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					                    SYLLABUS HANDOUT
                          FOR
                                        FALL 2009

Concepts of Health Assessment and Therapeutic Intervention II
                   NURS 2520 7A and 7B

                               INSTRUCTORS:
                             Diana Blum, RN, MSN
                             Alex Winter, RN, MSN




            WELCOME TO METROPOLITAN COMMUNITY COLLEGE




       Metropolitan Community College       1       Template Rev. 7/24/06
                                Metropolitan Community College
                                           Course Syllabus – Fall 2009

COURSE IDENTIFICATION
Title:                     Concepts of Health Assessment and Therapeutic Intervention II
Prefix/Section:            NURS 2520 7A and 7B
Credit Hours:              1 Credit hours (Class hours 5.5, lab hours 20 for 11 weeks)
Begins/Ends/No-Class Days: Tuesday, Sept. 1, 2009 through Tuesday, Nov. 10, 2009
Meeting Day/Time:          Tuesdays
                           Section7A: 12:00am-2:30pm
                           Section 7B: 9:00am – 11:30am
Last Day to Withdraw       Monday, October 26, 2009
No Class:                  Saturday, Sept. 5, 2009 –Monday, Sept 7, 2009
Delivery Type:             Classroom/ Simulation Laboratory/Demonstration
Class Location:            SOC, Mahoney RM 505
Lab Location:              SOC, Mahoney RM 505
Course Web Address:        http://www.mccneb.edu/healthcareers/

CONTACT INFORMATION

Instructor Name:                 Diana Blum, RN, MSN
Office Location:                 SOC, Mahoney RM 513
Office Telephone:                402-738-4651
Facsimile:                       402-738-4552
Office Hours:                    Posted outside office area room 513
Email Address:                   dblum3@mccneb.edu
Faculty Web Site:                http://www.mccneb.edu/academics/alliedhealth/index.asp
Academic Program Area:           Health Careers
Dean’s Office Telephone:         402-738-4789

Instructor Name:                 Alex Winter, RN, MSN
Office Location:                 SOC, Mahoney RM 513
Office Telephone:                402-738-4784
Facsimile:                       402-738-4552
Office Hours:                    Posted outside office area room 513
Email Address:                   awinter@mccneb.edu
Faculty Web Site:                http://www.mccneb.edu/academics/alliedhealth/index.asp
Academic Program Area:           Health Careers
Dean’s Office Telephone:         402-738-4789

COURSE INFORMATION
Course Description: This course is designed to assist the student in developing assessment skills of the
professional registered nurse. It introduces physical assessment skills related to light palpation, percussion,
and the use of the ototscope/opthalmoscope. The therapeutic interventions related to intravenous therapy are
presented. Comprehension of underlying principles and mastery of skills will be demonstrated in the lab
setting.
Course Prerequisites: Successful completion of the LPN program and licensure as an LPN.

              Metropolitan Community College           2                      Template Rev. 7/24/06
Co-requisites: NURS 2410: High Risk Family.

Course Objectives: At the completion of this course, the student will be able to
 1.    Demonstrate head to toe physical assessment of the adult client.
2.     Demonstrate the use of the ophthalmoscope/otoscope in the assessment of the adult client.
3.     Demonstrate the proper techniques for light palpation and percussion.
4.     Assess abnormal heart sounds including S3, S4 sounds and murmurs.
5.     Assess neurological reflex activity.
6.     Demonstrate the safe administration of IV therapies.
7.     Demonstrate total parenteral nutrition administration.
8.     Demonstrate safe blood administration.
9.     Demonstrate chest tube management.

Required & Supplemental Materials:
Osborne, K. et al (2010). Medical-Surgical Nursing Preparation for Practice. Pearson: Boston:
Kaplan: Math for Nurses (2007)
Gahart: IV Medications (2009) 24th edition
Bakerman’s ABC’s of Laboratory Values (2002)
Wilkinson, J.M., Van Leuven, K.(2007). Fundamentals of Nursing: Theory, Concepts, and Applications.
Volume 1. F.A. Davis: Philadelphia.
Wilkinson, J.M., Van Leuven, K. (2007). Fundamentals of Nursing: Thinking and Doing. Volume 2.
F.A. Davis: Philadelphia.

Course Structure:
           a. Class activities will include lecture, discussion, demonstration, return demonstration,
              reading assignments, and application of content in the laboratory portions of the program.

COURSE ASSESSMENT
  Types of Assessment/Assignments
   COURSE OBJECTIVES                              ASSESSMENT MEASURES
 1. Demonstrate head to toe physical             Lab activities
 assessment of the adult client..                Return Demonstration
 2. Demonstrate the proper techniques for        Lab activities
 light palpation and percussion.                 Return Demonstration
 3. Discuss the use of the                       Lab activities
 ophthalmoscope/otoscope in the assessment       Return Demonstration
 of the adult client.
 4. Assess abnormal heart sounds including       Lab activities
 S3, S4 sounds and murmurs.                      Return Demonstration
 5. Assess neurological reflex activity.         Lab activities
                                                 Return Demonstration
 6. Demonstrate the safe administration of IV    Lab activities
 therapies.                                      Return Demonstration
 7. Demonstrate total parenteral nutrition       Lab activities

              Metropolitan Community College       3                      Template Rev. 7/24/06
 management.                                       Return Demonstration
 8. Demonstrate safe blood transfusion.            Lab activities
                                                   Return Demonstration
 9. Demonstrate nursing management of chest        Lab activities
 tubes.                                            Return Demonstration
 10. Objectives 1-9                                Final Exam



MAKE-UP TEST PROCEDURES:
If it is necessary to be absent during an assigned test period, the student must make-up that examination
within one week of the original test date (i.e., if the exam is given on Monday, it must be made up
PRIOR to the next Monday). Failure to do so will result in a zero for the examination. The student may
miss one examination without penalty, as long as the test is made up within the specific time period. If
the student misses more than one examination, the exam may be made up, but the maximum score
allowed is 80%. The final examination must be taken on the scheduled date and at the scheduled time.

Students may not enter the classroom after the testing has begun. If the student is not in the classroom
when tests are being distributed the student must follow the procedure for make up testing.

When it is necessary to make up an examination, it will be placed in the testing center. It is the student’s
responsibility to make an appointment and take the test within the specified period of time.

Exceptions to these guidelines may be considered, but only if the student consults with the instructor in
advance.

LATE ASSIGNMENTS:
The assignment for the teaching project is to be submitted at the time indicated. Failure to submit at the
appropriate time will result in a zero.

Grading Policy

METHODS OF ASSESSING STUDENT PROGRESS: Classroom assessment techniques will be
utilized periodically to determine the student’s understanding of the materials being studied.

CRITERIA FOR DETERMINING FINAL COURSE GRADE:

Grade 1        Perform venipunture on maniquin IV arm to saline lock and give
               IV push medication. Grades will be determined from checklist
               for venipunture and checklist for IV push medication. Total is 27
               steps on both checklists, each area worth 3.72%. (27 x 3.72% - 100%)
Grade 2        Perform sterile central dressing change. Grades will be determined
               from changing the central intravenous dressing checklist. There are
               25 steps, each step worth 4% (25 x 4 = 100%)
Grade 3        Multiple Choice test 50 questions. Each question worth 2%
               (50 x 2% = 100%)



              Metropolitan Community College         4                      Template Rev. 7/24/06
The grading scale is: 93 - 100 = A, 84 - 92 = B, 76 - 83 = C, 70 - 75 = D, Below 70 = F. There will
be NO rounding of grades, i.e., a 75.8 = 75%. A final course grade of C (76%) is required to continue
in the program.
Unit examinations will be administered as indicated on the course calendar.
A comprehensive final examination will be administered at the completion of the quarter.

