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					City College of San Francisco

  Department of Vocational

       Nursing 41 - A
                               City College of San Francisco
                            Fundamentals of Vocational Nursing
                                     Course VOCN 41-A



COURSE TITLE: VOCN 41-A Fundamentals of Vocational Nursing

CREDIT IN UNITS: 4 UNITS

COURSE DESCRIPTION:

This course provides an introduction to basic patient care in the hospital setting with a focus on the
following core components of Vocational Nursing, the nursing process, legal aspects of nursing, medical
terminology, therapeutic communication, basic bedside nursing care, client teaching, infection control
and basic needs assessment.

COURSE OBJECTIVES:

Upon completion of this course, the student vocational nurse will be able to:
   1. Summarize the historical background of vocational nursing including how the role of the LVN has
       evolved over time.
   2. Describe the basic concepts in vocational nursing including legal and ethical issues, the nursing
       process communication skills and documentation.
   3. Summarize the component parts of each basic nursing skill, and perform each procedure
       satisfactorily.
   4. Describe each basic nursing intervention and perform each procedure satisfactorily.
   5. The student will be able to apply nursing care according to client’s cultural background, belief and
       practices.
   6. Apply critical thinking knowledge and skills in providing care to the different type of clients by
       using Sim Man simulator.
   7. Demonstrate ability to render appropriate nursing care approach for elderly clients and patient’s
       with psychiatric disorder.


INSTRUCTIONAL METHODOLOGY
      A.   Assignments
           1.     Reading assignments from textbooks and handouts.
           2.     Group discussions and questions on relevant class issues such as, "Role of the L
                  VN in Health Care", "Legal and Ethical Issues in Nursing", and "Chain of
                  Command: Problem Solving for the Student Vocational Nurse".
           3.     Instructor led review of each procedure with accompanying demonstrations,
                  group practice of each procedure as demonstrated by instructor and individual
                  return demonstration of each procedure under the supervision of the skills or
                  clinical lab Instructor.




                                                2
     B.     Evaluations
           1.       Homework assignments that measure the students' ability to differentiate
                    appraise and compare the fundamentals of nursing care: vital signs, pain
                    assessment, and medication administration.
           2.      Quizzes and unit exams which assess the student's knowledge and
                   comprehension of topics such as communication skills, medical
                   terminology and stress management.
           3.      Skill performance check off which will evaluate the students' ability to perform
                   each skill satisfactorily. Satisfactory performance consists of the student
                   implementing the following steps as part of their individual return demonstration.
                   a. Verbalize the LVN Department's Standard Steps of Nursing
                        Procedures prior to performing any procedure.
                   b. Verbalize the purpose of each procedure performed.
                   c. Identify and collect the appropriate equipment needed to perform each
                        procedure.
                   d. Perform each skill under the supervision of an Instructor in either the skills
                        lab or clinical lab.
           4.      Midterm Exam covering topics such as the legal aspects of vocational nursing,
                   infection control, body mechanics and basic hygiene and comfort measures. To
                   promote critical thinking skills and prepare the student for the L VN licensure
                   exam, the preponderance of questions will be in a multiple-choice format.
           5.      Final Exam covering topics such as basic needs assessment, head-to-toe
                   assessments, transferring techniques, obtaining specimens and monitoring
                   intake and output. To promote critical thinking skills and prepare the student for
                   the L VN licensure exam, the preponderance of questions will be in a multiple-
                   choice format.


COURSE EVALUATION:

  1. Quizzes (4 @ 2.5% each         = 10%
  2. Midterm Examination            = 40%
  3. Final Examination              = 50%




                                            3
REQUIRED TEXBOOKS AND OTHER MATERIALS

    1. Taylor, Lillis, LeMone, and Lynn,Taylor's Video Guide to Clinical Skills


    2.    Lynn, Taylor Clinical Nursing Skills (Second Edition)

    3. Lynn, Skill Checklists to Accompany Taylor's Clinical Nursing Skills,

         (Second Edition)

    4. Stedman Health Professional and Nurse Dictionary

                                                                  th
    5. Timby & Smith, Introductory Medical-Surgical Nursing (9 Edition)

    6. Timby & Smith, Study Guide to Accompany Introductory to Medical-

                             th
         Surgical Nursing ( 9 Edition)

                                                nd
    7. Lois White, Foundations of Nursing ( 2        edition)



