LPN 181 by runout

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                                           LPN 181
                         NURSING OF ADULTS 1B

   Laboratory Syllabus & Content Objectives

                                           Fall 2, 2007




                                             Instructors

                                       Sharon Nowak, RN, MSN
                                       Terri Waisanen, RN, MSN
                                       Jerolyn Towne, RN, MSN




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                                       JACKSON COMMUNITY COLLEGE
                                    CERTIFICATE – Practical Nursing Program
                                          LABORATORY SYLLABUS
                                                Fall 2, 2007

COURSE NUMBER                                  LPN 1810

COURSE TITLE                                   Nursing of Adults 1B Laboratory

DEPARTMENT                                     Nursing

CREDITS                                        Zero Credits (required component of Nursing of Adults 1B)

FACULTY                                                    Office Number and Phone

Sharon Nowak, RN, MSN                                      Whiting 132         796-8487
     nowaksharonm@jccmi.edu

Terri Waisanen, RN, MSN                                    Whiting 230         796-8551
      waisaneterria@jccmi.edu

Jerolyn Towne, RN, MSN                                     Adjunct, contact information to be given in class
      townejerolynr@jccmi.edu

OFFICE HOURS                                   See instructor‘s bulletin board for office hours

COURSE DESCRITPION

Refer to Nursing of Adults 1B Course Syllabus. The laboratory component will provide the
student with visual demonstrations of procedures, as well as hands on practice with various
equipment.

PREREQUISTIES                                  Refer to Nursing of Adults 1B Course Syllabus.

STUDENT RESPONSIBILITIES

A.    CLASS REQUIREMENTS                             Refer to Nursing of Adults 1B Course Syllabus.

B.    CLINICAL REQUIREMENTS                          Refer to Nursing of Adults 1B Course Syllabus.



C.    LABORATORY REQUIREMENTS
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1.   Attendance in laboratory is required. If a student must be absent, it is the student‘s
     responsibility to obtain all lecture notes and other information shared in class PRIOR
     to returning to the class. If you are absent for a lab, it is better to attend a
     different lab covering the same content rather than miss the content all together.
     Again, please notify faculty when missing a lab whether attending a lab at a different
     time or not. In addition, it is the student‘s responsibility to contact faculty regarding
     the missed skill content and demonstrations.

2.   Students must be present in laboratory to participate in and receive credit for group
     work and quizzes. Tardiness to class may mean missing group work or quizzes.

3.   Students are expected to be courteous of others in the classroom. Students who talk
     and disrupt the class inappropriately will be asked to leave the room. Faculty expects
     students to be kind to one another and to faculty at all times, & faculty will
     reciprocate.

4.   Reading assignments (text, assigned articles, handouts, etc.) should be read for
     understanding before coming to the class for which they are assigned. Students are
     encouraged to bring questions to class. Some questions, however, will be best
     answered following class because of limited class time.

5.   Students are responsible for finding out the meaning of any unfamiliar words or terms
     encountered in the readings or laboratory.

6.   All written work should be neatly done using proper grammar, spelling, punctuation, and
     sentence structure. Written work with three or more spelling errors or grammatical
     errors will be unsatisfactory.

7.   Nursing Department Academic Honest Policy
     Honesty and integrity are essential qualities in the profession of nursing. Any student
     found to be cheating on an exam, quiz, or other assessment will receive a maximum
     grade of 1.5 in the course. Lack of integrity in the classroom or clinical setting may
     result in failing a course or removal from the program.

     Cheating can take on many forms. These may include but are not limited to:
      Bringing an answer source to the testing site.
      Copying from another student‘s test.
      Changing an answer after a test has been submitted.
      Sharing information about a test with someone who has not yet taken it.

     Plagiarism is another form of cheating. This may involve but is not limited to:
      Submitting a paper written by someone else (obtained from the web or a fellow
        student).



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Additional areas of concern specific to nursing include but are not limited to:
       Covering up or not reporting a clinical error.
       Charting something that was not done.
       Altering any legal documentation.

      Not everything is cheating. Some examples of acceptable practices include:
       Studying together prior to an exam.
       Sharing notes from class.
       Using quotes in papers and referencing them appropriately.

      If you are unsure if a practice might be considered cheating, please check with an
      instructor and/or do not engage in that practice. Please remember that failing a
      course may mean permanent dismissal from the program.

      THE BEST POLICY IS ALWAYS HONESTY AND INTEGRITY.

While the nursing faculty recognizes that communication with family and friends is
important, the use of cell phones and beepers in class is very distracting to other students
and to your instructor. Please keep all electronic devices on either vibrate or voice mail mode
during class. If you are experiencing a family emergency and must keep a cell phone on,
please obtain instructor permission prior to class. We appreciate your cooperation in
providing an environment conducive to learning for all students.

INSTRUCTIONAL METHODS

Discussion                                         Demonstrations
Audiovisual material                               Return demonstrations
Handouts                                           Assigned Readings

LAB TIME

o This laboratory portion of LPN 180 includes required class time in the lab and extra
  scheduled time during open lab times for skill practice and return demonstration / check-
  off of skills.

o No check-off of skills will be done during laboratory class time.

o It is expected that when the student schedules time with a lab instructor that the
  student will arrive on time and call prior to their scheduled appointment if they will be
  late or absent.

o A student will be allowed only 1 “no-call-no-show”. After the first missed
  appointment, 5% points will be deducted from the quiz grade for the nursing skill
  being demonstrated.
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o In addition, it is expected that when students schedule time for check-off of a skill that
  them are prepared to do the skill independently, without coaching and within a reasonable
  time frame of 10 minutes.

o Only one attempt at checking-off of a skill will be allowed per open lab session AND no
  practice of a particular skill will have been done during the session that the skill is being
  checked-off. The student must bring their skills checklist book with them to the lab in
  order to be checked off on a skill. If any of these conditions are not met, the student
  does not pass the skills check-off and must reschedule another time to be checked-off on
  the procedure.

All required skill check-offs must be successfully completed by October 30, 2006. If the
skill check-offs are not completed by the assigned date, five percent (5%) will be deducted
from the students lab grade for each week or portion of week past the deadline the check-
offs remain delinquent.

TEXTBOOK(S) REQUIRED

      Williams, LS and Hopper, PD. (2007). Understanding Medical-Surgical Nursing. 3rd ed.
Philadelphia: FA Davis.

     DeWit, S. C. (2005). Fundamental concepts and skills for nursing. Philadelphia: W.B.
Saunders.

      DeWit, S. C. (2001). Student Learning Guide for: Fundamental concepts and skills for
nursing. Philadelphia: W.B. Saunders.


AVAILABLE LEARNING SERVICES

Students with disabilities who believe that they may need accommodations in this class are
encouraged to contact the Office of Learning Support Services at 787-0800, extension
8270 as soon as possible to ensure that such accommodations are implemented in a timely
fashion.

The Nursing Laboratory is staffed by faculty that can assist in your learning. The hours
change each semester but are posted in rooms JW 200 and JW 204, as well as outside many
of the nursing faculty‘s offices. Tutors are available. See your instructor if you feel this
would be helpful for you. The writing center is available in Walker Hall to help with writing
needs. If you feel the need to talk with the faculty, their office hours are available and
posted on the bulletin boards outside their offices. Keeping communication open assists both
student and faculty.
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STUDENT EVALUATION CRITERIA

This course contains several grading components. The components consist of theory exams, group
work, written assignments, laboratory & clinical. A student must earn a minimum of 78% in each of
the following components:
       1. theory exam AVERAGE
       2. laboratory grade (includes lab class quizzes, pre-demonstration quizzes, lab prep
              points and assessment project)
       3. total course AVERAGE
If a 78% is not met in the laboratory grade, the student may not progress to the clinical setting.
Further, if any of these requirements are not met the student will receive a maximum of 1.5 in the
course.

The grading components for this course include:

                         PERCENT OF
 COMPONENT                                          EXPLANATION
                         GRADE
I.   EXAMS                                          An exam will be given following each unit. A
                                                    CUMULATIVE final exam will be given at the end of
                                 70 %
                                                    the course. An average of 78 % of all exams must be
                                                    earned to pass the course.
II.                                                 Quizzes will be given based on readings throughout the
QUIZZES/                                            course. Group work will be assigned weekly. Make-up
GROUP WORK                                          for quizzes and group is at the discretion of the
/ LAB                            30%                instructor. Attendance at all labs is required. There
QUIZZES /                                           will be weekly quizzes in lab. The one lowest group
PRE-DEMO                                            work or quiz grade will be dropped prior to figuring
QUIZZES                                             final grades (excluding lab quizzes).
III.                                                Quizzes will reflect laboratory learning objectives and
LABORATORY                                          assigned readings. Make-up for the weekly lab theory
GRADE                                               quizzes is at the discretion of the instructor.
(includes lab                                       Attendance at all labs is required. One nursing
theory & pre-                                       assessment project will be included in this portion of
demo quizzes,                                       the grade.
lab prep points,                                    LABORATORY LEARNING OBJECTIVES:
and assessment                                      Students are required to present their completed
project)                                            written lab learning objectives at the BEGINNING of
                                                    class to receive credit. No partial credit will be given
                                                    for partially completed objectives.
IV. CLINICAL                Pass / Fail             Clinical is evaluated based on the Clinical Performance
                                                    Guide. A pass/fail grade will be given. The student
                                                    must earn a passing grade in clinical in order to pass
                                                    the course. See the Nursing Handbook for evaluation
                                                    behaviors based on the Code of Nursing.
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PORTFOLIOS(S

We recommend that you keep all Nursing Care Plans and other papers for a portfolio you will
be developing during your last semester in the program. A portfolio is not required for this
course.

TESTING POLICY

Only answers to questions that are recorded on the student’s scantron answer sheet will
be graded, unless instructed by the instructor at the beginning of the test to record
answers in a different place. When grading tests, faculty reserves the right to not count
questions that they deem are not of good quality. In this situation, all students will receive
one point for the question(s) that is discarded. NO extra point will be given if the student
had the question ―right‖ prior to it being discarded.

GRADING SCALE

The grading scale for this course follows the Nursing Handbook which is as follows:

               4.0        94 – 100 %

               3.5        90 – 93%

               3.0        86 – 89%

               2.5        82 – 85 %

               2.0        78 – 81 %                A 2.0 is required to pass the course.

               1.5        74 – 77 %

               1.0        70 – 73 %

               0.5        66 – 69 %

               0.0        < 66 %


MAKE-UP POLICY

Laboratory attendance is required. The student is responsible for his or her own learning.
In the event that the student must miss or be late to class, it is the student‘s responsibility
to obtain lecture notes, messages, instructions, announcements, etc. from a fellow student.
The student will be held responsible for ALL material and information regardless of whether
the student was in class.



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A student must be present in class to participate in and receive credit for group work or
quizzes as deemed appropriate by faculty. Tardiness to class may mean missing group work
or a quiz, or reduced time to take a quiz.



NURSING PROGRESSION POLICY

See Nursing Handbook for progression policies.

The student must earn a 2.0 minimum grade in Theory (see above) and a satisfactory in
Clinical to pass the course.

Students who withdraw or fail this course will not be allowed to progress to the next course
or level. If a student wishes to repeat the course, s/he must write a letter to the
Department Chairperson of Nursing & request a ―space available‖ placement while detailing a
plan to ensure his/her success in the program.




TOPICS TO BE COVERED

I.     IV flow rate calculation
       Discontinuing IVs
       Review Monitoring IV sites

II.    Tracheostomy Care

III.   Nasopharyngeal Suctioning
       Tracheostomy Suctioning

IV.    Ostomy Care




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                                            JACKSON COMMUNITY COLLEGE
                                         CERTIFICATE – Practical Nursing Program
                                              LABORATORY OBJECTIVES
                                                     Fall 2, 2007

LAB I                          INTRAVENOUS INFUSIONS and CALCULATIONS

                               Readings: Susan deWit      pgs. 697 - 721
                                         IV handout

1.      State rationale for checking IV fluid for clarity & sterility.



2.      Define ―drip factor‖.



3.      List four types of IV tubing, when each is commonly used and each of their drip
        factors.

        a)

        b)

        c)

        d)

4.      Describe the three general classifications of IV fluids according to their
        concentrations and fluid movement within the body.

        a)

        b)

        c)

5.      Describe five potential complications of IVs.

        a)

        b)

        c)

        d)

        e)
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6.    List the steps involve in hanging IV piggybacks.




7.    List the appropriate checks to be made when assessing an IV.




8.    Describe the procedure for discontinuing an IV.




9.    Describe what a central line is & its purpose.




10.   Describe six potential complications of central lines.

      a)

      b)

      c)

      d)

      e)

      f)




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11.   Describe the method for removing and replacing a gown with an IV in place.




12.   Identify the correct drip rate when given problems or scenarios with 100% accuracy.




Suggested Learning Activities / Supplies:

Various IV tubings
Bulk IV with IVPBs
Mannequin with IV in place and gown




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LAB II                      TRACHEOSTOMY CARE

                            Readings:            Susan deWit       pgs. 512; 521 - 522
                                                 Williams & Hopper pgs. 565 - 570

1.   Name 4 types of tracheostomy tubes.

     a)

     b)

     c)

     d)


2.   Describe the parts of a trach tube.




3.   State 3 important safety measures and the rationale for each regarding tracheostomy
     patients.

     a)

     b)

     c)


4.   List observations / assessment findings to be made prior to trach care.




5.   List the equipment needed for tracheostomy care.




6.   State the correct patient position for tracheostomy care (conscious & unconscious).




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7.    State the explanation to be given to the patient before tracheostomy care.




8.    List the procedural steps in cleaning and redressing the tracheostomy.




9.    State information and observations that need to be documented after tracheostomy
      care.




Suggested Learning Activities / Supplies:                PreDemo Quiz & Return Demo

―line-up of procedure                                    Providing Tracheostomy Care
practice documentation scenario for procedure                              (skill 28 – 7)
concept map of procedure
Various samples of tracheostomy tubes
Mannequin with tracheostomy tube in place
Trach cleaning kits with solutions




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Tracheostomy Care Check-Off                                     Name: ______________________________



The student:                                                                                                   Done   Not
                                                                                                                      Done
States assessment finding indicating need for trach care:
-performed after suctioning, soiled trach dressing, performed according to agency policy, etc.
Gathers all equipment:
-clean gloves, trach kit, hydrogen peroxide, sterile normal saline, extra sterile Q-tips and/or
4x4s if needed, clean scissors and/or hemostats/forceps, trash receptacle, non-sterile towel or
drape, protective gear etc.
Prepares self:
-washes hands and dons protective gear if necessary
Prepares client:
-explains procedure
-positions client in semi-Fowler‘s
-places non-sterile drape or towel over chest
Prepares work area and equipment:
-sets up sterile field on a waist high, clean dry surface within nurses field of vision—(i.e. Bedside
table)
-opens sterile trach kit and empties contents onto center of sterile drape and places empty basin
on table
-―lips‖ solutions prior to pouring into the three basin sections—agency policy dictates which
solutions to use
-opens any extra supplies if needed and ―drops‖ them onto center of sterile field
Dons clean gloves
Assures client has adequate oxygenation during procedure:
-removes oxygen source from client, increases oxygen level and places it on client‘s chest near
stoma providing adequate oxygen but not contaminating sterile field
Unlocks and removes inner cannula placing it into the hydrogen peroxide container
Removes and disposes of old tracheostomy dressing
Removes and disposes of clean gloves
Dons sterile gloves
Organizes sterile items on sterile field:
-arranges items in order of use so as to minimize reaching over the sterile field
Cleanses inside and outside of inner cannula:
-uses tube brush or pipe cleaner
-avoids splattering especially onto the sterile field
-thoroughly rinses cannula in normal saline, taps cannula gently against side of container to
remove excess fluid
-dries inner cannula with pipe cleaner and/or 4x4s
Cleanses stoma using principles of wound care
Reinserts inner cannula into outer cannula:
-uses 4x4 moistened with normal saline to wipe away any secretions from the front of the trach
face plate before reinserting inner cannula and locking it into place
Changes trach ties:
Two strip method:
-cuts twill tape into two unequal strips diagonally
-cuts a 1 cm. Long slit approximately 2.5 cm from one end of each strip or pokes
hemostats/forceps through tape to make hole

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-leaves old ties in place but moves them up as far as possible
-threads the slit end of one clean tape through the eye of the tracheostomy flange from the
bottom side; then threads the long end of the tape through the slit, pulling it taut until it is
securely fastened to the flange
Note: If old ties are very soiled or it is difficult to thread new ties through the flange with the
old ties in place, seek the assistance of a second person donned with gloves to hold the trach in
place while replacing ties.
-repeats the process for the second tie
-wraps longer tie around client‘s neck
-ties strips securely using a square knot, allowing enough slack for one or two fingers under the
neck
-cuts old ties off once new ties are secured
One strip method:
-cut ends diagonally
-threads one end of the ties into one side of the flange leaving 2-3 inches
-wraps tie around back of neck and threads the end through the other trach flange
-brings both ends together at the side of the client‘s neck, keeping the ties flat and untwisted
-ties strips securely using a square knot, allowing slack for one or two fingers under the neck
-cuts off any long ends of tie
Applies sterile trach dressing
Replaces oxygen delivery device over tracheostomy and adjusts flow rate as ordered
Assures client comfort and safety
Disposes of equipment
States items to be documented after completing procedure:
-character and amount of secretions on the old dressing and during procedure, drainage from the
tracheostomy, appearance of stoma and surrounding skin, complaints of pain or discomfort at the
site, how client tolerated procedure, etc.



Date practiced:                                              Date Completed:

Instructor                                                   Instructor
Signature:                                                   Signature:




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LAB III                     NASO / OROPHARYNGEAL SUCTIONING and TRACHEOSTOMY
                            SUCTIONING

                            Readings:            Susan deWit       pgs. 509 – 512; 518 - 520
                                                 Williams & Hopper pgs. 571

1.   State 2 assessment findings that indicate the need for suctioning.

     a)

     b)



2.   List 4 complications that deep tracheal suctioning can cause.

     a)

     b)

     c)

     d)



3.   State 1 nursing intervention that can be done to minimize the risk of each of the above
     complications.




4.   List the equipment needed for suctioning:

     a) nasopharyngeal –




     b) tracheostomy –




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5.   State the correct position for suctioning (conscious & unconscious)

     a) nasopharyngeal –




     b) tracheostomy




6.   State the explanation to be given to the patient before suctioning:

     a) nasopharyngeal –




     b) tracheostomy




7.   Describe the procedure for suctioning:

     a) nasopharyngeal –




     b) tracheostomy



8.   State the sequence to be used when naso / oropharyngeal and tracheal suctioning is to
     be performed (and your rationale).




9.   State two contraindications for performing nasopharyngeal suctioning.

     a)

     b)


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10.   State information and observations that need to be documented after suctioning.




11.   Suction       IS / IS NOT applied to the catheter while inserting into the patient.

12.   The maximum length of time the suction should be applied is _________ seconds.




Suggested Learning Activities / Supplies:                   PreDemo Quiz & Return Demo

Mannequin with tracheostomy in place                        Endotracheal & trach suctioning
Various suction catheters                                                     (skill 28 – 6)
Suction kits                                                Nasopharyngeal suctioning
Suction machine                                                               (skill 28 – 5)




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Tracheostomy Suctioning                                    Name:__________________________________

The student:                                                                                                   Done   Not
                                                                                                                      Done
States assessment findings indicating need for suctioning:
-adventitious breath sounds, frequent moist cough without clearing airway, cyanosis or
respiratory distress
Gathers all equipment:
-suction cath kit, sterile normal saline, non-sterile drape or towel, protective gear prn, ambu bag
or oxygen, suction source
Prepares self:
-washes hands and dons protective gear if necessary
Prepares client:
-explains procedure
-positions conscious client in semi-Fowlers, unconscious client in side-lying with head elevated
-places non-sterile towel or drape across client‘s chest
Prepares work area and equipment
-adjusts suction controls to appropriate mmHg
-opens suction kit onto a waist high, clean, dry surface, within nurse‘s field of vision—(i.e. bedside
table)
-carefully removes solution container from kit by picking it up from the bottom, keeping the
inside sterile and places it on the table within easy reach of nurse
-checks status of sterile saline, label side up, ―lips‖ saline before pouring into solution container
-dons sterile gloves
-removes sterile catheter and wraps it securely around dominant hand leaving connecter piece
exposed
-grasps the non-sterile tubing from the suction machine in non-dominant hand and connects tubing
with the sterile catheter in dominant hand
-turns on suction machine with non dominant hand
-checks suction status (places thumb of non-dominant hand over suction port and then releases)
-places catheter tip into solution and applies suction to lubricate inside of tubing:
Oxygenates client with nondominant hand:
-hyperventilates client with ambu bag if noncopious secretions exist/per agency policy
-increases oxygen delivery device for several breaths before suctioning/ agency policy
Suctions client:
-quickly but gently inserts catheter about 5-6 inches, or until the client coughs or resistance is
felt, --then pulls catheter back slightly before applying suction
-applies intermittent suction, rotating catheter as it is being withdrawn within 10-15 seconds
-releases suction completely
-rinses inside catheter and suction tubing with sterile saline
Reassesses oxygenation status and repeats suctioning if necessary
Disposes of equipment and ensures availability for next suction
States information included in documentation:
-Assessment findings indicating need for suctioning, time procedure began, amount and character
of secretions suctioned, client response, reassessment finding etc.


Date practiced:                                        Date completed:
Instructor Signature:                                  Instructor Signature:



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LAB IV                      OSTOMY CARE

                            Readings:            Susan deWit       pgs. 575 - 580
                                                 Williams & Hopper pgs. 710 - 716

1.   Differentiate between various types of ostomies according to their common locations
     & characteristics.




2.   List steps in procedure for changing the colostomy pouch.




3.   List 3 stoma / periostomal complications that may occur.

     a)

     b)

     c)



4.   State 2 reasons why the client may not recognize stoma complications.

     a)

     b)




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5.    List observations to make before, during and after changing an ostomy pouch.




6.    List items that should be indwelling in documenting the procedure.




Suggested Learning Activities / Supplies:          PreDemo Quiz & Return Demonstration

Video on ostomy care                                Attached sheet
Practice documentation of a ostomy scenario.
Various ostomy supplies
2 - ‗contact paper‘ ostomy wafers per student
2 – ‗transparency‘ plastic packaging wrappers for tracing




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OSTOMY CARE                                            NAME ___________________________

The student:                                                                                 Done Not
                                                                                                  Done
States assessment finding indicating need for ostomy care:
- seepage of drainage onto skin, ostomy pouch 1/3 – ½ full of drainage or       flatus,
stomal discomfort

Gathers all equipment:
- adhesive wafer, drainable pouch, skin barrier, graduated container, clean gloves,
tissues, scissors, bath blanket, plastic bag, waterproof pad

Prepares self:
- washes hands

Prepares work area and equipment:
- adjusts bed to comfortable height
- brings bedside table to accessible location
- arranges supplies in order of use

Prepares client:
-    provides privacy
-    explains procedure
-    positions in semi-Fowler's
-    places bath blanket over client's chest
-    fold top linen down to expose abdomen
-    places waterproof pad under pouch

Dons clean gloves

Empty Ostomy Bag:
-    places graduate on bed and extends clamped end of drainage pouch over it
 -   hold clamped end of pouch higher than stoma
-    opens pouch clamp and allows drainage to spill into graduate
-    measure and observe contents
-    dispose contents into toilet

Remove Old Pouch:
- pushed against wafer while releasing pouch seal
- discard in disposable bag
- pushes against skin to remove old wafer

Skin and Stoma Care:
-    cleans around the stoma removing any fecal material with tissues
-    cleanses the stoma and skin around the stoma with non-irritating soap & water
-    dries gently by patting the stoma and skin around it
-    observes peristomal skin for excoriation and color
-    notes any changes in the stoma size, ulceration or color

Applying New Wafer:
- measures stoma with measuring guide
- cuts about 1/8 inch larger than measurement
- checks to ensure opening is larger enough to encircle stoma without pushing on
edges
- applies skin barrier to peristomal area
- wets fingers and spreads paste around stoma
- centers and applies new wafer
- instructs client to "puff" out stomach
- presses the adhesive wafer around the stoma to form a seal



            07f837ea-5381-4474-9cd0-6724c0457aa2.doc                                      Created on 8/31/2007 1:57 PM
                                                       23
The student:                                                                             Done          Not
                                                                                                       Done
Attaches Drainage Bag:
- closes bag and secures end of pouch with tail clamp
- ensures bowed end is next to body
- lays hook on top of bag and folds back 1 inch over end of pouch
- squeezes clamp together
- checks clamp is positioned correctly bowed end toward body and hook is on top left-
hand corner

Remove gloves and wash hands

Position patient for comfort

States items to be documented after completing procedures:
- condition of the stoma and skin
- describes contents of the bag




References:

Smith and Duell: Clinical Nursing Skills. P. 619 – 623.

Berger and Williams: Fundamentals of Nursing. P. 979 – 98.

Saunder: Manual of Nursing Care. P. 1277 – 1280.




LPN 181 Ostomy.care.checkoff




            07f837ea-5381-4474-9cd0-6724c0457aa2.doc                                Created on 8/31/2007 1:57 PM

								
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