water to irrigate the suction catheter.

31.Removed gloves, performed hand hygiene, and donned sterile gloves, eye protection, and mask, or mask with eye protection and gown if necessary.

*32.With the dominant hand, picked up the suctioncatheter, taking care to avoid touching any nonsterile surfaces. With the nondominant hand, picked up the connecting tubing. Connected thesuction catheter to the connecting tubing.

33. Checked the equipment for proper functioning by suctioning a small amount of sterile solution from the container.

*34.Hyperoxygenated the patient for 30 to 60 seconds using one of the following methods:

a.Using the nondominant hand increased the baseline FIO2 level to 100% on the mechanical ventilator. Returned FIO2 to the baseline level after completion of suctioning. Or

b. Using the nondominant hand, pressed thesuction hyperoxygenation button on the ventilator.

35. With the dominant hand, gently but quickly inserted the catheter into the artificial airway with the control vent of the suction catheter open.

36. Using the dominant thumb, depressed the control vent of the suction catheter to apply continuous suction while completely withdrawing the catheter into the sterile catheter sleeve within 10 to 15 seconds. Using the nondominant thumb and forefinger, stabilized the airway while withdrawing the catheter.

37. Performed one additional pass of the suction catheter if secretions remained in the airway and the patient was tolerating the procedure. Provided 30 to 60 seconds of hyperoxygenation before and after each pass of the suction catheter. Did not exceed two passes per suctioning procedure.



38.If the patient did not tolerate open suctioning despite hyperoxygenation, performed the following steps:

a. Ensured that FIO2 was set at 100%. b. Maintained PEEP during suctioning. c. Allowed longer recovery intervals between suction passes. d. If the patient did not tolerate open suctioning after these steps,

switched to a closed-suction technique.

39. Performed oropharyngeal suctioning using the same suction catheter or a Yankauer suction catheter when the lower airway had been adequately cleared of secretions.

40. Rinsed the catheter and connecting tubing with sterile normal saline or sterile water until clear. Suctioned up unused solution until the tubing was clear.

41. Wrapped the catheter around the dominant hand after the upper airway suctioning was complete. Pulled the glove off inside out so that the catheter remained in the glove. Pulled the other glove off in the same fashion and discarded.

42. Turned the suction device off.

43Ensured the FIO2 was returned to the baseline level.

44. Assessed the volume, consistency, and color of the airway secretions. Notified the practitioner of any changes in the airway secretions.

45. Maintained the suction collection tubing and canisters for subsequent suctioning episodes. Followed the organization’s practice for discarding and removing multiuse sterile solution containers and equipment.




Total 36



Student Name: …………………………………….. Day/Date: …………………............

Section: ……………….……………...


Procedure: preparing medications continuous infusion Evaluation Grade System:

0: constant assistance, unsafe 1: frequent assistance, usually unsafe 2: rare assistance, usually safe




Task Score

Comments 0 1 2

A. Preperation: 1.Check the medication administration record (MAR).

Check the label on the medication carefully against the

MAR to make sure that the correct

Medication is being prepared .

Follow the three checks for administering medications

.Read the label on the medication (1)

When it taken from medication cart,(2)before withdrawing the medication, and (3)after withdrawing the medication .

Confirm that the dosage and route is correct .

Verify which infusion solution is to be used with the

medication .

Consult a pharmacist , if required , to confirm compatibility

of the drugs and solutions being mixed .

2. organize the equipment .

B. Performance: 1. perform hand hygiene and observe other appropriate infection control procedures .

2.prepare the medication ampule for drug withdrawal

Flick the upper stem of the ampule several times with a finger

nail Rationale this willbring all medication down to the main

portion of the ampule .

Use an ampule opener or place a piece of sterile gauze or

alcohol wipe between your thumb and the ampule neck or

around the ampule neck ,and break off the top by bending it

toward you to ensure the ampule is broken away from yourself

and away from others .Rationale: the sterile gauze protects the

fingers from the broken glass, and any glass fragments will

spray away from the nurse .

Place the antiseptic wipe packet over the top of the ampule

before breaking off the top. Rationale : this method ensures that

all glass fragments fall into the packet and reduces the risk of

cuts.

Dispose of the top of the ampule in the sharps container .

*3. withdraw the medication

Place the ampule on a flat surface

Attach the filter needle to the syringe .Rationale the filter needle

prevents glass particles from being withdrawn with the

medication .

Remove the cap from the filter needle and insert the needle into

the center of the ampule .Do not touch the rim of the ampule

with the needle tip or shaft .rationale this will keep the needle

sterile .Withdraw the amount of drug required for the dosage .

Dispose of the filter needle by placing in a sharps container .



4. Add the fluid (ensure that there is sufficient fluid in the volume – control fluid chamber to dilute the medication .check the directions from the drug manufacturer or consult the pharmacist .

5. Close the inflow to the fluid chamber by adjusting the upper roller above the fluid chamber ; also ensure that the clamp on the air vent of the chamber is open .

6. Clean the medication port on the volume – control fluid chamber with an antiseptic swab.

7. Inject the medication into the port of the partially filled volume –control set .

8. Gently rotate the fluid chamber until the fluid is mixed .

9.Open the line’s upper clamp , and allow the mixed fluid to reach at the tip of the volume –control set .

10.Attach a medication label to the volume –control fluid chamber .

11. connect the infusion system to the intended IV line or catheter .

12.convert the concentration of the solution to the same units of measure as the dose. all units of measure must be the same to perform the mathematical functions

*13.calculate the concentration of the medication per ml of fluid .necessary for medication calculation

*14.enter the concentration and the dose into the formula and solve for flow rate . necessary for medication calculation(variation for medication doses measured per minute (mg/min or µgm/min)) To determine unknown flow rate : Dose mg/min or µgm/min ×60min/hr / Concentration (mg/min ) or( µgm/ml ) ⁼ flow rate ml/ hr variation for weight based medication doses measured per minute (µgm/kg/min) To determine unknown flow rate : Dose µgm/kg/min ×60min/hr × pt weight (kg) / Concentration (µgm/ml )⁼ flow rate ml/ hr Mg milligram µgm microgram

15. Double check the calculations.

*16.document relevant data and monitor the client and the infusion .

Total 32

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