WEEKLY SCHEDULE:
     THEORY: M-W @ 8:00 am- 4:30 pm
     Skills Lab: M @ 12:30 - 14:30. T – W @ 14:30 - 16:30 and Posted


ATTENDANCE:
         Review the department's Attendance Policy in your Student Information Booklet


INSTRUCTOR OFFICE HOURS:
         As Posted




                                                 4
CONTENT


A. Introduction to Vocational Nursing
  1. History of Nursing
  2. Evolution of Vocational Nursing
  3. Sources for Standards of Care
          a. Nurse Practice Act
          b. National Council Licensure Examination
              for Practical/Vocational Nurses (NCLEX)
  4. Role of the Vocational Nursing Student
          a. Study Techniques
          b. Stress management
          c. Organizational Skills
          d. Time Management

B. Basic Concepts in Vocational Nursing
  1. Legal and Ethical Issues
           a. Privacy
           b. Confidentiality
           c. Competent care
           d. "Chain of command"
           e. Mandatory reporting of abuse and neglect
            f. Accidents, mistakes & errors (Unusual
               Occurrence reporting)
           g. Board of reportable offenses
           h. Durable Power of Attorney for Heath Care
           i. Living wills
           j. Patient Bill of Rights and Responsibilities
  2. Nursing Process
          a. Assessment
          b. Diagnosis
          c. Planning
          d. Implementation
          e. Evaluation
          f. Role of the Vocational Nurse
 3. Communication Skills
           a. Styles of communication
           b. Therapeutic communication techniques
           c. Factors affecting communication
           d. Barriers to communication
           e. Client teaching




                                          5
 4. Documentation
         a. Types of Patient Records
         b. Medical Terminology
         c. Medical Abbreviations
         d. Basic Guidelines for Documentation
                  1. Admission and discharge
                  2. Daily Assessment
                  3. Narrative Charting

C. Basic Vocational Nursing

  Skills and Procedures

       1. Vital Signs
                a. Guidelines for obtaining Vital Signs
                b. Temperature
                c. Pulse
                d. Respirations
                e. Blood Pressure
                f. Height
                g. Weight
                h. Recording Vital Signs

       2. Medical Asepsis and Infection Control
            a. Asepsis
            b. Sterility
            c. Handwashing
            d. Chain of infection
            e. Prevention of infection
            f. Nosocomial infections
            g. Standard Precautions
                    1. Gloves
                    2. Gowns
                    3. Eye protection
            h. Isolation Techniques
                    1. Respiratory
                    2. Contact
                    3. Reverse

       3. Safety
               a.   Patient's Environment
               b.   Hospital Environment
               c.   Fire Safety
               d.   Earthquake Safety
               e.   Disaster Preparedness
               f.   Patient Safety
                    1.Fall Precautions
                    2.Restraint



                                       6
        4. Body Mechanics and Patient Mobility
               a. Principles of proper body
                  mechanics
               b. Immobilized Client
                    1. Effects of immobility
                    2. Patient positioning
                    3. Range of motion exercises
                    4. Anti-embolic devices
               c. Assisting with mobility
                    1. Patient transfers
                    2. Ambulation

        5. Patient Hygiene and Environmental Care
                a. Bedside environment
                b. Components of patient hygiene
                c. Bed baths
                d. Bed making

        6.Intake and Output, Specimen Collection and

         Diagnostic Tests
               a. I&0
                    1. Assisting with nutrition
                    2. Maintaining hydration
                    3. Measuring output
               b. Specimen Collection
                   1.Urine
                   2. Blood
                   3. Feces
                   4. Cultures
              c. Assisting with diagnostic tests

D. Basic Vocational Nursing Interventions

        1. Basic Needs Assessment
                a. Maslow's Hierarchy of Needs
                b. Comfort measures

        2. Physical Assessment
                a. Nursing Health History
                        1. Biographical data
                        2. Reason for seeking health care
                        3. Present illness/concerns
                        4. Past medical history
                        5. Family medical history
                        6. Environmental history
                        7. Psychosocial and cultural history
               b. System Assessment

        3. Basic Nutritional Therapy
                a. Basic nutrition
                b. Therapeutic diets
                c. Nutritional supplementation
                c. Age-related dietary modifications

                                       7
4. Medication Administration
       a. Mathematics Review
       b. Review of the metric system
       c. Review of the apothecary system
        d. General principles of medication
          administration
       e. Medication administration
                 1.   PO
                 2.   IM
                 3.   SQ
                 4.   Topical
       f.Methods of positive patient identification
       g. Age related concerns




                                      8
                                                    TABLE OF CONTENTS
Program Syllabus        ------------------------------------------------------------------- 1 - 8
Table of Contents ------------------------------------------------------------------- 9
LESSON A: Introduction to Vocational Nursing
Introduction to Vocational Nursing ------------------------------------------------- 10
Study Techniques ---------------------------------------------------------------------- 11
Stress Management ------------------------------------------------------------------- 12
LESSON B: Basic Concepts in Vocational Nursing
Legal and Ethical Issues ------------------------------------------------------------- 13
Nursing Process ------------------------------------------------------------------------ 15
Communication Skills ----------------------------------------------------------------- 16 - 18
Client Teaching ------------------------------------------------------------------------- 18
Documentation ------------------------------------------------------------------------- 19
Admission and Discharge ----------------------------------------------------------- 20
Medical Terminology and Medical Abbreviations ----------------------------- 21
LESSON C: Basic Vocational Nursing Skills and Procedures
Vital Signs ------------------------------------------------------------------------------ 22-24
Height and Weight -------------------------------------------------------------------- 25
Metric System ------------------------------------------------------------------------- 26
Medical Asepsis and Infection Control ------------------------------------------ 27 -28
Safety ------------------------------------------------------------------------------------ 29 -30
Body Mechanics and Patient Mobility -------------------------------------------- 31
Care of the Immobilized Client ----------------------------------------------------- 32
Range of Motion Exercises --------------------------------------------------------- 33
Anti – Embolism Devices ------------------------------------------------------------ 34
Positioning ------------------------------------------------------------------------------ 35
Transfers and Ambulation ----------------------------------------------------------- 36
Patient Hygiene and Environmental Care --------------------------------------- 37
Bed Bath --------------------------------------------------------------------------------- 37 -39
Bed Making ----------------------------------------------------------------------------- 40 - 42
Intake and Output -------------------------------------------------------------------- 43 - 45
Specimen Collection and Diagnostic Tests ------------------------------------- 46 - 47
LESSON D- BASIC VOCATIONAL NURSING INTERVENTIONS
Basic Needs Assessment ----------------------------------------------------------- 48 - 49
Physical Assessment ----------------------------------------------------------------- 50
Basic Nutritional Therapy ------------------------------------------------------------ 51 - 52
Medication Administration ----------------------------------------------------------- 53




                                                                      9
LESSON A: INTRODUCTION TO VOCATIONAL NURSING

OBJECTIVES:

1. Define the following vocabulary as it relates to nursing and health care:
                  a. Patient
                  b. Client
                  c. Consumer
                  d. Holism
                  e. Biomedical engineering
                  f. Biopsychosocial
                  g. Patient advocate
                  h. Health care team
                  i. Health care practitioner
                  j. Demography
2. Trace a brief history of Practical Nursing in the U.S. A.
3. Define Nursing
4. Summarize the role of the L.V.N.
5. Identify the agencies regulating licensure, education and practice of vocational nursing.
6. List and identify the function of all the various members of the health care team.
7. Discuss the wellness-illness continuum.
8. Discuss the changing health care delivery system.
9. Describe and explain the purpose of H.M.O.s.
10.Discuss the positive and negative aspects of D.R. G.s.



    CONTENT:

            A. History Nursing
            B. History of Practical/Vocational Nursing
            C. Nursing Defined
                       1. Models of Care
                       2. Roles and functions
            D. Role of the LVN.
                    1. Description
                   2. Essentials for Practical Nursing
            E. Sources of Standards of Care.
                       3. Nurse Practice Act
                       4. National Council Licensure Examination for Practical/Vocational Nurses (NCLEX)
                       5. ANA
                       6. JACHO
                       7. HOSPITALS
            F. Role of Vocational Nursing Student
                      1. Time Management
                      2. Organizational Skills
                      3. Study Techniques
                      4. Stress Management




                                                         10
A–I   STUDY TECHNIQUES



      OBJECTIVES:
        1. State the purpose of studying.
        2. Discuss effective study habits.
        3. Describe the student's responsibility and role in learning through lectures, audiovisual
           presentations, computer - assisted instruction & reading.
        4. List ways to organize your notes and learn time management.
        5. State general rules in test taking.




         CONTENT:
           A.     Purpose of Studying
           B.     Effective Study habits
                  a. Reading
                  b. Use of high-lighter
                  c. Advance preparation
                  d. Routine study time
                  e. Group study
                  f. Study questions

             C.      Types of learning, roles & responsibilities of students in learning
                     takes
                     a. Active vs. passive
                     b. Auditory
                     c. Visual
                     d. Demonstration
                     e. Association

             D.      Methods of organizing notes and time management
                     a. Subject
                     b. Instructor

              E.      Rules in test taking
                      a. Pencil with a dull point
                      b. Process of elimination
                      c. Focus on safety related items
                      d. Avoid erasing upon review unless absolutely sure
                      e. Do not spend too much time on one question
                      f. Avoid guessing
                      g. Look for key words
                      h. Read the directions
                      i. Check for complete test
                      j. Erase completely
                      k. Write out formulas on paper provided.
                      l. Control Anxiety
                      m. Perform bathroom needs before exam
                       begins.

                                             11
A – II     STRESS MANAGEMENT

           OBJECTIVES:
                   1.       Define stress, adaptation, stressor, homeostasis, lack of       oriented

                            behaviors and defense and coping mechanisms.

                   2.       List factors influencing the response to stressors.

                   3.       Compare and contrast the Local Adaptation Syndrome with the General Adaptation

                            Syndrome.

                   4.       Describe the psychological response to a stressor.

                   5.       Discuss the physical, psychological developmental results of prolonged stress.

                   6.       List behavioral, physical and emotional indicators of stress.

                   7.       Discuss the role of the nurse in the management of stress.

                   8.       Identify the role of the nurse in relieving stress.

                   9.       Describe stress management techniques that can benefit nurses themselves.



         CONTENT:


         A. Regular Exercise
         B. Nutrition and diet

         C. Rest

         D. Support systems

         E. Time Management
         F. Problem-Solving Process




                   a.   Define overall needs, purposes and goals
                   b.   Define the problem
                   c.   Analyze capabilities, constraints, and interest groups
                   d.   Specify an approach to problem solving
                   e.   State behavioral objectives
                   f.   Generate alternative solutions
                   g.   Choose the best alternative
                   h.   Implement and control the
                        Action
                   i.   Evaluate the effectiveness of the action.




                                                              12
LESSON B: Basic Concepts in Vocational Nursing


OBJECTIVES:

B–I       LEGAL AND ETHICAL ISSUES

1. State and explain the two basic sources for
   contemporary law.
2. Differentiate between the civil and criminal law
3. List three roles of the nurse performing care from a legal standpoint

4. State the purpose of the nurse practice act

5. Explain at least three sources and purposes for the standards of care

6. Discuss the rationale for licensure for nurses

7.   Describe the legal responsibilities of the student nurse
8. Define and give examples of crime, tort, negligence, invasion of privacy, defamation of

     character, assault, battery

9. Explain the "Patient's Bill of Rights"

10. Discuss the nurse's legal responsibilities & obligations

11. State at least 10 key concepts of legal issues in nursing

12. Discuss legal implications of negligence




CONTENT:

         A. Sources of contemporary law
                          1.   rules
                          2.   regulation
                          3.   mores
                          4.   norms
                          5.   English Common Law
       B. Civil vs. criminal law

                          1. Definitions of civil law
                          2.   Definitions or criminal law

      C. Legal implications of the role of the nurse
                          1. Knowledge of scope of practice
                        2. Hospital policies and procedures
                        3. Accountability and responsibility for actions
      D. Legal and Ethical Issues
                        1. Privacy
                        2. Confidentiality
                        3. Competent care
                        4. "Chain of command"
                        5. Mandatory reporting of abuse and neglect
                                                             13
              6.    Accidents, mistakes & errors (Unusual
                    Occurrence reporting)
                        a. Definition of incident report
                        b. Occurrences requiring incidence reports
                        c. Uses for incident reports and where documentation is stored
                        d. Role of the student nurse when an unusual occurrence requires an
                            incident report
              7.    Board of reportable offenses
              8.    Durable Power of Attorney for Heath Care
              9.    Living wills
              10.   Patient Bill of Rights and Responsibilities


E.   Nursing responsibilities related to:
         1.   Physician's orders
         2.   Incident reports
         3.   Controlled Substances
         4.   Good Samaritan Laws
         5.   Contracts
         6.   Staffing ratios
         7.   Reporting statutes
F.   Key concepts regarding legal issues in Nursing
G.   Legal implications of Negligence
H.   Responsibilities of the Student Nurse
                      Define:
                            1.   Crime
                            2.   Tort
                            3.   Negligence
                            4.   Abandonment
                            5.   Invasion of privacy
                            6.   Defamation of character
                            7.   Assault
                            8.   Battery
                            9.   Malpractice




                                               14
B – II   NURSING PROCESS


         OBJECTIVES:

         1. Define the nursing process.
         2. Define the terms related to the nursing process.
         3. Outline the phases of the nursing process.
         4. Describe the methods to collect data.
         5. List the steps use in planning client care.
         6. State the rationale for developing a nursing care plan.
         7. Discuss the purpose of evaluation and the nursing process.



         CONTENT:

         A. Definitions
                1.        Nursing Process
                2.        Objective & subjective data
                3.        Assessment
                4.        Problem
                5.        Goals
                6.        Plan
                7.        Implementation
                8.        Evaluation
                9.        Nursing care plan

         B. Phases of the nursing process
         C. Methods for data collection

         D. Nursing Care Plan
                 1.       Steps of the nursing care plan
                 2.       Rationale for the nursing care plan
         E.Purposes for evaluation in the nursing process

         F.Role of the vocational nurse in the nursing process




                                                         15
B – III COMMUNICATION SKILLS


OBJECTIVES:


1.    Define communication
2.    Describe factors affecting the communication process
3.    Describe the nature of communication
4.    Explain the purposes of communication
5.    List each element of the communication process
6.    Discuss the role communication plays in the nursing process
7.    Describe the phases of the therapeutic relationship
8.    Explain the role communication plays in the performance of the nursing care measures
9.    Identify factors that promote and inhibit effective communication
10.   Discuss nursing interventions for worry, anxiety, fear, anger, denial, self-pity, depression & over
      dependence




CONTENT:



                 a.    Definition
                 b.    Factors influencing communication process
                       1. Perception
                       2. Values
                       3. Development
                       4. Space and territoriality
                       5. Emotions
                       6. Socio-Cultural background
                       7. Knowledge
                       8. Roles and relationships
                       9. Environmental setting
                c.    Types of communication
                       1. Interpersonal
                       2. Public
                       3. Verbal
                       4. Non-verbal
                d.    Purposes of communication
                       1. Association
                       2. Transmission
                       3. Establishing contracts
                e.    Elements of Communication Process
                       1. Sender
                       2. Message
                       3. Receiver
                       4. Feedback
                f.     Role of Communication in the Nursing Process
                g.     Phases of a therapeutic relationship
                                                       16
               1.  Pre interaction phase
               2.  Orientation
                       a. Testing
                       b. Building trust
                       c. Identifying problems and goals
                       d. Clarifying roles
                       e. Forming contracts
               3. Working phase
                       a. Confrontation
                       b. Immediacy
                       c. Self-disclosure
                       d. Integrating communication with nursing
                         actions.
               4.Termination
                       a. Evaluation of goal achievement
                       b. Separation
      h.       Role of communication in performance of nursing measures.

      i.       Factors which promote and/or inhibit effective communication
                      1.    Movement
                      2.    Vocabulary
                      3.    Denotative and connotative
                      4.    Pacing
                      5.    Intonation
                      6.    Humor
                      7.    Clarity and brevity
                      8.    Timing and relevance
                      9.    Appearance
                      10.   Posture and gait
                      11.   Facial expression
                      12.   Eye contact
                      13.   Gestures
                      14.   Touch

 j.            Communication Interventions for:



1.         Anxiety
2.         Worry
3.         Fear
4.         Anger
5.         Denial
6.         Self-pity
7.         Depression
8.         Over dependence

k.            Client Teaching




                                              17
B – IV CLIENT TEACHING

OBJECTIVES:

Describe the similarities and differences between teaching and learning
1. Identify the purposes of client teaching
2. Compare the communication process with the teaching process
3. Describe the domains of learning
4. Differentiate those factors that determine readiness to learn from those that determine
   ability to learn
6. Identify principles of effective teaching
7. Apply client teaching in the nursing process
8. Describe the importance of attention set, motivation, psycho social adaptation, developmental
   capability.

CONTENT:

1. Teaching and learning similarities and differences
2. Purposes for client teaching.
3.Communication process compared to teaching process.
4.Domains of learning
5.Factors differentiating readiness to learn from ability to learn.
6.Principles of effective teaching.
7.Integration of client teaching in the nursing process.
8.Basic learning principles related to:

                                   a.   Attention set
                                   b.   Motivation
                                   c.   Psychosocial adaptation
                                   d.   Developmental capabilities




                                                           18
B – V DOCUMENTATION



OBJECTIVES:

  1.   State the general rules for charting

  2.   Explain the importance of documentation

  3.   Describe the relationship of charting and the nursing process

  4.   Identify different forms of charting

  5.   Explain the concept of confidentiality

  6. Create at least one example of charting the initial assessment of a client

  7. Create at least one example of charting the initial assessment of a client.



CONTENT:

           a. General rules of charting
                    1. Rules for charting

                    2. Importance of documentation and legal issues

                    3. Charting and the nursing process

                    4. Types of charting

                    5. Confidentiality

           b. Examples of charting the initial assessment of a client .

           c. Types of patient records

           d. Basic guidelines for documentation

               1. Narrative charting

               2. Daily assessment

               3. Admission and Discharge

           e. Medical Terminology and Abbreviations




                                                       19
B – VI ADMISSION AND DISCHARGE

OBJECTIVES:

Explain the rationale for introducing the client to the staff and to the new environment
1. Discuss the rationale for orienting the client to the role expectations and of the client
2. Describe various physical and emotional needs clients may have on admission and
    discharge
4. State initial observations which must be made by the nurse
5. List information which must be obtained on admission and discharge
6. Describe the nurse's responsibility for the client's personal property
7. Identify the equipment needed for the admission process
8. List the hospital department that may be involved in the admission and discharge
9. Discuss the nursing care plan with goals for discharge
10. Describe the discharge planning team
11. Outline special services often needed for extended care, long term care and home care.


CONTENT:




A. Rationale for introductions
        a. Staff
        b. New environment

B. Rationale for orientation to role of the client
        a.   Unit rules
        b.   Staff expectations
        c.   Client views of client role
C. Admission procedure
        a.   Client needs on admission and discharge
                i. Physical
                    ii. Emotional
        b.   Initial admission observations by the nurse
        c.   Required admission information
        d.   Equipment required for admission
        e.   Personal property
                  i.Nurse's responsibilities
                  ii. Property safety options
                  iii. Discharge responsibilities
D. Hospital departments involved in admission and discharge of clients

E. Discharge planning
        a.   Nursing care plan goals
        b. Discharge planning team members and responsibilities

F.   Medical terminology and abbreviations




                                                           20
B – VII MEDICAL TERMINOLOGY AND MEDICAL ABBREVIATIONS

OBJECTIVE:


Define medical/nursing terminology.
1. List 5 each of the following: prefixes, suffixes, and roots.
2. Enumerate the 40 most commonly used abbreviations.
3. Discuss and contrast the axial and the appendicular subdivision of the body.
4. Identify specific anatomical regions in each area.
5. List and define the principal directional terms and sections/planes used in describing and the relationship of
    body parts to one another.
6. List 9 abdominal regions and the abdominal quadrants.




CONTENT:

                1. Definition of Medical Terminology
                2. Examples of medical terms
                       a. Root words
                       b. Suffixes
                       b. Prefixes
                3. Common Abbreviations
                                  1. Time
                                  2. Weights and measures
                                  3. Body regions, sections, parts
                                  4. Diseases
                                  5. Latin prepositions
                                  6. Titles of health care priorities, departments & procedures
                4. Anatomical Regions and Planes of the Body
                                  4.1 Regions
                                          a. Upper and lower extremities
                                          b. Head and neck
                                          c. Thorax
                                          d. Abdomen
                                  4.2 Planes, directions & surfaces
                                          a. Sagital, transverse, midline
                                          b. Proximal vs. distal
                                          c. Ventral, dorsal, front, back
                5. Uncommon abbreviations and safety issues.




                                                        21
LESSON C: BASIC VOCATIONAL NURSING SKILLS AND PROCEDURES

C–I   VITAL SIGNS

      OBJECTIVES:
        1. State the basic components of vital signs.
        2. List factors that can cause variations in vital signs.
        3. Define terminology related to vital signs.
        4. Identify the normal ranges of vital signs.
        5. Describe the protocol for reporting and recording vital signs.
        6. State the procedure for measuring height and weight in an adult.

      CONTENT:

      a. Components of Vital Signs
                    1. Temperature
                    2. Pulse
                    3. Respirations
                    4. Blood Pressure
                    5. Pain level

      b. Factors which Causes Changes in Vital Signs
                      1. Temperature
                      2. Physical Exertion
                      3. Effect of Illness
      c. Situations where Vital Signs should be taken
                      1. Admission
                      2. Hospital routine
                      3. Before and after surgical procedures
                      4. Before and after invasive diagnostic procedures
                      5. Before and after medication administration
                      6. Changes in general condition
                      7. Before and After Nursing Interventions Influencing Vital Signs
                      8. Nonspecific symptoms of physical distress and stress.
      d. Normal Temperatures for adults
                      1. Oral
                      2. Rectal
                      3. Axillary
      e. Factors which cause variations in Body Temperature
                      1. Age
                      2. Exercise
                      3. Hormonal Influences
                      4. Diurnal Variations
                      5. Stress
                      6. Environment
                      7. Ingestion of hot/cold liquids

      f. Procedure for taking oral temperature in adults
                       1. Steps
                       2. Length of time

                                                       22
                 3. Length of insertion
g. Procedure for taking axillary temperature in adults
                 1. Steps
                 2. Length of time
h. Safety factors required when taking temperatures
i. Equipment used to measure body temperature
                1. Glass thermometer
                2. Digital thermometer [Electronics]
                3. Disposable single use thermometer strip
j. Temperature Conversion formulas
                 1. To convert Fahrenheit to Centigrade

                 2. To convert Centigrade to Fahrenheit i.

k. Definitions
                          1. Hypothermia
                          2. Hyperthermia
                          3. Pyrexia
l. Factors effecting pulse/respirations/blood pressure
                          1. Age
                          2. Body build
                          3. Blood pressure
                          4. Drugs
                          5. Exercise
                          6. Foods
                          7. Temperature
                          8. Disease processes
                          9. Pain
m. Characteristics of pulse
                          1. Pulse
                          2. Pulse deficit
                          3. Tachycardia
                          4. Bradycardia
                          5. Dysrhythmia
n. Common pulse points
                  1. Apical
o. Normal pulse rate
                  1. Normal adult
                  2. Athletes
                  3. Men
                  4. Women

p. Respiratory patterns
                 a. Dyspnea
                 b. Tachypnea
                 c. Shallow
                 d. Cheyne-stokes
                 e. Hyperventilation
                 f. Kussmaul's respirations
q. Definitions use to describe respirations

                                                 23
                 1. Crackles
                 2. Rhonchi
                 3. Stertorous
                 4. Stridor
                 5. Wheezing
r. Define
                  1. Blood pressure
                  2. Hypertension
                  3. Hypotension
s. Equipment used for measuring blood pressure
                  1. Sphygmomanometer
                  2. Stethoscope
t. Principles related to blood pressure
                  1. Brachial artery
                  2. Cuff size
                  3. Palpate the brachial artery
                  4. Inflation
                  5. Deflation
                  6. Listen
u. Korotkoff sounds
                  1. Tapping
                  2. Swishing
                  3. Knocking
                  4. Muffling
                  5. Silence
v. Recording vital signs
                  1. Charting / graphing of vital signs
                  2. Abnormal vital signs protocol

w. Height and Weight
x. Metric System/Conversion Factors




                                                   24
C – II Height and Weight


OBJECTIVES:

1. State the purpose of asking the client "How much do you weight?" and "How tall are
   you?"
2. Give the purpose for weighing a client before breakfast.
3. Relate the rational for weighing at the same time on the same scale
4. List types of scales and state when they are used.
5. State the purpose for the use of barrier on the scale.
6. State the procedure for measuring weight in an adult.
7. List the steps in the procedure for obtaining a height in an adult.
8. Convert kilograms to pounds and reverse; centimeters to inches and reverse

CONTENT:



A.     Rationale for obtaining "Stated height and weight"
B.     Rationale for weighing before breakfast
C.     Factors influencing accuracy of weight.
       a. Routine time
       b. Same Scale
       c. Clothing

D.     Types of scales
       a. Standing platform
       b. Bed scales
                i. Sling with hydraulic lift ii. Flat board with
               lift
       c. Chair scale

E.     Rationale for use of barrier on scale
F.     Steps involved in weighing a client
       a. Obtain appropriate working scale for client
       b. Apply sanitation barrier
       c. Balance scale including barrier, clothing or other linens
       d. Assist client to scale
       e. Weigh & record weight
       f. Assist client away from scale
       g. Employ safety measures throughout process
       h. Record weight appropriately using correct conversions

G.     Steps for obtaining client height
H.     Convert
       a. Kilograms to pounds
       b. Pounds to kilograms
       c. Centimeters to inches
       d. Inches to centimeters




                                                         25
       C – III Metric System/Conversion Factors


       OBJECTIVES:

        1.        Define the Apothecaries and the metric system.
        2.        Review the household measurements.
        3.        State the rationale for converting measurements between systems.
        4.        Explain the process of converting measurements within one system.
        5.        Summarize the process of converting measurements between systems.
        6.        List the metric, apothecary and household equivalents.
        7.        Practice converting measurements from household equivalents.
        8.        Practice converting measurements from household or apothecary to the metric system.




CONTENT:




A. Apothecaries
                                 a. Units of measurement
                                 b. Common abbreviations
                                 c. Units of measurement
                                 d. Common abbreviations

B.     Household Measurements
                     1. Units of measurements
                     2. Common abbreviations

C.     Rationale for Conversion
D.     Conveliing Measurements in the same system
E.     Converting from one system to another
F.     List Equivalents
                        1. Metric
                        2. Household
                        3. Apothecary




                                                        26
C – IV MEDICAL ASEPSIS AND INFECTION CONTROL


            OBJECTIVES:




                         1. Define the following terms: antiseptic, contaminated, friction, germicides medical
                             asepsis, microorganisms, pathogenic, portal of entry, portal of exit.
                         2. State ways in which microorganisms move from one area to another.
                         3. State basic infection control guidelines related to handling linens and
                             disposition of soiled articles.
                         4. List body substances included in [CDC, 1988] UNIVERSAL
                             PRECAUTIONS
                         5. Identify situations requiring gloves, eye protection, masks, caps, gowns, or
                             aprons
                         6. List body substances for which gloves are worn that are not
                             included in Universal Precautions.
                         7. State when hand washing is indicated.
                         8. State the effects of friction.
                         9. Describe correct hand washing techniques
                         10. State personal hygiene guidelines related to hair, fingernails, and jewelry ..
                         11. State the greatest risk when using bar soap.
                         12. Give reasons for keeping the hands and cuticles well lubricated.

            CONTENT:

            A. Definitions:

            1. Asepsis
            2. Sterility
            3. Handwashing
            4. Chain of infection
            5. Prevention of infection
            6. Nosocomial infections
            7.Standard precautions
                        i. Gloves
                       ii. Gowns
                      iii. Eye protection
            8. Isolation Techniques
                      i. Respiratory
                      ii. Contact
                      iii. Reverse



            B.      Methods of Transmission of Microorganisms
                       1. Infected Water
                       2. Raw Vegetables
                       3. Vectors

                                                    27
            4.   Direct Contact
            5.   Sexual Contact
            6.   Airborne
            7.   Droplet Spread

10.   Infection Control Measures When Handling Linen
11.   Body Substances

       1.   Blood
       2.   Urine
       3.   Sputum
       4.   Emesis
       5.   Vaginal Secretions
       6.   Amniotic fluids
       7.   Peritoneal Fluid
       8.   Thoracentesis Fluid
       9.   Spinal Fluid

E.     Uses of gloves, eye protectors and aprons
       1. Surgical procedures
       2. Generation of droplets
       3. Splashing blood or body fluids


F.     Situations requiring gloves not included in Universal Precautions


       1.   Administration of injections
       2.   Application of topical preparations
       3.   Emptying drainage bags, e.g., bile, urine, etc.
       4.   Perineal care
       5.   Handling soiled linen

G.     Indications for hand washing
       1. Before and after contact with all clients
       2. After touching organic material
       3. Before performing procedures
       4. Before and after handling dressings
       5. After handling contaminated equipment
       6. Between contact with different clients

H.     Rationale for friction, running water and cleaning agents for hand washing.
I.     Steps in hand washing
J.     Guidelines R/T to hair, fingernails, and jewelry
K.     Disadvantages of bar soap
L.     Rationale for lubricating hands and cuticles




                                        28
C – V SAFETY

OBJECTIVES:

1. Define vocabulary related to hospital/client environment.
2. Discuss purposes of space and how a nurse can respect the client's space.

3. Describe how to maintain the client's right to privacy.

4. Describe specific environmental factors that contribute to the comfort and safety of the client.

5. List the common types of injury that may occur in the hospital setting.

6. Discuss the effects of sensory deprivation for the client.

7. Identify personnel and committees that are involved in maintaining a safe, comfortable and the therapeutic

     environment in the hospital.

8.   Discuss rationale for using restraints.

9. Define the terms:
        a. Immobilized
        b. