ralph r willis career & technical center school of ... · making an unoccupied bed making an...

1

Ralph R Willis Career & Technical Center

School of Practical Nursing

CLINICAL HANDBOOK

2020-2021

Name: ____________________

2



Skills Lab Guidelines and Objectives

Guidelines:

The skills lab is an evaluation of the student’s ability to perform skills previously taught in the Nursing

Skills lecture prior to coming to lab.

Students are expected to come to the skills lab and conduct themselves in a professional manner and

treat the lab as a clinical setting.

Students must follow the guidelines and directions of the lab instructors at all times.

Objectives:

1. To assist the student to integrate theory with the hands on training in a controlled environment

within the lab.

2. Apply nursing knowledge and critical thinking skills to perform selected nursing skills at a

minimally competent level.

3. To provide supervised practice with various nursing procedures and to help the student feel

comfortable in performing the procedures.

4. Demonstrate principles of asepsis in the performance of nursing skills.

5. Demonstrate how to effectively obtain data collection on a client and document data

demonstrating effective communication techniques.

6. To reinforce and apply the principles learned in the classroom.

7. Apply knowledge to safely and competently perform medication administration, isolation

precautions, IV therapy, enema administration, catheterization, ostomy care, wound care,

hygiene needs, ADL’s, oxygen therapy, and basic nursing skills.

8. To help the student understand the importance of maintaining the confidentiality and privacy of

the patient.

9. Competently perform return demonstrations on specific nursing skills as directed by the lab

instructor.

3



Clinical Experience Objectives

1. To assist the student to integrate theory with the actual care of patients.

2. To help the student realize that each patient is an individual and that nursing is modified to meet

the individual’s needs.

3. To provide supervised practice with various nursing procedures and to help the student feel

comfortable in performing them.

4. To provide an opportunity to participate in the total care and rehabilitation of the patient.

5. To assist the student in recognizing and meeting the physical, spiritual, mental, and emotional

needs of the patient.

6. To reinforce and apply the principles learned in the classroom.

7. To observe how various departments, work together in providing for the total needs of the

patient.

8. To help the student understand the importance of maintaining the confidentiality of the patient,

both verbal and recorded.

9. To help the student recognize the importance and the reason for cooperation with all hospital

and nursing home personnel.

10. To make the student aware of hospital/nursing home policies.

11. To perform authorized IV procedures as specified in law and Board of Nursing rules.

12. To help the student understand the families' involvement with the patients/clients care in the

healthcare facility.

Objectives:

1. Communicate effectively with persons and groups.

2. Incorporate teaching principles in nursing practice.

3. Collaborate with the health care team in organizing, managing, and supervising nursing care.

4. Utilizes principles of safety in the delivery of care.

5. Accepts responsibility for professional and personal growth as a lifelong process.

6. Develop awareness and abilities of leadership in the nursing role.

7. Develops awareness and abilities in nursing delegation.

4

RALPH R WILLIS CAREER & TECHNICAL CENTER SCHOOL OF PRACTICAL NURSING CLINICAL ROTATIONS

Long Term Care Objectives

I. Adjustment of student to nursing home setting

A. Assess and compare the care of a geriatric individual in an acute care facility and a

nursing home.

B. Realize that the nursing home is considered to be a permanent home for its residents,

not an acute care facility, and reinforce this concept.

II. Communication with the residents

A. Learn to communicate with individuals having aphasia or other speech impairments.

B. Recognize the need for and practice reality orientation with the residents.

III. Emotional needs of the residents

A. Realize that the resident has gone or is going through adjustment form home life to that

of the nursing home.

B. Identify dependent behavior that can develop in geriatric client.

C. Encourage residents to vocalize their feelings about how they are living now, and their

past life, by being a good listener.

D. Institute steps to guide residents toward resumption of contacts with family, friends,

and other persons to avoid isolations.

IV. Daily living activities of the resident

A. Identify the special needs of the geriatric client relating to specific body systems:

example impaired sight, hearing, equilibrium and/or ambulation.

B. Observe those residents who need special skin care or oral hygiene and institute

measures to meet these needs.

C. Encourage residents to exercise; accompany them to special activities rooms and

participate with them in activities.

D. Observe eating habits of individual clients, encourage them to eat a well-balanced meal

and report to team leader those who are not eating.

E. Observe elimination of residents and institute measures to correct or deal with any

deficiencies.

V. Emotional needs of students

A. The student will assess their own emotions relating to the aging process

B. Recognize the fact that residents have chosen or been place in the facility because of

necessity

5

FOCUS: Medication administration to the geriatric patient

I. Utilization of the 5 rights for each patient.

II. Utilization of nursing measures when administering medications to the elderly as follows:

A. Elevates head of bed unless contraindicated

B. Administers one tablet at a time

C. Allows for rest periods

D. Avoids a sense of hurry while administering medications

E. Prepares water prior to medication

F. Promotes independence by allowing the patient to take medication themselves

G. Gives simple explanation prior to administering medications

H. Determines if drug has been swallowed

I. Utilizes a portion of the food on patient’s tray as a means to administer medication

6

Ralph R Willis Career & Technical Center School of Practical Nursing

CLINICAL OBJECTIVES

These clinical objectives will be used on a weekly basis as selected by the instructors.

The objectives specify the clinical competencies, which you must demonstrate to complete the

program. Except where specifically noted, they must be achieved in order to graduate.

In most instances they will be achieved during the week they are assigned, however,

Some individuals on some particular assignments may take additional time. As the length

of time may be significant in your overall evaluation, you are to fill in the actual date on

which you met the objective if it was later than the assigned week. If this was due to

unavailability of assignment, please note this.

Each student is responsible for presenting the objective sheet to the instructor

and for calling her attention to any areas in which you need experience.

The objective specifies minimal expected competence so the instructor may evaluate that you need

additional experience in any area of the index sheets. As each objective is achieved, you

will be expected to continue to perform the competency throughout the program. Any necessity to re-

learn a mastered objective will be considered as a significant factor in performance evaluation.

7


CLINICAL PROCEDURES MASTER CHECK-OFF SHEET

PROCEDURE Performed Date Instructors Initials

ADMITTING A CLIENT TO A NURSING DIVISION

DISCHARGING/TRANSFERRING A CLIENT

MEASURING BODY TEMPERATURE

ASSESSING PULSE RATE

ASSESSING OF OXYGEN SATURATION WITH A PULSE OXIMETER

ASSESSING BLOOD PRESSURE BY AUSCULTATION

HANDWASHING

CARING FOR A CLIENT UNDER ISOLATION PRECAUTIONS

APPLYING A SURGICAL MASK

PREPARING A STERILE FIELD

SURGICAL SCRUB PREPARING FOR GOWNING

APPLYING A STERILE GOWN AND PERFORMING CLOSED GOWNING

PERFORMING OPEN GLOVING

ADMINISTERING ORAL MEDICATIONS

ADMINISTERING INJECTIONS FROM AMPULES AND VIALS

EAR IRRIGATIONS

8


ADMINISTERING SUBCUTANEOUS AND

INTRAMUSCULAR INJECTIONS

ONE-HANDED NEEDLE RECAPPING TECHNIQUE

ADDING MEDICATIONS TO IV CONTAINERS

ADMINISTERING MEDICATIONS BY IV

BOLUS (PUSH)

ADMINISTERING MEDICATIONS BY PIGGYBACK

VOLUME ADMINISTRATION SETS, OR MINIFUSERS

(SYRINGE PUMP)

ADMINISTERING OPTHALMIC MEDICATIONS

ADMINISTERING EARDROPS

ADMINISTERING NASAL DROPS AND SPRAYS

ADMINISTERING VAGINAL MEDICATIONS

ADMINISTERING RECTAL SUPPOSITORIES

USING METERED DOSE INHALERS

SEIZURE PRECAUTIONS

APPLYING RESTRAINTS

INTERVENING IN POISONING

PROPER LIFTING

POSITIONING CLIENTS IN BED

MOVING A CLIENT UP IN BED

TRANSFER TECHNIQUES

9

PROCEDURE Performed Date Instructors Initials APPLYING ELASTIC STOCKINGS

ASSESSMENT FOR RISK OF PRESSURE ULCER

PLACING A CLIENT ON A SUPPORT SURFACE MATTRESS

PLACING A CLIENT ON A CLINITRON BED

TREATING PRESSURE ULCERS

BATHING A CLIENT

PERINEAL CARE

ADMINISTERING A BACKRUB

NAIL AND FOOT CARE

PERFORMING MOUTH CARE FOR AN UNCONSCIOUS OR DEBILITAED

PATIENT

CLEANING DENTURES

SHAMPOOING HAIR IN BED

TAKING CARE OF CONTACT LENSES

CARE OF A BEHIND THE EAR HEARING AID

MAKING AN UNOCCUPIED BED

MAKING AN OCCUPIED BED

ADMINISTERING ENTERAL FEEDINGS VIA GASTROSTOMY OR

JEJUNOSTOMY TUBE

INSERTING A SMALL-BORE NASOENTERIC TUBE FOR

ENTERAL FEEDINGS

PULSE OXIMETRY

10


ADMINISTERING A CLEANSING ENEMA

POUCHING A COLOSTOMY OR ILESOSTOMY

CARE OF STOMA

IRRIGATING COLOSTOMY

DEMONSTRATING POSTOPERATIVE EXERCISES

IRRIGATING AND MAINTAINING A NG TUBE

APPLYING A WET TO DRY DRESSING

PERFORMING WOUND IRRIGATION

APPLYING AN ABDOMINAL OR T-BINDER

APPLYING AN ELASTIC BANDAGE

APPLYING HOT MOIST COMPRESS TO AN OPEN

WOUND

POSITIONG AND MOVING A PATIENT IN BED

ROM PROM

WHEELCHAIR STRETCHER

SPUTUM COLLECTION SPECIMEN

C & S COLLECTION

REPLACEMENT OF G-TUBE

NURSES NOTES

INCIDENT REPORTING

CARE PLANS

NOTING ORDERS

11


COMPUTER CHARTING

EMAR DRUG ADMINISTRATION

INITIATING ENTERAL TUBE FEEDINGS VIA NASOENTREIC

TUBES

SUCTIONING

CARE OF THE PATIENT WITH CHEST TUBES

APPLYING NASAL CANNULA

USING HOME LIQUID OXYGEN EQUIPMENT

CARDIOPULMONARY RESUSCITATION

VENIPUNCTURE WITH AN OVER THE NEEDLE PLASIC

CATHETER

REGULATING IV FLOW RATES

CHANGING IV SOLUTIONS AND TUBING

CHANGING AN IV DRESSING

OBSERVING A BLOOD TRANSFUSION

OBSERVING ARTERIAL PUNCTURE

COLLECTING MIDSTREAM (CLEAN-VOIDED) URINE

SPECIMEN

INSERTING A STRAIGHT OR INDWELLING CATHETER

INDWELLING CATHETER CARE

CLOSED AND OPEN CATHETER IRRIGATION

APPLYING A CONDOM CATHETER

MEASURING OCCULT BLOOD IN THE STOOL

12

Ralph R Willis Career & Technical Center School of Practical Nursing CLINICAL ROTATIONS

ORIENTATION TO GERI CENTERS Date: _________________

Name: ______________________________________________________

During this clinical experience, the student will have a brief orientation of location and meeting

the department supervisor if possible.

Satisfactory Unsatisfactory Housekeeping Laundry Dietary/Dining Room Maintenance Administrative Offices Nursing Offices Medical Records Conference Room-Procedure Books-Reference Books Chapel Central Supply Physical Therapy Department Nursing Station Chart Room Dirty Service Room Clean Service Room/Supplies Show/Tub Room Beauty Room Break Room Where extra wheelchairs are kept Emergency equipment is kept-O2 Suction

13


CLINICAL ROTATIONS

Name: ______________________________________Date: _____________________________________

Satisfactory Unsatisfactory

Have an in-depth orientation to various floors on which students will practice:

A. Location of Fire extinguishers, hose and exits B. Location of and how to operate fire alarms C. Location of and operation of oxygen shut-off

valves

Location of utility room, diet kitchen, treatment and pan rooms, linen closets, conference room and patient’s rooms

Location of emergency equipment: A. Suction machine B. Defibrillator C. Crash cart

Demonstrate and return demonstration of: A. Call system/Nurse button B. T.V. if have C. Addressograph System

Instructor’s Comments Student Comments

Instructor’s Signature:

Date:

Student’s Signature:

Date:

14

Ralph R Willis Career & Technical Center School of Practical Nursing CLINCAL ROTATIONS

Name: _______________________________________ Date: ____________________________

Pre-Conference Satisfactory Unsatisfactory

Demonstrate correct hand washing techniques to the

instructor. State four circumstances that necessitate

hand washing.

Use communication skills with patients using both: A. Verbal techniques

1. Interpret the messages of others correctly through conscious striving to find the speakers intended message—verbal, nonverbal, or both.

2. Become aware of one’s own pattern of nonverbal communication.

3. Recognize one’s own feeling responses to the behavior of another person, to a situation, or to one’s own expectations of a situation.

Attend post conference and be prepared to discuss: A. Orientation to patient’s room including:

1. Call light 2. Lighting 3. ER bathroom call light 4. How to cleanse bed pan

B. Explanation of fire drill code and regulations C. Explanation of linen area and provision for dirty

linen.



Date:


Date:

15


CLINICAL ROTATIONS

Name: ___________________________________ Date: __________________________________

Pre-Conference Satisfactory Unsatisfactory Utilize good body mechanics throughout all activities Wash hands as frequently as made necessary by assigned activities

Make a closed bed Make an open bed:

A. Select and assemble all linens required before beginning to make a bed

B. Center and tuck each piece of linen under the mattress neatly and make each unit

C. Fold back the top sheet and adjust the spread Correctly in relation to the top sheet

D. Lower the bed and lock brake E. Place bell cord and stand in proper place F. Handle soiled linen in a manner which avoids

cross contamination

Prepare a patient for a meal in a manner which demonstrates knowledge of:

A. Hygienic needs B. Relationship of environment to appetite C. Effect of disabilities or ability to feed self

Feed a patient in a manner which demonstrates awareness of need for:

A. Safety B. Similarity to persons normal food habits C. Maintaining as much independence as possible

Accurately chart the patient’s dietary intake according to facility procedure

Strip and clean a discharge unit: A. Remove the soiled linen in manner to minimize

transfer of microorganisms B. Operate the controls of the bed in order to adjust

the position of the bed as may be required C. Clean the unit with proper disinfectant and in the

correct method to prevent transfer of pathogenic organisms to the next patients

For Post-Conference, locate in a patient record, the following items:

A. Admission sheet B. Graphic Record C. Medication Administration Record D. Physician Order Sheet/Progress Notes

16

E. Flow Sheet F. Nurse’s Notes G. Laboratory Sheet H. X-Ray Reports I. DNR Status

Nursing Database Name four safeguards of confidentiality for a patient record

Locate and record nursing care plan for two patients: A. Participate in discussion of components of a

nursing care plan B. Identify two uses which make the nursing care

plan a valuable tool Post Conference



Date:


Date:

17


CLINICAL ROTATIONS Name: ___________________________________ Date: __________________________________


Attend pre-conference Demonstrate skill in giving a partial bath and making an open or occupied bed using the following guidelines:

A. Collect the linen necessary from the bath cart/linen room

B. Prepare the client 1. Explain the procedure 2. Provide safety and equipment

C. Prepare the linen and equipment 1. Apply bath blanket and remove top covers

D. Offer bedpan and follow through with care of bedpan

E. Obtain bath water and prepare mouth care equipment

F. Assist with bath as was demonstrated in class lab including: 1. Mouth Care 2. Instruction to patient 3. Back rub 4. Comb hair

G. Make occupied open bed H. Leave be in low position, side rails up and bell

Cord within reach (need order for both side rails) I. Maintain appropriate communication with patient

throughout procedure J. Clean bath equipment and return same to proper

place K. Daily care of the unit L. Report and record

Clean dentures in a manner demonstrated safety and hygienic awareness.

Attend post conference and be prepared to discuss: A. Obtain diabetic urine or blood glucose B. Obtaining stool specimen C. Obtaining sputum specimen D. Explanation of lab slip and practice filling out

proper forms E. Practice with positioning of patient in bed F. Practice writing nursing care plans

18



Date:


Date:

19


CLINICAL ROTATIONS Name: ___________________________________ Date: __________________________________


Attend pre-conference During the clinical experience, the student will: Fill out his/her assignment sheet using the patient care plan

A. Considering the factors listed below, discuss the plan of action with the supervisor before starting the patient’s care: 1. Abilities and limitations 2. Diagnosis 3. Doctor Orders 4. Diet 5. Special treatments

Give a bed bath and make an occupied bed using the following guidelines:

A. Collect the necessary linen from the bath care B. Prepare the patient

1. Explain the procedure, provide safety and privacy

C. Prepare the linen and equipment 1. Apply bath blanket and remove top covers 2. Stack linen in order and neat fashion

D. Offer bedpan and follow through with care of patient and bedpan 1. Wash hands

E. Obtain bath water and prepare mouth care equipment

F. Give bath as was demonstrated in class laboratory including: 1. Mouth care 2. Wash, rinse and dry body parts in correct

sequence a. Identify specific indications, such as

cyanosis, increased redness, or broken skin that could lead to a decubitus and begin appropriate preventive measures

3. Care of nails 4. Back rub

G. Maintain appropriate communication with patient throughout procedure

H. Make an occupied or open bed I. Leave bed in low position, side rails up and call

cord within reach

20

J. Clean both equipment and return same to proper place

K. Daily care of the unit L. Report and record

Observation: A. If available on the department, observe a patient

on a pressure mattress. Be prepared to discuss instructions necessary when a pressure mattress is in use.

Attend post-conference and be prepared to discuss: A. Charting TPR and B/P on proper form B. Catheter care C. Condom catheter application D. Application of bed stocking (TEDs –knee high and

thigh high) and ACE bandages E. Name ways patient may be safeguarded against

decubitus ulcers.



Date:


Date:

* All objectives so indicated will be accomplished as the assignment is available within the clinical

laboratory.

21


CLINICAL ROTATIONS

Name: _________________________________ Date: _________________________________________

Satisfactory Unsatisfactory Attend pre-conference During the clinical experience, the student will: Discuss the plan of care with nurse before starting the patient’s care

Fill out his/her assignment sheet using the patient care plan Give a tub bath and make an open bed using the following guidelines:

A. Tub bath 1. Check the tub and clean it if necessary 2. Obtain linen 3. Fill tub to aprox 1/3 full with temperature 110 °F 4. Assist patient to bathroom and into tub 5. Keep the patient under constant observation

while in the tub 6. Provide privacy for the patient at all times 7. Assist with bath as needed, when finished help

patient out of the tub. Dry skin well, assist with clothing and back to room

8. Make bed 9. Return to bathroom and clean tub, take used

linen to proper room 10. Chart

B. Shower 1. Prepare shower room and equipment for patient 2. Assist patient to shower, provide privacy 3. Give instruction to the patient

a. Use call cord b. You will check on him/her at least twice c. Make bed while patient is in shower d. When patient has returned to room, clean

shower e. Chart

Practice with obtaining: 1. Urinalysis 2. Diabetic (one touch/urine strips/glucometer) 3. Stool Specimen 4. Sputum Specimen 5. C & S (urine and wound) 6. MRSA Swab

22

*Prepare and give a patient a shampoo in bed using principles of safety, good body alignment and patient comfort A. Explain four safety policies of using the hairdryer and carry out same when doing the procedure

Attend post-conference and be prepared to discuss: A. Demonstration of B/P apparatus B. Demonstration of IVAC thermometer C. Demonstration of taking apical pulse D. Demonstration of taking respirations E. Demonstration of taking systolic pressure by

pulsation F. Discuss admission procedure for agency


Instructor’s Signature: Date:


Date:

23


CLINICAL ROTATIONS

Name: ___________________________________ Date: __________________________________

Satisfactory Unsatisfactory Attend pre-conference During the clinical experience, the student will: Discuss the plan of care with nurse before starting the patient’s care Discuss with the instructor the proper place and method for storing the stethoscope, sphygmomanometer, IVAC thermometer, battery charger and probe covers

Fill out his/her assignment sheet using the patient care plan Take three patient’s temperature oral y with the IVAC thermometer using the following guidelines:

A. Insert the probe cover while the cover is sill in the box

B. Have the patient open slightly, hold the probe loosely between thumb and index finger while slowly inserting and sliding it back under front of the tongue along the gum line to back of the mouth; i.e. to the sublingual area at base of tongue

C. Hold the probe steady and in contact with the sublingual tissue until an audible signal is heard and the red light comes on

D. Remove probe, discard the probe cover in bedside bag; press on top of the probe with thumb while holding the probe collar between index and middle finger

E. Return the probe to its storage channel and record temperature reading

Take three patient’s pulse and respirations following these guidelines:

A. Have patient’s arm resting on the bed or over his/her chest 1. Palm of his/her hand down

B. Place your index and middle finger over the radical artery, locate the pulse beat and count the pulse for one minute.

C. Without removing your fingers from the pulse beat count the respirations for one minute

D. Record pulse and respirations

24

Accurately chart the three blood pressures using the following key points:

A. Have patient in sitting or supine position B. Place bottom edge of cuff one inch above elbow,

wrap the cuff neatly and snugly around arm 1. Support patient’s arm while applying the cuff

C. Place his/her arm in a comfortable outstretched position on bed or chair arm

D. Attach tube and place stethoscope ear pieces in your ears

E. Locate brachial pulse beat and place diaphragm of stethoscope over are

F. Inflate B/P cuff until mercury rises to approximately 160 in sphygmomanometer

G. Release the air form the bulb smoothly H. Watch the mercury column and listen to the sound

through the stethoscope I. Disconnect tubing and remove B/P cuff J. Record B/P

Attend post-conference and be prepared to discuss: A. Application of wet to dry dressing B. Application of compresses C. Aseptic technique D. Sterile technique




Date:

25


CLINICAL ROTATIONS

Name: _________________________________ Date: _________________________________________


Fill out his/her assignment sheet using the patient care plan Take three patient’s temperature orally A. List and describe three methods of measuring body

temperatures 1. State situations in which each method could or

would not be used 2. List the normal readings for each method

Take three patient’s pulse accurately recognizing deviations from normal rate, rhythm, and volume

A. Name and define three abnormal pulsed

Demonstrate ability and skill to count three patient’s respirations

A. Discuss with the instructor the meaning of apical-radial pulse and implication of pulse deficit

Obtain an accurate brachial B/P reading in three patients of varying age and various diseases as verified by instructor.

A. List three factors that may affect the patient’s B/P B. List one condition or disease that may affect the

patient’s B/P C. Take one systolic pressure by pulsation D. Locate the pulse beat at the dorsalis pedis artery E. Accurately record TPR’s on graphic record

*Correctly apply a wet to dry dressing *Correctly apply a compress Attend post-conference and be prepared to discuss:

A. Catheter care B. Condom catheters C. Three way catheters D. Supra pubic catheters



Student’s Signature: Date:

26


Name: _________________________________ Date: _________________________________________


Fill out his/her assignment sheet using the patient care plan With minimal supervision, accurately measure and record TPR and BP of three patients:

A. Report any suspected abnormalities to instructor for verification

1. Describe difference in pulse volume which can be detected

B. Relate observable skin and color changes to vital sign of patient

C. Relate Verified abnormalities to change nurse in a clear, concise manner

Discuss the apparent significance to one of the assigned patients of having vital signs measured. Be prepared to discuss in post conference:

A. A medication that will lower the temperature to normal

B. Two medications that affect the pulse rate C. Two medications that affect the BP D. Any problems of potential problems that did or could

occur in obtaining an accurate measurement of TPRS and BPs

E. The effect of position and environment on vital signs F. Discuss appropriate nursing response to questions

by the patient and family about the precise measurement of patient’s vital signs

Give response why precise measurements and descriptions of vital signs is a primary nursing function

*Correctly do catheter care *Correctly apply a condom catheter Attend post-conference and be prepared to discuss

A. Experience on unit




*Objectives so indicated will be accomplished as the assignment is available within the clinical experience. Written 01/04 Reviewed: 01/06;01/08;01/10;01/12;01/14;01/15;01/16;01/17;01/1;/01/19

27


Name: _________________________________ Date: _________________________________________


Fill out his/her assignment sheet using the patient care plan *Discharge a patient following agency procedure A. Review the procedure and discuss steps with the Instructor before beginning discharge

B. Check chart for discharge order

Review discharge instructions with patient or observe the nurse as he/she discusses these with the patient:

A. Information about activities permitted/restricted after discharge B. Dietary needs C. Future appointment with the doctor

Special instructions (i.e. Wound care, medications, etc.)

D. Abnormal symptoms to report to doctor E. Remove IV/heplock

Give copy to patient pulse prescriptions, diet sheet, etc Assist the patient with dressing or packing Obtain wheelchair and transport patient and belonging to waiting vehicle

A. Remind patient to remain safely in wheelchair until you have come to a stop, put on brakes, and raise the foot peddles

B. Assist the patient from chair into car

Return wheelchair to proper place Strip bedroom/place on to be cleaned list for housekeeping Inform ward clerk/supervisor of pt. discharge Complete nurse note

A. Discharge information were reviewed with patient B. Time, method, where and with whom patient was

discharged

Attend Post Conference Instructor’s Comments Student Comments



*Objectives so indicated will be accomplished as the assignment is available within the clinical experience. Written 01/04 Reviewed: 01/06;01/08;01/10;01/12;01/14;01/15;01/16;01/17;01/1;/01/19

28


Name: _________________________________ Date: _________________________________________


Fill out his/her assignment sheet using the patient care plan *Give cleansing enema to assigned patient using the following guidelines:

A . Discuss the procedure with the instructor before beginning the enema B . Check doctor orders to be sure enema has been

ordered C. Preparation of Patient

1. Make accurate identification 2. Provide privacy and explain the procedure 3. Apply bath blanket and fan-fold top covers to foot of bed 4. Protect bed linen with rubber and cotton

treatment squared D. Prepare tray and solution

1. Wash hand 2. Line tray with cotton treatment square 3. Squeeze out enough lubricant (to lubricate colon 4 inches) and on toilet tissue and place toilet tissue in emesis basin or tray 4. Prepare 1000 cc water at temperature 105° F 5. Add 1 pkg. of enema soap and pour solution into enema bucket/bag

E. Return to patient’s room and give enema 1. Assist patient to turn to left side 2. Run small amount of solution through tubing 3. Lubricate colon tube 4 inches 4. Insert colon tube approx. 4 inches into rectum a. Have patient to take deep breath at this time

F. Open clamp and allow solution to flow into rectum 1. Hold enema bucket approximately 12 inches above arms

G. After prescribed amount has been given, remove colon tube H. Elevate head of bed, and place toilet tissue and bell

within reach

29

1. Instruct patient to ring; if he/she finishes before your return

Take enema tray to soiled side of utility room and dispose Return to patient, remove bedpan and treatment squares Give patient water to wash hands and replace top covers; Wash hands

Note the color, amount and consistency of stool Accurately chart enema on chart

A. If any abnormalities, report immediately to nurse and chart same on nursing note

Attend post conference



Date:


*Objectives so indicated will be accomplished as the assignment is available within the clinical experience.

30

Ralph R Willis Career & Technical Center School of Practical Nursing Student Performance Evaluation

Four Unsatisfactory Can Result in Dismissal from the PN Program

Student: _______________________________ Rotation: __________________________

Instructor: ______________________________ Date: _____________________________

Promptness: Communications

_______Tardy _______Maintains Integrity in Communication

_______ Dates _______Maintains Confidentiality

_______Absences _______Converses Appropriate

_______Dates(s) __________ _______Follows Proper Chain a Command

_______Reports Sick/Off Appropriately _______Reports/Records Observations Appropriately

Prepared for Assignment: Affective Behaviors:

______Watch _______Exhibits Professional Behavior/Attitude

______Scissors _______Cooperates with Staff, Instructor, Peers

______Blank Ink Pen _______Follows Directions

______Note Pad _______Complies with Policies of School & Agency

______Care Plan _______Identifies Own Strengths/Areas for Improvement

______Name Tag _______Reports Errors/Unsafe Conditions Timely

Manner

_______Positive/Appropriate Facial Expressions

Uniform/Professionalism: _______Appropriate Responses

______Clean Shoes _______Readily Accessible to Instructor/Staff

Appropriately

______Clean/Unwrinkled

______Name Badge

______Make-Up Appropriate

______Jewelry Within Guidelines End of Rotation Comment: ____________

______Hair Off Collar/Out of Face __________________________________

______No Perfume/Heavily Scented Products __________________________________

______No Chewing Gum __________________________________

______Nails Short/No or Light Polish __________________________________

__________________________________

Student Signature Date

Patient Care:

_______ Appropriate Hand/Body Gestures ___________________________________

_______Activities Clinically Oriented Instructor Signature Date

_______Conversation Clinically Orients

_______Performs Procedures Appropriately

_______Provides Quality Care

_______Practices Safety

_______Identifies/Meets Patient’s Needs

_______Protects Patient’s Privacy/Rights

_______Acknowledges Patient During Care

31


CLINICAL ROTATION

STUDENT NAME: ___________________

ROTATION: ________________________

Comments per Day Date Satisfactory Unsatisfactory

32


CLINICAL ROTATIONS: Medical Surgical Nursing

Name: _________________________________ Date: _________________________________________

Satisfactory Unsatisfactory Effectively give total nursing care except medications of one Assigned patients and demonstrated knowledge of the implications of care by:

A. Knowing the names and diagnosis of the assigned patients before morning report

B. Attend morning report and pay special attention to report of assigned patients

C. Review the patient’s care plan D. Discuss plan of care with instructor before starting

patient care E. Adequately and correctly perform the following:

1. Measure TPR and record. If any abnormalities. report immediately to nurse and instructor.

2. Prepare patients and serve meals in manner which demonstrates knowledge of:

a. Hygienic needs b. Effect of disabilities or ability to feed self c. Chart dietary intake according to hospital procedure 3. Complete, partial bath or shower as patient’s condition indicates:

a. Mouth care b. Care of nails c. Back rub d. Care of hair e. Open/occupied bed f. Care of unit g. Measure B/P and record h. Chart

F. Accurately execute care appropriate to diagnosis or needs of patient. List care below: _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________

G. Become familiar with unit activities and participate in activities if time permits

33

H. Be prepared to discuss in post conference: a. Values of care given b. Reasons the doctor ordered the special care of

procedures c. How these were executed d. Problems encountered and how solved




34



Name: _________________________________ Date: _________________________________________ Care of a patient with an infectious disorder requiring isolation such as Tuberculosis or hepatitis, and demonstrate responsibility in preventing the spread of infectious agents and controlling infectious disease. Upon completion of this rotation, the student will: Attend Pre-Conference

Satisfactory Unsatisfactory Execute strict isolation technique, following hospital Procedures

Demonstrate good hand-washing and discuss important Guidelines to be followed

Perform proper and safe gown technique Feed or assist with feeding of patient in isolation Consult with dietician regarding food preferences, and/or special diet

Discuss with and teach the patient the necessity of eating proper food/fluid intake for recovery

Care for contaminated dishes and refuse using hospital procedure

Observe any skin testing performed Using proper technique, obtain specimens for diagnostic study (if ordered) as:

A. Urinalysis B. Sputum specimen C. Stool specimen

Dispose of excreta, using hospital isolation procedure Assist with discharge of patient from isolation and perform terminal cleaning of unit and room

In post conference: A. State reasons for using isolation technique B. Discuss incubation period, type of isolation needed,

immunization infectious disease C. Discuss antiseptics used at hospital and how each is

used D. Discuss chemical disinfectants used at assigned

hospital and explain what each is used for E. Discuss psychological effects of isolation o patient F. Be prepared to discuss the hospitals medications

ordered for the patient with infectious disorder, regarding action and patient’s response

G. Be prepared to discuss in post conference the reason for and results of skin testing

35




36

Ralph R Willis Career & Technical Center School of Practical Nursing CLINICAL ROTATIONS: Medical Surgical Nursing THE TOTALLY DEPENDENT OR IMMOBILE PATIENT

Name: _________________________________ Date: _________________________________________ Attend Pre-Conference

Satisfactory Unsatisfactory Care for a totally dependent patient and effectively give nursing care by providing the following:

A. Bathe patient gently with added attention to extremities, folds, etc.

B. Include catheter care if indicated C. Provide frequent peri-anal hygiene for the

incontinent patient D. Initiate special mouth care E. Provide eye care F. Encourage fluid intake and assist patient with food G. Provide proper position of

1. Head for better respiration 2. Extremities to prevent deformities

H. Reduce and prevent formation of pressure areas by: 1. Using protective aids 2. Changing position at least 1-2 hours 3. Give special skin care 4. Give decubitus care when indicated

Post clinical conference: Describe the effects of immobility on each of the following body systems:

A. Cardiovascular System B. Respiratory System C. Gastrointestinal System D. Musculoskeletal System E. Urinary System

Describe the effects of immobility on the skin Describe the psycho-social effects that may occur because of the immobility




37



Name: _________________________________ Date: _________________________________________ Upon completion of this rotation, the student will:

Satisfactory Unsatisfactory Care for a patient with fluid and electrolyte imbalance providing the following:

a. Daily personal care b. Special skin care when indicated c. Keep and record strict intake and output records d. Demonstrate the proper method to obtain daily

patient weight

Observe for symptoms of edema and dehydration Observe symptoms physical or emotional that may indicate an electrolyte imbalance

Observe for symptoms of acidosis and alkalosis *Assist with discharge of patient from isolation and perform terminal cleaning of unit and room

In post conference: Be prepared for post conference to report on the following in regard to fluid-electrolyte imbalance

Review laboratory studies in regard to electrolytes Observe for symptoms of acidosis and alkalosis *Assist with discharge of patient from isolation and perform terminal cleaning of unit and room

In post conference: Be prepared for post conference to report on the following In regard to fluid-electrolyte imbalance:

a. Symptoms of assigned patient b. Laboratory studies of assigned patient c. Nursing care of the assigned patient d. Emotional support needed for the assigned patient



Student’s Signature Date:

38


CLINICAL ROTATIONS:

Medical Surgical Nursing Cardiovascular System

Name: _________________________________ Date: _________________________________________ During this clinical experience the student will:

Satisfactory Unsatisfactory Blood Disorder Objectives 1. Care for a patient with a blood disorder such as anemia, or leukemia and one requiring a blood transfusion and give effective nursing care A. Special items relating to anemia and leukemia 1. Provide and teach patient aspects of

a. Good skin care b. Oral hygienic c. Check stools and urine for bright red or old

blood-report any abnormalities to charge nurse or doctor

2. Discuss dietary habits of patient 3. Discuss with patient the importance of mild exercise, frequent rest, periods with feet elevated

B. Review laboratory report (CBC) in patient’s chart. discuss variations for normal, cause, and treatment in post conference C. Observe a sternal puncture and discuss reason for procedure, precautions, and possible sequelae during post conference.

Heart Disorders Objectives 1. Care for a patient with a heart disorder such as CHF, MI in the recuperative phase A. Organizes nursing care to reduce the work of the heart by decreasing oxygen and lessening body’s metabolic demands 1. Provides periods of rest during administration of nursing care and between meals

1. Considers the “rest habits” of the patient when developing and implementing his nursing care plan

2. Provides a quiet, well-ventilated esthetic environment to promote rest

3. Uses supportive devices such as pillow, foot Board, and over bed table to maintain positions which enhance breathing and comfort

39

4. Promotes rest by the use of comfort measures, e.g. skin care, position changes, mouth care, appropriate diversion such as reading to him, unhurried nursing care etc.

5. Screens mail and visitors which may trigger apprehensive pain shock cycle

6. Prevents constipation and straining by administration of medicines as ordered, fluid intake, limited exercise, diet control, use of bedpan (with privacy) or bedside commode

7. Provide opportunity for verbalization of anxiety and fears

1. Anticipates and intervenes to prevent complication of cardiac disease

A. Observe and records stimuli which results in increased anxiety, dyspnea, pain

A. Instructs patient in performances of breathing exercises and leg exercises (after

consultation with physician) B. Observes and records vital signs; determines

frequency according to patient’s condition C. Functions effectively in a CPR situation D. Observes, records and reports such signs of

cardiac complications as skin turgor, cyanosis, dyspnea, rales, anxiety, and restlessness or diaphoresis (Rales-Chest rattles)

2. Talk with dietician re: low-sodium diet and specifically any dietary needs of this patient

3. Accurately measure and record apical/radial pulse 4. Weigh patient daily if ordered and maintain intake and

output 5. Accurately describe the patient’s apparent response to

his illness, his inactivity and dietary restriction in post conference

6. Observe one of the following diagnostic tests used in detecting heart disease: electrocardiogram

7. Apply support hose A. Measure calf or leg for correct fit B. Instruct patient regarding proper use C. Care of Hosiery regarding washing and drying

9. List and demonstrate four ways in which the nurse Can assess fluid retention

A. Weight control B. Smoking C. Food intake e.g. foods to avoid and amount taken

each meal Written01/04Reviewed:01/06;01/08;01/10;01/12;01/14;01/15;01/16;01/17;01/1;/01/19

40



Digestive System

Name: _________________________________ Date: _________________________________________ During this clinical experience the student will: Be assigned a patient with a digestive disorder requiring medical treatment such as a peptic ulcer, cirrhosis colitis, or cancer of colon (colostomy) and he/she will adequately and correctly perform the following:

Pre-Conference Satisfactory Unsatisfactory Prepare the patient for G.I. series and/or Barium enema

Observe patient and activity in x-ray Take care of patient’s needs following x-ray

A Diet, special diet B. Hygiene C. Enema (as ordered) D. Good skin care E. Providing rest

Accurate charting, regarding symptoms, progress and observations

Observation and recording of: A. Color of skin B. Stools C. Urine

Collect, record and/ or assist with the following laboratory procedures:

A. Stool specimen for occult blood B. Stool specimen for ova and parasites C. Gastric analysis (if available)

Review laboratory reports and discuss variations from normal in post conference

Review x-ray reports and discuss finding in post conference Teach patient and family important points in keeping ulcer under control:

A. Diet B. Emotions C. Eating habits D. Rest E. Medications

Make medication cards for patient Discuss drug actions, effects, and patient’s response with instructor or in post conference

41



Date:


42



Surgical Digestive Disorders

Name: _________________________________ Date: _________________________________________ During this clinical experience the student will: Be assigned a patient with a digestive disorder requiring medical treatment such as a cholecystectomy, gastric resection, colostomy, herniorrhaphy, or appendectomy and will effectively give nursing care providing the following:

Pre-Conference Satisfactory Unsatisfactory Discuss plan of care with instructor before starting each day and as needed

Prepare patient for surgery: A. Provide privacy and safety during the preoperative

Preparation B. Safeguard the patient from any food or fluids in the specified time C. Provide personal hygiene as required by the polices

of the hospital D. Accurately give pre-operative care and check prior

preparation E. Read chart, records and lab report, discuss post

surgery with instructor

Observe surgical procedure Remain with patient during post-operative period Discuss surgical procedure with instructor or in post Conference on return for surgery

Provide post-operative care for the next two day Provide for patient’s personal needs by:

A. Giving complete bath for necessary time B. Giving particular attention to oral hygiene C. Sponging perspiration for secretions from

body/change linen as necessary

Provide passive exercised of arms and legs Encourage active exercise by the alert patient and promote goal of early ambulation

Accurately measure and record vital signs every four hours Frequently inspect dressing for signs of unusual bleeding

A. Report any abnormalities to charge nurse in a clear, concise manner

B. Reinforce dressing as needed

43

C. Change dressing as ordered/needed Give effective care and instruct patient with colostomy the following aspects of care:

A. Skin care around stoma-changing dressing or colostomy bag

B. Irrigation of colostomy C. Care of ostomy equipment D. Diet

Care of patient with hepatitis requiring isolation, if available

Attend Post Conference



Date:


Objectives will be accomplished as assignment is available

44



Muscular-Skeletal Disorder

Name: _________________________________ Date: _________________________________________ During this clinical experience the student will: Be assigned a patient with a musculo-skeletal disorder example: fracture, arthritis, amputation or other related condition and specific care given regarding the following:

Attend Pre-Conference Satisfactory Unsatisfactory Techniques of lifting and turning the patient

Orthopedic bed making Prevention of deformities

A. Body in good alignment B. Active and passive alignment C. Use of pillow, sandbags, trochanter rolls, etc.

Transporting patient in a manner which demonstrates awareness of safety and comfort for the patient when using

A. Wheelchair B. Stretcher C. Hoyer lift

Review x-ray report and discuss in post conference Observation/assisting with cast application (if cast is ordered)

Daily care of patient and cast: A. Cleanliness B. Skin care C. Itching D. Position E. Noting the color and warmth of toes/fingers F. Charting

Care of patient in traction: A. Daily care B. Maintenance of alignment C. Weights hanging free D. Giving/removing a bedpan E. Use of trapeze F. Preventive measures for decubiti

Visit and assist with physical therapy if ordered: A. Crutch walking B. Special exercises and/or water therapy C. Discuss follow-through of therapy with physical

therapist for unit use

45

Attend Post Conference Instructor’s Comments Student Comments


Date:



46

Ralph R Willis Career & Technical Center School of Practical Nursing CLINICAL ROTATIONS:

Medical Surgical Nursing Respiratory Disorder


Attend Pre-Conference Satisfactory Unsatisfactory

1. Demonstrate knowledge of principles of pathogen Transfer in the card of patients with infectious respiratory diseases by constructing and implementing an acceptable care plan for such a patient

A. Utilizes surgical and/or medical aseptic technique In all dressing changes, care of specimens, handling of linen, disposal of excreta, and performance of patient care

B. Teaches patients importance of hand washing and Proper care of secretions

2. Give care to a patient with chronic or acute respiratory disorder by adequately and correctly performing the following:

A. Skin care C. Oral hygiene D. Proper positioning E. Providing rest F. Accurate charting regarding symptoms, progress and

observation

3. Prepare the patient physically and psychologically for diagnostic procedures such as bronchoscopy, bronchogram, arterial gas studies, skin testing, thoracentesis, sputum studies and ventilator function tests

A. Explains procedures at patient’s level of understanding to alleviate fear and promote cooperation

B. Recognizes, reports and records expected and/or untoward reactions

C. Checks for gag reflex before allowing fluids in those Procedures which involve pharyngeal anesthesia

D. Interprets variations of specific lab reports such as arterial blood gas

4. Assist assigned patients in the selection of special diet and teach principles of good nutrition related to the treatment and prevention of respiratory disease

A. Emphasized balance between hydration, fluid retention, and fluid loss

B. Recognizes role of adequate nutrition in overcoming

47

respiratory infections and preventing relapses C. Recognizes and teaches patient importance of oral hygiene in promoting appetite and in preventing extension of respiratory infections D. Keeps accurate intake and output records of

patients 5. Demonstrates skill and understanding in the use of oxygen and equipment related to oxygen therapy:

A. Observes patients for oxygen needs B. Maintains a safe environment during oxygen

administration C. Assists in efforts to improve ventilation

1. IPPB 2. Coughing and deep breathing exercises 3. Postural drainage 4. Chest physiotherapy 5. Tracheostomy care 6. Oxygen administration including use of venti- mask

D. Administers oxygen as a medication, observing, reporting and recording the effects, therapeutic and/or toxic

6. Know medications as assigned, example: antipyretics, antihistamines, bronchodilators, antibiotics, cough medicines, liquefying agents

7. Prepare drug cared of assigned medications and discuss actions, effects and patient’s response with instructor or in post conference.

8. Discuss two major concerns in suctioning the patient and be able to perform oropharyngeal suctioning

9. Care for a patient requiring the following acute nursing: A. Closed drainage system (chest tube) 1. Keeps two hemostats at bedside while tubes are In situation 2. Never lift pleuravac above level of chest 3. Maintain potency of tubes 4. Observe for fluid fluctuations in bottle 5. Assist physician during removal of chest drains B. Post –operative chest surgery 1. Demonstrate knowledge of importance of effective coughing post-op by encouraging patient to cough at least every two hours 2. Assess dressing frequently; reinforcing as needed and reporting and excess bleeding to charge nurse and instructor immediately 3. Assess Vital Signs for abnormalities as ordered and Report to charge nurse and instructor if any

48

Attend Post-Conference



Date:



49



Nervous System Name: _________________________________ Date: _________________________________________ During this clinical experience the student will: Be assigned to a patient with a disorder of the nervous system as traumatic injuries, a tumor involving the brain or spinal cord, or a neurological disorder that handicaps the patient in some way as Parkinson’s, multiple sclerosis, epilepsy or myasthenia gravis, or to a patient with a condition such as a ruptured disc.

Pre-Conference Satisfactory Unsatisfactory

1. The student will effectively give nursing care and Demonstrate knowledge of preventing measures Regarding complication by providing the following:

A. Skin care B. Position change C. Maintain body alignment D. Active/passive exercises E. Traction care (if applicable) F. Decubitus care (preventive/treatment G. Proper nutrition and fluids H. Emotional support I. Adequate elimination J. Foley catheter care

1. Inserting catheter 2. Catheter care 3. Position of tubing, emptying bag and charting output 4. Prosthesis of appliance care

2. Observation of the following procedures when available: A. Lumber puncture B. Angiography C. Myelogram D. Brain Scan E. Neurological examination F. Prepare drug cards; Look at Medication record

3. Prepare drug cards and discuss actions, effects, patient’s response with instructor

A. Interprets variations of specific lab reports such as arterial blood gas

4. Accompany patient to physical therapy, if ordered A. Special exercise

B. Hot packs C. Talk to therapist regarding following through on unit

50




Date:


Written 01/04 Reviewed: 01/06;01/08;01/10;01/12;01/14;01/15;01/16;01/17;01/1;/01/19

51


Medical Surgical Nursing Endocrine System



1. Care for a patient with an endocrine disorder such as diabetes mellitus, hypo or hyper thyroidism and effectively give nursing care and demonstrate knowledge of care and patient teaching.

A. Provide good physical care especially in diabetes 1. Provide good feet, skin and nail care for the diabetic patient

B. Understand importance of rest as in the patient with hyperthyroidism C. Provide psychosocial needs of the patient with hyperthyroidism D. Assess the psychosocial needs of the patient with endocrine disorders E. Identify appropriate nursing intervention for emergency situations relating to the management of endocrine disorders

2. Recognize common manifestation of endocrine disorder: A. Hypothyroidism B. Hyperthyroidism C. Cushing’s Syndrome D. Addison’s disease E. Diabetes mellitus

3. Prepare patient physically and psychologically for endocrine diagnostic tests:

A. Explain all tests to the patient in terms he understands, document all explanations and teaching on the patient record B. Instruct the patient in his responsibilities for

specimen collection as associated with Glucose Tolerance test

C. Administer medications such as iodine in performing diagnostic tests

4. Examine mediation record; (example: Synthroid) 5. Complete drug care on medications given in endocrine disorder and note actions, effects and patient’s response and be prepared to discuss with instructor

6. Discuss diet and special dietary problems in patient with

52

endocrine problems 7. Discuss with and teach special aspects of diet and food Intake and restrictions with patients:

A. Fluids B. Diabetic exchange food list C. Food high in potassium and low in sodium in the

patient with Cushing’s disease D. High caloric and vitamin diet in patients with

hyperthyroidism

8. Recognize the significance of laboratory blood values in the diagnosis and/or treatment of endocrine disorders

9. Teach the diabetic family: A. Symptoms B. Teach the patient how to give his/her own insulin by First using an orange for demonstration and practice C. Inform the patient the importance of exercise D. Teach diabetic how to perform diabetic urines E. Teach diabetic the importance of foot care and describe techniques of foot care

10. Discuss with the instructor and in group conference complications of diabetes

11. Obtain information from the patient in reference to his understanding of preventive care associated with diabetes mellitus

12. Demonstrate knowledge and skill of endocrine surgery Such as thyroidectomy and post-operative treatment

A. Vital signs are checked at frequent intervals B. Patient watched closely for signs of bleeding and

swelling at operative site C. Position patient-place in semi-Fowler’s or High

Fowler’s position to facilitate breathing D. Place all articles within eye and hand range E. Be able to observe and identify complications from

endocrine surgery

13. Discuss a plan for rehabilitation and patient instruction for the person experiencing a chronic endocrine disorder

14. Assist the R. N. in charge in developing a learning program for the assigned patient with an endocrine disorder Post Conference




53



Eye and Ear Disorders Name: _________________________________ Date: _________________________________________ During this clinical experience the student will:

Satisfactory Unsatisfactory 1. Demonstrate knowledge when providing care for a patient with:

a. Eye disorder – e.g. glaucoma, cataracts, detached Retina or one with near or complete blindness

b. Ear disorder – otitis media, mastoiditis, Meniere’s Syndrome or with a partial/complete hearing loss

2. Effectively give nursing care and demonstrate preventive Care by providing the following:

A. Explain ordered tests and procedure to patient B. Explain rationale for forms or emotional support

provided C. Evaluate effectiveness of emotional support ordered D. Maintain appropriate communication by:

1. Listen carefully and accurately 2. Enunciate words carefully 3. Look at patient with hearing problem while Talking

E. Maintain safe patient environment (e.g. obstructions, Wheels locked, rails up)

F. Know eye, eardrops medication and how to give

3. Prepare a medication record for assigned medications (drug cards) giving actions, effects and patient’s Response and discuss with instructor.

4. Execute the following procedures demonstrating sound Understanding of:

A. Warm or cold compresses to eye (if ordered by physician)

B. Assist with eye, ear examination C. Perform accurately eye, ear irrigations D. Care of hearing aid or eye prosthesis

5. Be present during doctors visit to patient and Demonstrate appropriate nursing intervention

6. Identify eye care specialist and their functions 7. Discuss nutrition factors in eye disorders 8. Discuss ocular emergencies and first aid considerations in these emergencies in post conference

54

9. Demonstrate knowledge and skill of surgical treatment of eye, ear and postoperative treatment.

A. Promote comfort of patient and reorient him to his Surroundings

B. Observe for postoperative complications-hemorrhage

C. Take vital signs frequently D. Patient warned not to blow nose especially when

he/she has had ear surgery E. Movement (violent) of head should be avoided F. Provide for frequent mouth and oral hygiene G. Reduce pain H. Observe for respiratory difficulty




Date:


55


Medical Surgical Nursing Oncology Patient

Name: _________________________________ Date: _________________________________________ During this clinical experience the student will: Effectively give nursing care to the cancer patient by providing the following:

Attend Pre-Conference Satisfactory Unsatisfactory 1. Discuss plan of care with instructor starting each day as needed

2. Maintain adequate ventilation of lungs of the early stage and advanced stage of cancer patient by encouraging deep breathing and activity, use of devices such as blow bottles

3. Accurately observe vial signs of cancer patient noting abnormality or daily changes which may require symptomatic relief, e.g. temperature elevation and antipyretic

4. Ensure safety of the cancer patient as indicated by the stage of illness, particularly use of side rails, keeping bed in low position, locking wheels of bed, wheelchairs, and assisting with ambulation and transfer activities

5. Maintain integrity of the skin of the cancer patient particularly if he has had radiation therapy and/or prolonged bed rest, including turning, massaging, application of any ordered ointments, etc.

6. Maintain adequate nutrition of cancer patient by attention and encouragement regarding diet and preferences, including special mouth care

7. Accurately record intake and output from all sources 8. Administer tube feedings or assist with/or observe hyper alimentation of the later stage cancer patient

9. Observe and maintain elimination. Check for urinary output either by voiding or Foley, recognizing signs of urinary retention

10.Provide for patient’s personal needs by assisting with or administering a bath, oral hygiene, hair and nail care and care of linen

11. Provide emotional support without given false hope to the cancer patient and his family/friend. Provide for opportunities for talking/listening to the patient. recognize stages of grief

12. Encourage recreational/social activities and assist the cancer patient with these as needed and as is possible during his stage of illness

56

13. Encourage and assist with rehabilitation following therapy such as surgery, radiation and chemotherapy

14. Observe for signs and symptoms of toxicity from radiation or chemotherapy

TERMINALLY ILL AND DYING PATIENT 1. Care for a terminally ill and dying patient and effectively give nursing care by providing the following:

A. Bathe patient gently with added attention to extremities, folds, etc.

B. Provide frequent perineal hygiene for the incontinent patient

C. Initiate special mouth care D. Provide eye care if needed E. Encourage fluid intake/assist patient with food F. Demonstrate knowledge and skill in tube feeding G. Provide proper position of

1. Head for better breathing 2. Body to prevent deformities

H. Reduce and prevent formation of pressure areas by: 1. Using protective aids (e.g. sheepskin) 2. Changing position at least every two hours

I. Move the patient toward the head of the bed and use good body movements to prevent strain or injury to yourself or patient J. Initiate oropharyngeal suctioning as necessary

K. Accurately take temperature rectally

2. Provide psychological support for the patient A. Providing privacy and safety during this period B. Avoid unnecessary noise or confusion C. Stay with the patient when the patient feels the need

to talk D. Assist the patient in going through the five stages of

dying (denial, anger, bargaining, depression and acceptance)

E. Use nonverbal communication (touch) in caring for the patient

F. Provide for religious requests

3. Provide psychological support for the dying patient’s Family

4. Accurately perform post mortem care Attend Post-Conference




* Objectives will be met as assignment is available

57


CLINICAL ROTATIONS: Medical Surgical Nursing - MEDICATIONS

Name: _________________________________ Date: _________________________________________ During this clinical experience the student will be assigned to care for patients requiring specific medications. Examples: The diabetic, the patient with respiratory disorder, the arthritic, the heart patient, etc. He/she will administer medications by several routes, using correct steps of accuracy. The student will have an orientation to the nursing unit, example: Physical plan of unit and introduction to personnel. During this clinical experience the student will:

Attend Pre-Conference Satisfactory Unsatisfactory Review of charting, relating to drug administration:

A. Doctor’s order sheet B. Medication record C. Nurse’s notes D. Pharmacy E. Narcotic and dangerous drug book

Medication room: A. Storage of supplies, syringes, stock drugs B. Unit dose cart, refrigeration area and stock supplies C. Emar: Use of- scanning D. “Crash cart”

Unit library: A. PDR, dictionary, Med. Surg Textbooks, Pharm text, computer

Discuss the following in group conference with instructor (Review material before conference begins) Basic rules and considerations:

A. Administering drugs B. Sources of standardization of drugs C. Forms of dugs D. Routes of administrations E. Pouring/preparing liquid and solid medicine for oral

administration F. Administering medications to the eye/ear

1. Special points to remember and specific medications used for eye/ear

Special precautions in drug administration’s: A. Taking B/P before giving anti-hypertensive drugs B. Counting pulse and withholding digitalis if pulse is

below 60 C. Giving medication well diluted and through straw D. Giving medications before or after meals, for greater

effectiveness

58

E. Checking for allergies and allergic reactions F. Checking respirations before giving narcotics G. Counting pulse if giving thyroid extract, withholding

if over 100 Administer medications to two assigned patients requiring:

A. Oral route B. Liquid preparations (elixir and/or tinctures) C. Solid preparations (tablets and/or capsules) D. Rectal and/or vaginal route suppositories E. Eye and ear medications

Safety points to carry out when taking medication to patient:

A. Carry medicine in medicine cup to bedside after doing 5 right check on med cart

B. Call patient by name, if able to speak, ask them their name and birthday… if not check ID band. Have smile of interest and encouragement

C. Remain with patient until medication has been swallowed

Discard disposable medicine container in patient’s bedside garbage. If glass/syringe, return to med cart and dispose in sharps container

Chart medications using facilities charting policies Clean and restock med cart after use Report to charge nurse and chart any medications held, any adverse reactions to medications

Discuss in group conference the action of local anti-infection and give examples of various antiseptics and disinfectants

Prepare a medication record for the patient assigned and discuss action of each

INJECTIONS Discuss three methods of injections 1. Intramuscular 2. Subcutaneous 3. Intradermal

Demonstrate knowledge of: A. Components of syringe and needle B. Various size of syringe used C. Various gauge needles D. Parts of syringe and needles that must be kept sterile

to give injections 1. Plunger 2. Inside of barrel 3. Tip of syringe 4. Shaft of needle E. Angle of needle for injection 1. Intramuscular injection 2. Subcutaneous injection 3. Intradermal 4. Position of patient

59

F. Using sterile technique, prepare syringes, needle and Withdraw solution from: 1. Vial 2. An ampule 3. Prepare a tubex syringe 4. Mix-O-Vial G. Needleless

Demonstrate knowledge of sterile technique and skill in administering intramuscular medication

Accurately record medications given Prepare a medication record of the medicines given and discuss actions, effects and patient’s response with instructor or in group conference

E-mar Discuss various medications and their effect of body system:

A. Musculoskeletal System B. Circulatory System C. Respirator System D. Digestive System E. Reproductive System F. Central Nervous System




Date:


60

Ralph R Willis Career & Technical Center School of Practical Nursing Student Performance Evaluation

Four Unsatisfactory Can Result in Dismissal from the PN Program

Student: _______________________________ Rotation: __________________________

Instructor: ______________________________ Date: _____________________________

Promptness: Communications

_______Tardy _______Maintains Integrity in Communication

_______ Dates _______Maintains Confidentiality

_______Absences _______Converses Appropriate

_______Dates(s) __________ _______Follows Proper Chain a Command

_______Reports Sick/Off Appropriately _______Reports/Records Observations Appropriately

Prepared for Assignment: Affective Behaviors:

______Watch _______Exhibits Professional Behavior/Attitude

______Scissors _______Cooperates with Staff, Instructor, Peers

______Blank Ink Pen _______Follows Directions

______Note Pad _______Complies with Policies of School & Agency

______Care Plan _______Identifies Own Strengths/Areas for Improvement

______Name Tag _______Reports Errors/Unsafe Conditions Timely

Manner

_______Positive/Appropriate Facial Expressions

Uniform/Professionalism: _______Appropriate Responses

______Clean Shoes _______Readily Accessible to Instructor/Staff

Appropriately

______Clean/Unwrinkled

______Name Badge

______Make-Up Appropriate

______Jewelry Within Guidelines End of Rotation Comment: ____________

______Hair Off Collar/Out of Face __________________________________

______No Perfume/Heavily Scented Products __________________________________

______No Chewing Gum __________________________________

______Nails Short/No or Light Polish __________________________________

__________________________________

Student Signature Date

Patient Care:

_______ Appropriate Hand/Body Gestures ___________________________________

_______Activities Clinically Oriented Instructor Signature Date

_______Conversation Clinically Orients

_______Performs Procedures Appropriately

_______Provides Quality Care

_______Practices Safety

_______Identifies/Meets Patient’s Needs

_______Protects Patient’s Privacy/Rights

_______Acknowledges Patient During Care

61


CLINICAL ROTATION

STUDENT NAME: ___________________

ROTATION: ________________________

Comments per Day Date Satisfactory Unsatisfactory

62


CLINICAL ROTATIONS Clinical Objectives for the Surgical Patient

During this clinical experience of the surgical patient, the student will accurately complete the following:

PRE-OPERATIVE 1. Identify the patient and assess the mental status of the pre-operative patient and allay the

fears of the patient by answering questions pertaining to surgery. Determine whether patient is: discouraged, happy, frightened, apprehensive, agitated, restless, timid, withdrawn, or depressed.

2. Assist with preparation; documentation in proper nursing notes. 3. Write pre-operative nursing notes indicating: Date, time, and type of transportation to

surgery.

INTRA-OPERATIVE

Describe the role of an LPN or scrub technician in surgery.

1. Describe the role of a Nurse Anesthetist. 2. Describe the role of the circulator. 3. Observe and describe procedure of induction an anesthesia. 4. Observe procedure and explain purpose of prepping of patient. 5. Observe procedure and explain purpose of draping patient. 6. Name the operation and describe the type of incision made, the purpose of the operation. 7. Observe and describe the suture used on the skin. 8. Describe the type of position the patient was placed in during surgery. 9. Describe the type of dressing used on incision site 10. Describe what type of equipment patient was placed on such as Levine tubes, Penrose

Drains, I.V., Hemavacs, chest tubes, etc. 11. Observe recovery stabilization procedure of patient after anesthesia is turned off. 12. Observe transfer to Recovery Room. Describe procedure.

POST-OP OR RECOVERY ROOM 1. Describe the role of the recovery room nurse. 2. Assist with and record vital signs. 3. Describe any equipment used on patient and the reason for using it. Example: suction,

oxygen, respirators, monitors. 4. Assess the level of consciousness and record. 5. Describe activity of patient. 6. Assess for symptoms of shock. 7. Describe rate and depth of respirations. 8. List any therapeutic measures used for patient while in post-op period such as blood

transfusions, oxygen, suction, catheters, cast, traction, and special beds. etc.

Student Signature: _________________________________ Comments: _______________________________________

Preceptor Signature: ________________________________ Comments: _______________________________________

63


CLINICAL ROATATIONS

Name: _________________________________________________ Date: _________________________________________

Surgical Nursing: POST OPERARTIVE PATIENT

Satisfactory Unsatisfactory Reduce or relieve discomfort related to patient’s gastrointestinal tract (example: nausea, vomiting,

ralph r willis career & technical center school of ... · making an unoccupied bed making an...

Documents