Maintenance of Student Records
The tests will be reviewed in the following class period. All test papers are to be returned to the
instructor at the completion of the review. Exams will be kept for one academic year.

STUDENT EXPECTATIONS
Required Expectations

METHODS OF LEARNING: Students will be expected to read all assigned material, participate in the
lecture-discussion classes, and participate in small group activities as assigned, and demonstrate lab
skills. Objectives for each unit of study are provided in this syllabus. Students will be expected to
prepare for activities related to the assigned objectives.

ATTENDANCE STATEMENT:
The student is expected to attend all classes. If it is necessary to be absent from class, the student is
responsible for all assignments and materials covered in class. It will be necessary to obtain a fellow
classmate’s notes or have a classmate tape-record the lecture for you. If there are questions or handouts
see the instructor as necessary. Students who attend no class meetings up to and including the Section
Census Date published in the Class Schedule at www.mccneb.edu/schedule/ may be disenrolled from
the class. There is no appeal for this disenrollment.

Attendance and participation in lab activities is mandatory. Any missed labs must be made up prior to
the next scheduled lab time.

Notice: This syllabus is written as an expectation of class topics, learning activities, and expected
learning outcomes. However, the instructor reserves the right to make changes in this schedule that may
result in enhanced or more effective learning for students. These modifications will not substantially
change the intent or objectives of this course and will be done within the policies and guidelines of
Metropolitan Community College.

LEARNING SUPPORT

Metro's Learning, Math, and Writing Centers can help you achieve educational success. The staff in
these centers provide drop-in assistance with basic math, reading, writing and computer skills. We offer
a friendly, supportive learning environment. Self-paced computer-assisted instructional support in
reading, vocabulary, typing, English as a Second Language, and online course orientation is also
available.

Detailed information about these services are in the Student Handbook, College Catalog, and online.
Links to these resources are located at http://www.mccneb.edu/learningcenter/.




              Metropolitan Community College         5                      Template Rev. 7/24/06
COLLEGE POLICIES

College policies, such as student rights and responsibilities, academic standards, plagiarism, and etc. are
outlined in the College Catalog and Student Handbook. This information can be accessed via the online
catalog at http://www.mccneb.edu/academics/catalog.asp.

STUDENT WITHDRAWAL: If you cannot participate in and complete this course, you should
officially withdraw by calling Central Registration at 402-457-5231 or 1-800-228-9553. Failure to
officially withdraw will result in either an attendance-related failure (FX) or failing (F) grade. The last
date to withdraw is noted in the CLASS IDENTIFICATION section of this syllabus.

STUDENT CODE OF CONDUCT: The College has a standard code of conduct that involves
consequences for specific academic and non-academic behavior that may result in a failing grade,
probation, or suspension from the college. More complete information about the code of conduct is
located in the Student Services portion of the online catalog
(http://www.mccneb.edu/catalog/studentinformation.asp).

ACCOMMODATIONS FOR STUDENTS WITH DISABILITIES: If you have a disability that may
substantially limit your ability to participate in this class, please contact a Vocational Special Needs
Counselor, located in the Student Services Office on each campus. Metropolitan Community College
will provide reasonable accommodations for persons with documented qualifying disabilities. However,
it is the student’s responsibility to request accommodations. For further information, please contact the
Student Services Office at your campus.
Other pertinent college policies are posted on the CDS website www.mccneb.edu/cds.




              Metropolitan Community College          6                      Template Rev. 7/24/06
REQUIRED ATTACHMENTS

   SCHEDULE OF ASSIGNMENTS *Subject to change at Instructor’s discretion.

DATE                  CLASSROOM ACTIVITY
Week 1                Introduction to course. Head-to-toe assessment review. Light palpitation and
                      percussion. Use of opthalmoscope/otoscope                        Sept. 1

Week 2                Abnormal heart sounds                                            Sept. 8

Week 3                Neurological assessment                                          Sept. 15

Week 4                Venipuncture                                                     Sept. 22

Week 5                Venipuncture and IV medications                                  Sept. 29

Week 6                Venipuncture, IV Piggyback (Secondary)                           Oct. 6
                      Grade #1

Week 7                Central Lines, TPN                                               Oct. 13

Week 8                Sterile Dressing Change to Central Line                          Oct. 20

Week 9                Blood transfusion                                                Oct. 27
                      Grade #2

Week 10               Chest tube management. Finish Grade #2.                          Nov. 3

Week 11               Final Examination.                                               Nov. 10

IMPORTANT DATES see Metro’s Academic calendar at www.mccneb.edu/academics/calendar.asp?Theme=2




            Metropolitan Community College        7                     Template Rev. 7/24/06
UNIT I: Head to toe assessment review

1. Demonstrate head to toe assessment of the adult client.
2. Document findings by narrative charting.



                              REQUIRED LEARNING ACTIVITIES

Assignment: Osborn: Chapters 6-7, Chapter 9, Chapter 14 (pages 272-276), Chapter 15 (pages
338-341.)
Wilkinson: Chapters 16, 17, 19

Lab activities: be prepared to utilize procedure checklist to demonstrate head to toe assessment.
Document by narrative charting.
Complete the unit objectives.
Unit grade evaluated by unit test.
Evaluated by performance of head to toe assessment in lab setting.

                             SUGGESTED LEARNING ACTIVITIES

View the video on the complete physical assessment.




              Metropolitan Community College        8                      Template Rev. 7/24/06
                                       Metropolitan Community College
                                             Procedure Checklist
                                          Head-to-Toe Assessment


Procedure Steps                               Yes   No                  Comments
1. Hand hygiene.
2. Introduce self. Explain procedure
to patient, provide privacy.
3. Demonstrate therapeutic
communication during assessment.
4. The following are to be noted:
   -Appears stated age
   -Level of consciousness
   -Oriented to person, place, time
   - Skin color
   - Obvious physical deformities
   - Mobility, gait
   - ROM
   - Facial expressions
   - Mood and affect
   - Speech
   - Vision (glasses?)
   - Hearing (hearing aid?)
   - Personal hygiene
   - Pain assessment
   - Allergies
   - Unexplained weight loss
5. Skin
   -Inspect nails
   -Inspect for presence of dryness,
rashes, discolorations, any
abnormalities
   -Note general texture and color
   -Inspect in regions as exam
progresses
6. Vital Signs
   -Radial pulse/apical pulse
   -Respirations
    -Blood pressure
   -Temperature
   - Pulse ox if necessary




             Metropolitan Community College              9                Template Rev. 7/24/06
Head-to-Toe Assessment – continued

7. Head
    - Inspect face, scalp, hair, cranium
    - Observe facial expression for
symmetry, appropriate affect
    - Test pupils for size, reaction to
light and accommodation
    - Note sclera, conjunctiva, cornea,
any redness, drainage, swelling.
    - Palpate sinus areas for
tenderness if appropriate.
    -Inspect outer ear
    - Observe hearing ability
    - Note presence of hearing aides
    -Inspect nose for symmetry,
drainage, lesions.
    -Inspect mouth for moist mucous
membranes, note any abnormalities,
any difficulty swallowing.
    - Note presence of dentures,
lesions, loose teeth
    - Inspect neck, note any swelling,
limited range of motion.
    - Palpate for tenderness, nodules.
8. Lungs assessment: Cough
present, difficult breathing?
Posterior chest:
    - Inspect, note symmetry,
configuration
    - Palpate for symmetrical
expansion, fremitus, tenderness
    - Auscultate over all lung field in
a consistent pattern

Anterior chest:
   -Inspect respiratory pattern,
symmetry, symmetry of breasts
   -Palpate, note fremitus, lumps
   -Auscultate over all lung fields in
a consistent pattern.




              Metropolitan Community College   10   Template Rev. 7/24/06
Head-to-Toe Assessment – continued

9. Cardiovascular
    -Inspect precordium, note any
pulsations or heaves
    -Auscultate apical rate and
rhythm,
    - Capillary refill
    - Listen to all areas of precordium
with diaphragm, including traditional
valve areas. Note S1 and S2, as well
as other sounds (murmurs).
    -Assess for peripheral edema,
assess peripheral pulses, assess
capillary refill, assess Homan’s sign
or any tenderness to calves.
10. GI
    -Inspect
    -Auscultate all four quadrants
    -Palpate all quadrants, noting
tenderness/guarding.
    -Soft, firm, distension, flat
11. Extremities
    -inspect, noting any swelling,
lesions, discoloration, hair pattern
    -palpate for swelling, tenderness
    -palpate pulses, compare quality
side to side
    -test hand grasp strength and foot
push strength. Note equality
12. GU: Assess voiding changes or
problems
13. Maintain patient comfort.
14. Hand Hygiene
15. Document – report any abnormal
findings to physician.

Recommendation: Pass_______________________ Needs more practice_____________________

Student______________________________________________Date_________________________

Instructor____________________________________________




              Metropolitan Community College   11             Template Rev. 7/24/06
UNIT II: Physical assessment techniques for the lungs, and abdomen

Unit Objectives: At the completion of this unit of study the student will be able to:

1. Demonstrate the assessment technique of light palpation and percussion to abdomen.
2. Demonstrate the assessment technique of percussion of the thorax and abdomen.



                             REQUIRED LEARNING ACTIVITIES
Assignment: Osborn: Chapters 33 and 44
              Wilkinson: Chapter 19
Lab activities: Utilize procedure checklist.
Complete the unit objectives.


                             SUGGESTED LEARNING ACTIVITIES

Review anatomy and physiology of thorax and abdomen.




              Metropolitan Community College        12                      Template Rev. 7/24/06
                                       Metropolitan Community College
                                              Procedure Checklist
                                         Physical Assessment of Lungs
                                    Utilizing Light Palpation and Percussion

Procedure Steps                                Yes   No                  Comments
1. Explain Procedure to patient.
2. Lung Visual:
    a. Sitting position if patient can
tolerate.
    b. Inspect shape of thorax:
       1. Estimate visually transverse
diameter of thorax then antero-
posterior diameter.
       2. Inspect for superficial veins
on thorax.
       3. Estimate angle at which
ribs articulate with sternum.
       4. Assess for retractions, use
of accessory muscles.
       5. Assess rate of respirations,
depth, pattern, audibility, mode of
breathing (nose or mouth breathing).
       6. Any sputum.
       7. O2 needed? Trach tube?
Any other assistive devices?
3. Lungs: Light palpation: posterior
    a. Carefully palpate any area
where pain is reported or lesions
evident as last portion of exam, for
patient comfort.
    b. Place your thumbs at level to
10th ribs, your hands grasping the
lateral rib cage. Slide hands
medially slightly to raise loose skin.
fold between thumbs and spine.
    Have patient inhale deeply and
feel for symmetry of respiratory
movement.
    c. Palpate posterior for fremitus
with ball of hand (palm side of hand
at base of fingers); ask patient to
repeat words “ninety nine”. Can use
both hands at once comparing
bilaterally.
    d. Identify, describe, and localize
any areas of increased or decreased
fremitus.

              Metropolitan Community College          13                       Template Rev. 7/24/06
Physical Assessment of Lungs - continued

4. Lungs: Percussion Posterior to
determine underlying tissues are air-
filled, fluid-filled, or solid.
    a. Press only distal phalanx and
joint of middle finger firmly on
surface.
    b. Quick strikes (one or two)
when move on with opposite hand,
middle finger to the distal phalanx
that has firm pressure on surface.
Compare one part chest to another.
5. Assess and identify 5 percussion
notes:
    a. Flatness: soft intensity, high
pitch, short duration (thigh).
    b. Dullness: medium intensity,
medium pitch, medium duration
(fluid in lungs)
    c. Resonance: Loud intensity,
low pitch, long duration (example
normal lung)
    d. Hyper Resonance: Very loud
intensity, lower pitch, longer
duration. (emphysematous lung,
hyperinflated)
    e. Tympany: loud intensity.
(gastric air bubble, puffed out chest.)
6. Percussion lungs: Posterior:
Percuss across top of each shoulder –
to identify lung apex with arm folded
across chest.
    a. Percuss symmetrical areas of
lung moving down chest.
    b. Below scapulae, percuss areas
along sides of chest and medially.
7. Identify level of diaphragmatic
dullness bilaterally during
respiration.
    a. Slightly higher level on right
than left. (sound is dull below
diaphragm.)
    b. Abnormally high “dull”
suggests pleural effusion or a high
diaphragm from paralysis or
atelectasis.



              Metropolitan Community College   14   Template Rev. 7/24/06
Physical Assessment of Lungs - continued

8. Lungs: Anterior Light Palpation
    a. Identify areas of tenderness.
    b. Respiratory symmetry.
        - place thumbs along each
costal margin
        - hands along lateral rib cage.
       - slide in to raise loose skin
fold between thumbs.
        - ask patient to inhale deeply
    c. Tactile Fremitus:
        compare symmetrical areas of
lungs using ball of hand. Have
patient say “ninety-nine”. Fremitis is
decreased or absent if bronchus
obstructed or fluid in pleural space.
Fremitus is increased near large
bronchus and over consolidated lung
such as pneumonia.
8. Lungs: Anterior: Percussion:
    a. Compare symmetrical points.
       - supraclavicular (above
clavicle)
       - infraclavicular (below
clavicle)
        move down chest wall. Heart:
dullness to left of sternum from 3rd to
5th interspaces.
    b. Dullness replaces resonance
when fluid or solid tissue replaces
air.
    c. Only large pleural effusion
detected anteriorly since pleural fluid
displaces posterior in supine patient.
    d. Identify upper border of liver
dullness to right.
    e. Identify tympanic gastric air
bubble to left.

Recommendation: Pass_______________________ Needs more practice_____________________

Student______________________________________________Date_________________________

Instructor____________________________________________



                                        Metropolitan Community College
              Metropolitan Community College         15                  Template Rev. 7/24/06
                                              Procedure Checklist
                                       Physical Assessment of Abdomen
                                    Utilizing Light Palpation and Percussion

Procedure Steps                                Yes   No                  Comments
1. Explain procedure to patient.
2. Provide for privacy.
3. Hand hygiene.
4. Assess abdomen using light
palpation.
    a. Identify abdominal tenderness,
superficial masses.
    b. Use pads of your fingertips
with finger together in a light, gentle
motion.
    c. Move smoothly in all 4
quadrants.
    d. Identify involuntary rigidity of
abdominal muscles (indicates
peritoneal inflammation.)
5. Percussion :
    a. Percuss lightly in all 4
quadrants.
    b. Tympany most prominent.
Dullness over distended bladder.
    c. Percuss liver for dullness in
right, midclavicular line.
    d. Percuss stomach: identify
tympany of gastric air bubble of left
lower anterior rib cage.
    e. Percuss spleen: small oval
area of splenic dullness near left 10th
rib posterior to mid axillary line.

Recommendation: Pass_______________________ Needs more practice_____________________

Student______________________________________________Date_________________________

Instructor____________________________________________




              Metropolitan Community College          16                       Template Rev. 7/24/06
UNIT III: Physical assessment techniques for the eye, ear, and nose


Unit Objectives: At the completion of this unit of study the student will be able to:
1. Demonstrate the proper use of the ophthalmoscope.
2. Demonstrate the proper use of the otoscope.
3. Assess the anatomical structures visible with the ophthalmoscope and otoscope.



                              REQUIRED LEARNING ACTIVITIES

Assignment: Osborn: Chapter 69.
              Wilkinson: Chapter 19
Lab activities: Utilize procedure checklist.
Complete the unit objectives.

                             SUGGESTED LEARNING ACTIVITIES

Practice using the otoscope and ophthalmoscope before the lab activities.




              Metropolitan Community College        17                      Template Rev. 7/24/06
                                     Metropolitan Community College
                                            Procedure Checklist
                                 Assessing Eye With Use of Opthalmoscope

Procedure Steps                               Yes   No              Comments
1. Explain Procedure to patient.
2. Darken room
3. Switch on opthalmoscope light
and turn lens disc to zero. Keep your
index finger on lens disc so as to be
able to refocus the scope during
examination.
   a. Large round beam (0) for large
pupils
   b. Small round beam for small
pupils the green (or red) beam used
to detect small red lesions)
4. Use right hand for patient’s right
eye. Use left hand for patients left
eye.
5. Place thumb of opposite hand on
patients eyebrow to give guidance as
you move in closer and may use
thumb to gently elevate patients
upper lid if necessary.
6. Ask patient to look straight ahead
and look at a specific point on the
wall.
7. Hold scope firmly against your
face with your eye directly behind
the sight hole.
8. From about 15 inches away and
about 15 degrees lateral to patient’s
line of vision, shine the light beam
on the pupil, keep both your eyes
open.
   a. Note orange glow (red reflex)
   b. Absence of red reflex
suggests:
      - cataract
      - detached retina
      - artificial eye
9. Keep the light beam focused on
red reflex as you move
opthalmoscope very close to pupil.
Your forehead is on or very close to
your thumb.
Procedure Checklist - continued

             Metropolitan Community College          18                    Template Rev. 7/24/06
10. Identify optic disc, note:
yellowish orange, oval or round, may
need to follow a blood vessel
centrally until visualized. There is
much branching away from optic
disc and progressive enlargement of
vessel size as approach disc.
11. Identify arterioles and veins:
Arterioles are light red, smaller,
bright light reflex, veins are dark red,
larger, absent light reflex.
12. Adjust lens disc to focus on
optic disc.
    a. Normal patient eye usually
“O” diopters (clear glass)
    b. Near sighted patient: use lens
with longer focus – rotate lens disc
counterclockwise (red numbers
indicates minus diopters)
    c. Farsighted patient or lens has
been removed: rotate disc clockwise
to plus diopters (black numbers).
13. Assess for normal white or
pigmented rings or crescents around
disc. Disc outline clear.
14. Note abnormalities of retina.
    a. Flame-shaped hemorrhages
(may indicate hypertension)
    b. Tiny red spots (may indicate
diabetic retinopathy)
    c. Small, slightly irregular red
spots (diabetes)
    d. Large, horizontal line
(preretinal hemorrhage)
15. Identify macular area
(responsible for central vision).
Shine light beam laterally or have
patient look directly into light.
    a. A vascular area, somewhat
larger than disc, has no distinct
margins. Shimmering light
reflection common in younger
patients.




              Metropolitan Community College   19   Template Rev. 7/24/06
Procedure Checklist - continued

16. Rotate lens disc progressively to
+10 to +12 diopters to focus on
anterior structures of eye.
   a. Lens: should be transparent
      - cataract symptoms of
impaired vision, annoying glare from
bright lights, distortion of vision.

Recommendation: Pass_______________________ Needs more practice_____________________

Student______________________________________________Date_________________________

Instructor____________________________________________




             Metropolitan Community College   20              Template Rev. 7/24/06
                                       Metropolitan Community College
                                              Procedure Checklist
                                      Assessing Ears With Use of Otoscope

Procedure Steps                                Yes   No                 Comments
1. Explain Procedure to patient.
2. Obtain otoscope and use correct
size speculum (the largest speculum
that the canal will accommodate).
3. Have patient tilt head to side not
being examined.
4. For adult: pulls Helix up and
back.
For preschool child: Pulls Helix
down and back.
Assess for ear pain with this
movement (maybe painful with acute
otitis externa)
5. Inserts speculum slowly, only into
outer 1/3 of canal.
6. Identify if wax, discharge, or
foreign bodies, redness or edema in
ear canal.
7. Identifies location of cone of light
and bony landmarks.
    a. Normal drum is pearly
grey/with good cone of light.
    b. The handle and short process
of the malleus are readily
identifiable.
8. Gently move speculum to observe
entire drum.
9. Examine bilaterally.
10. Dispose of speculum used.
11. Hand hygiene.

Recommendation: Pass_______________________ Needs more practice_____________________

Student______________________________________________Date_________________________

Instructor____________________________________________




              Metropolitan Community College          21                    Template Rev. 7/24/06
                                     Metropolitan Community College
                                             Procedure Checklist
                                  Assessing the Nose With Use of Otoscope

Procedure Steps                               Yes   No                Comments
1. Explain Procedure to patient.
2. Assess nose for deformity,
asymmetry, inflammation.
3. Using otoscope, use wide, short
nasal speculum.
4. Assess lower portions of nose
then upper portion.
5. Move your own head and
otoscope to view upper nasal cavity.
6. Assess:
   a. Nasal mucosa: note color
(normally slightly redder than oral
mucosa) edema, exudates, bleeding.
   b. Nasal septum: note any
bleeding, deviation.
   c. Inferior and middle turbinates
and middle meatus: note color,
edema, exudates, polyps.
7. Dispose nasal speculum after use.
8. Hand hygiene.

Recommendation: Pass_______________________ Needs more practice_____________________

Student______________________________________________Date_________________________

Instructor____________________________________________




             Metropolitan Community College          22                     Template Rev. 7/24/06
UNIT IV: Assessment of abnormal heart sounds

Unit objectives: At the completion of this unit of study the student will be able to:

1. Identify the events in the heart that create normal heart sounds of S1 and S2.
2. Identify the abnormal heart sounds of S3 and S4 and murmurs.
3. Identify heart murmurs as systolic or diastolic.
4. Demonstrate auscultation of heart sounds.




                             REQUIRED LEARNING ACTIVITIES
Assignment: Osborn: pages 1060-1072
              Wilkinson: Chapter 19
Lab activities: Practice the assessment of the various heart sounds.
Complete the unit objectives.
Utilize the procedure checklist.


                             SUGGESTED LEARNING ACTIVITIES

Review normal and abnormal physiology of the heart.




              Metropolitan Community College         23                      Template Rev. 7/24/06
                                       Metropolitan Community College
                                             Procedure Checklist
                                     Assessment of Abnormal Heart Sounds

Procedure Steps                                Yes   No               Comments
1. Explain Procedure to patient.
2. Position patient supine or sitting.
3. Provide privacy.
4. Hand hygiene.
5. Identify head piece of the
stethoscope
    a. Diaphragm transmits high-
frequency sounds
    b. Bell transmits low – pitched
sounds (rest only lightly on skin or
will act like the diaphragm.)
6. Identify S1: Use diaphragm of
stethoscope
    a. S1 loudest in mitral area (left
5th ICS at midclavicular line) “lub”
sound from “lub-dub”.
    b. Caused by closure of mitral
and tricuspid valves.
    c. Palpate carotid lightly as you
will hear S1 with each carotid pulse
beat.
7. Identify S2: Use diaphragm of
stethoscope
    a. S2 loud in aortic area (identify
angle of Louis, move your finger
laterally to right of sternum, this is:
2nd ICS to right of sternum)
    b. “Dub” in “lub-dub”
    c. Caused by closure of
semilunar valves.




              Metropolitan Community College          24                   Template Rev. 7/24/06
Assessment of Abnormal Heart Sounds - continued

8. Identify S3: Use bell of
stethoscope
    a. Auscultate mitral and tricuspid
area (Tricuspid area left of sternal
border with 5th ICS)
    b. “Gallop” or extra heart sound
just after S2.
    c. Indicated rapid ventricular
filing, CHF and fluid overload.
    S1 S2 S3
    Ken tuc ky
    d. Use mitral landmark for left
rapid ventricular filling.
    e. Use tricuspid landmark for
right rapid ventricular filling.
9. Identify S4 heart sound: Use bell
of stethoscope.
    a. Best in mitral or tricuspid area.
    b. Late diastolic filling and
occurs right before S1.
    c. S4 (left-sided) louder on
expiration. S4 (right-sided) louder
on inspiration.
    S4      S1      S2
    Ten     nes     see
    d. Increased resistance to filling
from poorly compliant ventricle from
MI, CAD, CHF, cardiomyopathy,
HTN, aortic stenosis.




              Metropolitan Community College   25   Template Rev. 7/24/06
Assessment of Abnormal Heart Sounds - continued

10. Auscultate patient for the
following concerning murmurs:
    a. Location: Note area where
murmur is loudest. Aortic and
pulmonic areas, with diaphragm of
stethoscope. Mitral and tricuspid
areas, with diaphragm and bell of
stethoscope.
    b. Timing: Systolic murmur:
between S1 and S2. Diastolic
murmur: between S2 and S1
    c. Intensity:
Grade I very faint.
Grade II faint, heard immediately.
Grade III moderate intensity.
Grade IV loud, may be associated
with palpable thrill.
Grade V loud, thrill palpable, audible
with stethoscope partially off chest
wall.
Grade VI very loud, heart with
stethoscope off chest wall, thrill
palpable.
    d. Identify quality: harsh,
rumbling, blowing, musical.
    e. Identify pitch: high, medium
or low. Low pitched with bell of
stethoscope. High pitched with
diaphragm of stethoscope.
    f. Identify configuration:
Crescendo: soft to loud.
Decrescendo: loud to soft.
Plateau: sound is sustained.
    g. Identify if murmur radiates to
another area such as neck, axilla.

Recommendation: Pass_______________________ Needs more practice_____________________

Student______________________________________________Date_________________________

Instructor____________________________________________




              Metropolitan Community College   26             Template Rev. 7/24/06
UNIT V: Neurological assessment

Unit Objectives: At the completion of the unit of study each student will be able to:

1. Assess the components of the basic neurological assessment to include pupils, level of
   consciousness and mental status, reaction to external stimuli, and the Glasgow Coma Scale.
2. Demonstrate the proper technique for the assessment of reflex activity using a reflex hammer.
3. Demonstrate the assessment techniques employed in the assessment of the cranial nerves.
4. Demonstrate the complete assessment of the neurological system.




                             REQUIRED LEARNING ACTIVITIES
Assignment: Osborn: pages 698-711
              Wilkinson: Chapter 19
Lab activities: Utilize the procedure checklist.
Complete the unit objectives.

                             SUGGESTED LEARNING ACTIVITIES

Complete a neurological assessment on a client in the clinical setting.
Review neurologic system.




              Metropolitan Community College        27                     Template Rev. 7/24/06
                                        Metropolitan Community College
                                              Procedure Checklist
                                           Neurological Assessment

Procedure Steps                                Yes   No                  Comments
1. Explain Procedure to patient.
2. Provide privacy.
3. Hand hygiene.
4. Consider patient’s language,
education and culture during
examination.
5. Assess behavior, facial
expression, posture, affect,
grooming.
6. Determine level of arousal, as
needed, in this order: verbal stimuli,
tactile stimuli.
7. Correctly describe altered level of
consciousness using Glasgow Coma
Scale.
8. Determine level of orientation.
    a. Checks orientation to time,
person, and place.
7. Assess recent memory – “How
did you get to the hospital?”
8. Assess remote memory – “What
is your birth date?”
9. Checks cranial nerves.
    a. CN I – identify the smell of
common substances.
    b. CN II – tests visual acuity and
visual fields.
    c. CN III, IV, and VI
Tests Extraoculor movement by
having patient move eyes through the
6 cardinal fields of gaze with the
head held steady. Tests papillary
reaction to light and accommodation.
    d. CN V – motor function –
move jaw from side to side,
clenching jaw, and biting down on a
tongue blade.
    e. CN V – sensory function –
close eyes and identify when nurse
touches patients face at forehead,
checks, and chin bilaterally.



              Metropolitan Community College          28                   Template Rev. 7/24/06
Neurological Assessment - continued

    f. Tests corneal reflex by puffs
air from a syringe over cornea.
    g. CN VII motor function – make
faces such as smile, frown, whistle.
    h. CN VII taste – test taste on
anterior portion tongue by placing
sweet (sugar) salty (salt) or sour
(lemon) substance on tip on tongue.
    i. CN VIII use – watch: the tic-
toc for hearing; Weber and Rinne test
for air and bone conduction; Romber
test for balance.
    j. CN IX and X observe ability to
talk, swallow and cough.
    k. CN IX and X motor function:
patient to say “ah” while depressing
tongue with tongue blade and
observing soft palate and uvula rise.
    l. CN IX and X sensory function:
       induce gag reflex (we will not
perform but be aware these nerves
responsible for this reflex).
    m. CN IX and X taste: (sweet,
salty, sour) tests on posterior portion
of tongue.
    n. CN XI place hands on
patient’s shoulders and patient to
shrug his/her shoulders against
resistance. Have patient turn head
from side to side against resistance.
    o. CN XII
        - Say “d, l, n, t”.
        - Protrude tongue and move it
from side to side.

10. Tests superficial sensations:
    a. Begin with most peripheral
part of limb, test with light touch.
    b. If patient does not perceive
touch, determine boundaries by
testing about every inch to determine
sensory loss area.




              Metropolitan Community College   29   Template Rev. 7/24/06
Neurological Assessment - continued

11. Use correct procedure to test
each reflex: Uses the following scale
to grade reflexes:
O – no response detected
+1 – Diminished response
+2 – Response normal
+3 – Response somewhat stronger
than normal
+4 – Response hyperactive with
clonus.
    a. Biceps reflex (spinal cord level
C5 and C6) Rests the patients elbow
in nondominant hand, with thumb
over the biceps tendon. Strikes the
percussion hammer to own thumb.
    b. Triceps reflex (spinal cord
level C8 and C8) abducts patient’s
arm at the shoulder and flexes it at
the elbow. Supports the upper arm
with non dominant hand, letting the
forearm hang loosely. Strikes the
triceps tendon about 1-2 inches
above the olecranon process.
    c. Brachioradialis reflex (spinal
cord level C-3 and C-6) Rests
patients arm on patients leg. Strikes
with the percussion hammer 1-2
inches above the bony prominence of
the wrist on the thumb side.
    d. Patellar reflex (spinal cord
level L-2, L-3, L-4) Patient sits with
legs dangling. Strikes the tendon
directly below the patella.
    e. Achilles reflex (spinal cord
level S1, S2) Patient lies supine or
sits with legs dangling. Holds the
patients foot slightly dorsiflexed and
strikes the Achilles tendon about 2
inches above the heel with the
percussion hammer.
    f. Test Plantar superficial reflex
with end of reflex hammer. Strokes
sole of foot in an arc from the lateral
heel to medially across the ball of the
foot.



              Metropolitan Community College   30   Template Rev. 7/24/06
Neurological Assessment - continued

Recommendation: Pass_______________________ Needs more practice_____________________

Student______________________________________________Date_________________________

Instructor____________________________________________




             Metropolitan Community College   31              Template Rev. 7/24/06
Unit VI: Intravenous interventions

Unit Objectives: At the completion of this unit of study, the student will be able to:

1. Explain the legal implications of intravenous therapy.
2. Apply the concepts of standard precautions in infusion therapy.
3. Discuss the risks, complications, and adverse reactions of intravenous therapy.
4. Identify central and peripherally placed vascular access devices utilized for various patient needs.
5. Identify the pharmacological principles and administration of intravenous medications.
6. Demonstrate peripheral venipuncture and discontinuation of IV push.
7. Demonstrate calculation of IV drip rates and IV dosages.
8. Demonstrate safe administration of medications and IV piggyback medications.


                               REQUIRED LEARNING ACTIVITIES

Assignment: Osborn: Chapter 22
              Wilkinson: pages 518-521, 525, (Procedures 23-14 through 23-16), Chapter 36
Lab activities: Demonstrate safety in delivering intravenous therapies.
Complete the unit objectives.
Utilize the procedure checklists.

                             SUGGESTED LEARNING ACTIVITIES

Demonstrate administration of IV medication or manikin IV arm.
Utilize Gahart 2009 for safe administration of IV medications..




              Metropolitan Community College         32                      Template Rev. 7/24/06
                                        Metropolitan Community College
                                              Procedure Checklist
                                            Peripheral Venipuncture

Procedure Steps                                 Yes    No                Comments
1. Verify physician order.
2. Assess purpose of IV (Blood
administration or IV fluids and/or
antibiotics) and choose proper IV gauge.
3. Identify patient and explain procedure.
Note any allergies.
4. Hand hygiene.
5. Obtain IV supplies and flush lock with
saline.
6. Assess venipuncture site – use of
tourniquet.
7. Remove tourniquet, put on gloves.
8. Prepare venipuncture with chloroprep.
9. Do Not Repalpate after prepping.
10. Reapply tourniquet.
11. Inform patient of needle stick.
Introduce needle with bevel up. Angle to
enter skin will depend on depth of vein.
Once vein is entered then bring IV device
flush with skin so able to thread into
vein.
12. Observe for blood return in
flash back chamber.
    a. When blood returns advance needle
slightly further then hold needle still (do
not advance needle) and advance only
catheter into vein.
    b. Immediately release tourniquet.
    c. Connect hub of catheter to saline
lock.
    d. Apply Tegaderm.
    e. Wipe saline lock port with alcohol
and infuse 5-10 mL of sterile saline to
assure patency and no infiltration noted.
    f. Discard supplies and sharp
properly.
    g. Remove gloves and wash hands.
    h. Maintain patient comfort.




              Metropolitan Community College          33                  Template Rev. 7/24/06
Peripheral Venipuncture – continued

   i. Documentation to include:
      - gauge used
      - how many attempts (limit to 2
per policy)
      - location of IV
      - saline lock or infusion as
ordered.
      - any comments said by patient
that relates to IV.

Recommendation: Pass_______________________ Needs more practice_____________________

Student______________________________________________Date_________________________

Instructor____________________________________________




             Metropolitan Community College   34              Template Rev. 7/24/06
                                         Metropolitan Community College
                                               Procedure Checklist
                                         Administering IV Push Medication

Procedure Steps                                 Yes   No                    Comments
1. Check physician order.
2. Verify Allergies.
3. Review information on the
medication, including reason for,
effects of proper dilution, rate of
administration, reactions,
compatibility with existing IV
fluids/meds.
4. Explain procedure to patient.
5. Hand hygiene.
6. Select appropriate equipment
needed.
7. Assure 6 rights to safe medication
administrated.
  Rt Patient
  Rt Drug
  Rt Dose
  Rt Time
  Rt Route
  Rt Documentation
8. Perform the 3 checks while
preparing the medication. maintain
sterility and always use alcohol wipe
before accessing on any IV ports.

9. Put on clean gloves. Flush
peripheral saline port with 5-10 mL
normal saline, observing IV site for
infiltration. (Need to perform if port
is locked). If central line capped
port, flush with 10mL sterile saline
and check of Blood return.
10. Give IV push medication
properly diluted (if indicated) at
recommended rate, timing with
watch.
11. Slowly flush with 10 mL saline
when completed. Again observing
IV site for infiltration for peripheral
lines.




               Metropolitan Community College          35                     Template Rev. 7/24/06
Administering IV Push Medication- continued

12. If IV fluids are infusing, assure
compatibility. May need to stop
infusion (if safe for patient) and flush
with 10 mL saline then give IV
medication then flush with IV 10 mL
saline slowly to clear tubing of
medication.
13. Observe for side effects.
14. Dispose of equipment properly
and hand hygiene.
15. Document med given, dose,
route, time, signature.

Recommendation: Pass_______________________ Needs more practice_____________________

Student______________________________________________Date_________________________

Instructor____________________________________________




              Metropolitan Community College   36             Template Rev. 7/24/06
                                        Metropolitan Community College
                                              Procedure Checklist
                                         Primary IV Fluid and Tubing

Procedure Steps                                Yes   No                  Comments
1. Check physician order.
2. Verify Allergies.
3. Assess if IV fluid appropriate for
this patient.
4. Gather equipment.
5. Explain procedure.
6. Hand hygiene.
7. Assure 6 rights to safe medication
administrated.
8. Spike IV bag to primary tubing.
fill drip chamber approximately ½
full. Prime this tubing carefully.
Remove all fluid, even in parts along
tubing, inverting these ports so fluid
will fill and air will move out.
9. Place tubing in pump (if using)
assure proper mL/hour and volume
setting into pump.
10. Flush a peripheral saline lock or
central heparin lock to assure
patency. Then attach aseptically
with gloves on. Always wipe lock
connector with alcohol before
attaching.
11. Assure clamps open; proper rate,
proper volume are set in pump.
12. Maintain patient comfort.

Recommendation: Pass_______________________ Needs more practice_____________________

Student______________________________________________Date_________________________

Instructor____________________________________________




              Metropolitan Community College          37                   Template Rev. 7/24/06
                                  Metropolitan Community College
                                        Procedure Checklist
              Administering IV Piggy Back Medication with Existing IV Line and Without

Procedure Steps                                Yes   No                Comments
1. Check physician order.
2. Wash your hands.
3. Verify any allergies.
4. Review information on the
medication, medical reason for, effects
of proper dilution, rate of
administrating, reactions, compatibility
with existing IV fluids/meds.
5. Assess IV access. If IV fluids are
infusing, assure compatibility. May
need to stop infusion if safe for patient
and flush with 10 mL saline, then
attach IV piggyback tubing then flush
with 10 mL saline slowly to clear
tubing of medication. Always use
alcohol wipe prior to accessing any IV
port.
6. Explain procedure to patient.
7. Select appropriate equipment.
8. Assure the 6 rights and 3 checks:
    Rt Patient
    Rt Drug
    Rt Dose
    Rt Time
    Rt Route
    Rt Documentation
    * With piggyback meds assess the
label attached by pharmacy as well as
the label on the bag itself to assure
proper dilution and proper med.
9. If using pump and existing IV line
    a. Assure compatibility
    b. Spike piggyback IV bag to
secondary tubing (clamp is closed at
this time)
    c. Fill drip chamber approximately
½ full
    d. Slowly open clamp and flush
secondary tubing so do not waste any
medication.
    e. Prime tubing



              Metropolitan Community College         38               Template Rev. 7/24/06
Administering IV Piggy Back Medication with Existing IV Line and Without – continued

   f. Attach to existing tubing above
pump. Remember to hang what you
want to be infusing the highest.
   g. Enter correct infusion rate and
volume into pump and start (make
sure clamp is open or pump will
alarm “occlusion”).
   h. Always date tubing. Good for
24-48 hour (check policy)
10. If using pump but no existing IV
line
   a. Some agencies use long
Continu-flo tubing for piggyback
medication. But medication is
wasted in this long tubing. Best to
prime Continu-flo with saline (or
compatible fluid) then spike
piggyback med with secondary
tubing and run through pump (follow
the steps in #8 above).
11. Tubing may be revised for 24
hours (check policy).


Recommendation: Pass_______________________ Needs more practice_____________________

Student______________________________________________Date_________________________

Instructor____________________________________________




             Metropolitan Community College    39                    Template Rev. 7/24/06
                                      Metropolitan Community College
                                             Procedure Checklist
                                  Changing IV Fluid With Existing IV Tubing

Procedure Steps                                Yes   No                Comments
1. Check physician order for type of
fluid and infusion rate.
2. Hand hygiene.
3. Select correct fluid IV bag.
4. Examine solution for clarity.
5. Assemble supplies.
6. Perform 6 rights to safe
medication administration.
    Rt Patient
    Rt Drug
    Rt Dose
    Rt Time
    Rt Route
    Rt Documentation
7. Close regulator on tubing. Verify
existing tubing date (tubing change
usually every 72 hours)
8. Remove cover from entry port of
new IV bag.
9. Remove old IV bag from
connector and insert connector into
new solution IV bag without
touching the portion of connector
that is going into the bag.
10. Invert new container and hang it
up.
11. Fill drip chamber approx. ½ full.
12. Open clamp, start, and regulate
flow rate through IV pump as
ordered.
13. Secure client’s environment and
comfort.
14. Dispose of used IV bag.
15. Reassess entire IV, including rate
and IV site.
16. Hand hygiene.
17. Document the procedure.

Recommendation: Pass_______________________ Needs more practice_____________________

Student______________________________________________Date_________________________

Instructor____________________________________________

              Metropolitan Community College          40                  Template Rev. 7/24/06
Unit VII: Total Parenteral Nutrition/Intralipids/Central Line Care

Unit Objectives: At the completion of this unit of study, the student will be able to:

1. Demonstrate safe administration and discontinuing of TPN.
2. Demonstrate a sterile central dressing change and changing central line caps.
3. Discuss safe administration of intralipids.
4. Demonstrate safety and sterility in discontinuing a central IV line.
5. Identify types of central lines, safety issues, and cares.


                                   REQUIRED LEARNING ACTIVITIES

Assignment: Osborn: pages 279-321, 515-516, and 526-527.
              Wilkinson: Chapter 26
Demonstrate safety in delivering TPN in simulation manikin IV arm.
Demonstrate a sterile dressing change and changing caps on simulation manikin.
Demonstrate discontinuing a PICC line on simulation manikin (only performed by RN and only with
physician order).
Utilize the procedure checklist.




              Metropolitan Community College         41                      Template Rev. 7/24/06
                                       Metropolitan Community College
                                             Procedure Checklist
                                   Changing the Central Intravenous Dressing

Procedure Steps                                Yes   No                 Comments
1. Check date and time of last
dressing change. PICC lines 7 days
(Check policy)
2. Wash your hands.
3. Assemble supplies.
4. Check clients’ identification.
5. Explain procedure to patient.
6. Clean overbed table and allow to
dry.
7. Place client in supine position if
patient can tolerate, with head turned
away from site.
8. Put on face mask and also on
patient if necessary. (PICC line
patient does not need to put on mask
(unless patient is watching the
procedure.)
9. Set up supplies on overbed table.
Open sterile field. Maintain sterile
field. Do not contaminate during
procedure.
10. Put on clean gloves and remove
old dressing.
11. Dispose of dressing in plastic
bag or contain in glove.
12. Remove gloves and wash hands.
(make sure patient is safe if moving
away from patient)
13. Visually inspect site carefully.
14. Put on sterile gloves. Maintain
sterility.
15. Cleanse area with antiseptic
solution, moving in a spiral direction.
Keeping both gloves sterile. Cleanse
area the size of the dressing that will
cover the site.
16. Dispose of used articles away
from sterile field.
17. Allow antiseptic solution to dry.
18. Apply new dressing and secure
tube if needed.



              Metropolitan Community College          42                       Template Rev. 7/24/06
Changing the Central Intravenous Dressing- continued

19. Remove gloves and mask.
20. Label dressing with date and
time. Do not cover site, place on
edge of dressing.
21. Reposition client for comfort and
safety (call light, side rails up).
22. Dispose of packages and wastes.
23. Wash your hands.
24. Assure proper IV flow rate.
25. Document site appearance and
procedure.



Recommendation: Pass_______________________ Needs more practice_____________________

Student______________________________________________Date_________________________

Instructor____________________________________________




             Metropolitan Community College     43            Template Rev. 7/24/06
                                 Metropolitan Community College
                                        Procedure Checklist
           Changing the Central Line Caps (this is usually done with Central Line Dressing)

Procedure Steps                                Yes   No             Comments
1. Hand hygiene.
2. Explain procedure to patient.
3. Assemble supplies: If triple
lumen, need:
   3 sterile caps
   sterile saline syringe
   alcohol pads x 3
4. Use 1 saline syringe to remove air
from each cap.
5. Put on clean gloves and place
patient in supine position.
6. Assure all lumens are clamped.
7. Wipe around existing central caps
with alcohol prior removal to
decrease bacteria count.
8. Make sure line is clamped or
kinked prior to removing cap so air
will not enter.
9. Remove 1 cap and quickly and
keeping end sterile, apply new cap
that has been flushed with saline.
10. Continue these steps until all 3
lumens have new caps.
11. Keep lumens clamped when not
in use to decrease incidence of air
emboli. Assure caps are secure.
12. Heparin flush 100 units is
infused once a day for each lumen to
keep these lumens from clotting.
(Power Piccs are flushed with saline)
complete all the 6 safe administration
rights if infusing the Heparin flush.
13. Document.


Recommendation: Pass_______________________ Needs more practice_____________________

Student______________________________________________Date_________________________

Instructor____________________________________________




              Metropolitan Community College          44                Template Rev. 7/24/06
Unit VIII: Blood Transfusion

Unit Objectives: At the completion of this unit of study, the student will be able to:

1. Discuss treatment with blood components.
2. Demonstrate safe nursing interventions in blood transfusions.
3. Assess transfusion reaction and safe interventions.


                                   REQUIRED LEARNING ACTIVITIES

Assignment: Osborn, Chapter 23.
              Wikinson: pages 918-921.
Utilize the procedure checklist in demonstrating blood administration.
Utilize the procedure checklist in demonstrating procedure for transfusion reaction..




              Metropolitan Community College         45                      Template Rev. 7/24/06
                                       Metropolitan Community College
                                             Procedure Checklist
                                            Blood Administration

Procedure Steps                               Yes     No                 Comments
1. Verifies blood administration consent
has been signed.
2. Verifies physician order, note type of
blood, number of units, rate of infusion,
any premedication orders.
3. Verify that the patient has been typed
and cross matched.
4. Notify lab if patient has not been
typed/cross matched.
5. Inquire to blood bank as availability
of blood.
6. Explain procedure to patient.
7. Obtain blood tubing and IV of
normal saline.
8. Assess IV administration site, state
proper gauge of peripheral IV catheter
appropriate for infusion.
9. Wash hands, put on gloves.
10. Prime blood administration tubing
with IV saline, squeeze drip chamber to
½ full, prime tubing, so no air in tubing
including “Y” tubing to where blood
unit will be connected. (make sure
clamp closed to “Y” tubing awaiting
blood product).
11. Flush IV lock with saline first to
assure patency.
12. Use aseptic technique and connect
to IV.
13. If using pump, or gravity, turn rate
to keep open – usually 20 ml/hour.
14. Remove gloves – wash hands.
15. Administer any pretransfusion
medications if prescribed depending on
the order (make sure the 6
administration rights have been
completed for any pretransfusion meds)




             Metropolitan Community College         46                  Template Rev. 7/24/06
Blood Administration - continued

16. Obtain the blood product from the
blood bank according to agency policy.
May need to take a form that has the
patients infusion number from wrist
band to take to blood band.
17. Put on gloves when handling blood
products.
18. Recheck physician order for any
possible changes.
19. Obtain pre-transfusion vitals.
20. Verify the patient and blood product
with another nurse following agencies
policy/procedure.
    a. Have patient state name/birthdate
and nurse compares to blood bank form.
    b. Compare patient name and
hospital ID number to patient name and
hospital ID number on blood bank form
attached to blood product.
    c. Compare blood unit ID number
located on blood bank form with the ID
number printed on blood product.
    d. Compare patient’s blood type on
the blood bank form with blood type on
blood product.
    e. Obtain signatures of both nurses if
no discrepancies to blood bank form
attached to blood product.
    f. Document on blood bank form the
date/time transfusion began.
    g. Keep blood bank form attached to
blood product until administration is
complete.
21. Observe blood bag for bubbles,
cloudiness, clots, sediment, and if
present, notify blood bank, then gently
invert blood product several times.
22. Carefully spikes blood product
through blood port “Y”. Do not touch
the connector that is going inside the
blood bag. Open clamp.




              Metropolitan Community College   47   Template Rev. 7/24/06
Blood Administration - continued

23. Using roller clamp, adjust to
prescribed drip rate (blood
administration sets have drop factor
of 10 drops/mL) or set pump.
24. Remain with patient the first 15
minutes (or according to
policy/procedures) and then obtain
vitals, assess for signs/symptoms of
transfusion reaction.
25. Assure patient has call light.
26. Then vitals hourly until
transfusion is complete, always
assess for transfusion reaction and
fluid status.
27. After infusion is complete, close
rollerclamp to “Y” transfusion bag
and allow normal saline to flush the
administrator set.
28. State tubing is used for no more
than 2 units and blood unit/tubing
not hanging longer than 4 hours.
29. Discard empty blood bag and
tubing per policy.
30. Obtain post transfusion vitals.

Recommendation: Pass_______________________ Needs more practice_____________________

Student______________________________________________Date_________________________

Instructor____________________________________________




             Metropolitan Community College   48              Template Rev. 7/24/06
                                       Metropolitan Community College
                                             Procedure Checklist
                                            Transfusion Reaction

Procedure Steps                               Yes   No                  Comments
1. Upon assessment of reaction,
stops transfusion immediately.
2. Do not flush blood administration
set with saline.
3. Disconnects administration set
from IV catheter.
4. Obtains vitals, assesses patient
including auscultating heart and
lungs.
5. Notify physician.
6. Hang new IV 0.9% with primed
new tubing TKO or saline lock IV
catheter.
7. Administer prescribed
medications as ordered.
8. Places administration set and
blood product with blood bank form
attached and place all inside
biohazard bag, notify blood bank,
and return it to blood bank regarding
policy.
9. Obtain blood and urine specimen
according to policy.
10. Continue to assess patient and
monitor vitals frequently – notify
physician of any changes
immediately.
11. Complete transfusion reaction
record.


Recommendation: Pass_______________________ Needs more practice_____________________

Student______________________________________________Date_________________________

Instructor____________________________________________




             Metropolitan Community College          49                   Template Rev. 7/24/06
Unit IX: Chest Tubes

Unit Objectives: At the completion of this unit of study, the student will be able to:

1. Demonstrate the role of RN in nursing intervention of chest tubes.
2. Perform therapeutic nursing interventions to clients with chest tubes.


                                   REQUIRED LEARNING ACTIVITIES

Assignment: Osborn: pages 680, 990-991.
              Wilkinson: Chapter 35.
Assess simulation of chest tube to manikin.
Utilize the procedure checklist.




              Metropolitan Community College         50                      Template Rev. 7/24/06
                                        Metropolitan Community College
                                               Procedure Checklist
                                        Preparing for Chest Tube Insertion

Procedure Steps                                Yes   No                      Comments
1. Insertion: Assure consent signed.
2. Reinforce procedure explanation
to patient.
3. Obtain pre-insertion vitals and
inquire as to pre-procedure pain
medication.
4. Obtains prescribed chest tube
drainage system.
    - Water seal
    - Dry seal
5. Hand hygiene
6. Prepare water seal system without
suction as prescribed
    a. remove cover on water-seal
chamber and fill the second chamber
with sterile water or normal saline to
2 cm mark, then replace cover on
water-seal chamber.
7. Prepare water seal system with
suction as prescribed.
    a. remove cover on water-seal
chamber and fill second chamber
with sterile water or normal saline to
2 cm mark.
    b. Add sterile water or normal
saline to suction – control chamber.
Add amount of fluid as specified by
physician – usually 20 cm.
    c. Attach tubing from suction –
control chamber to connecting tube
to suction source.
8. Position patient to semi-fowlers to
high fowlers according to indicated
insertion site.
9. Assist physician with mask,
sterile gown, sterile gloves and put
on mask to self.
10. Provide support to patient while
physician prepares sterile field, local
anesthetic is administered and
insertion and suturing of chest tube.



              Metropolitan Community College           51                      Template Rev. 7/24/06
Patient with Chest Tubes – continued

11. As soon as CT inserted, attach to
drainage system using a connector
(from sterile field).
12. Assist physician with occlusive
dressing around C.T., physician may
use petroleum gauze,
    - pre-cut drain-dressing over
petroleum gauge
    - Abd (lg dressing) over the 2
precut drain dressings
    - Secure dressing with 2 inch silk
tape or elastoplast to cover dressing
site completely. Must be air
occlusive dressing.
 13. If suction is prescribed, adjust
suction source (on wall) until gentle
bubbling occurs in suction – control
chamber. If suction not prescribed,
leave the suction tubing on the
drainage system open.
14. Assure drainage tube has no
kinks and no dependent drainage
tube. (tubing coiled up on bed).
15. Post insertion x-ray
16. Place Vaseline type dressing to
bedside in case chest tube becomes
dislodged.
17. Make sure chest tube unit is
cleared from bed and make sure there
will be no damage when bed changes
position.
18. Position patient for comfort.
19. Assess lung sounds/vitals.
20. Chart procedure.
21. Assure drainage system is
located below insertion site.


Recommendation: Pass_______________________ Needs more practice_____________________

Student______________________________________________Date_________________________

Instructor____________________________________________




              Metropolitan Community College   52             Template Rev. 7/24/06
                                          Student Services Important Dates
                                                 2009 – 2010 FALL
                                           August 29 – November 16, 2009

Fall Tuition Payment Deadline .................................................................................... August 3 (M)
Fall Quarter Begins ................................................................................................. August 29 (SA)
Labor Day Recess (College Closed) ............................................................ September 5-7 (SA-M)
Winter Priority Registration begins ..................................................................... September 23 (W)
Winter General Registration begins ........................................................................... October 7 (W)
Student Withdraw Deadline for “W” grade…………………………………….….October 26 (M)
Graduation Application Deadline Fall Quarter ........................................................ November 1(S)
Summer Term “I” Grades Due .......................................................................... November 10th(T)
Last Day of Fall Classes ..................................................................................... November 16 (M)
Grades Due and Posted to WebAdvisor by 5 p.m. ............................................... November 18(W)




*The Last Day to Drop for a “W” grade is also the last day for students to change from Credit to Audit
or Audit to Credit with instructor approval. Students must drop by this date to avoid being assigned a
grade of “F”. NOTE: “Last day to drop” refers to grades only.

To view the Last Day to Drop specific to your course section, go to the online class schedule at
http://www.mccneb.edu/schedule/classschedule.asp and click on the Important Dates next to the course.

The Refund drop dates for each course section are automatically calculated based on the start and end
dates and the number of sessions for the course. NOTE: Refer to refund policy below to determine the
last day to receive a refund for your course.


                                                  REFUND POLICY

Eligibility for a refund is automatically calculated by the date of the withdrawal. The amount of refund
is based on the number of class meetings held prior to the withdrawal compared to the total number of
scheduled sessions for the course.
For refund or account questions call: (402) 457-2405 or 1-800-228-9553, extension 2405.




                  Metropolitan Community College                     53                             Template Rev. 7/24/06

				
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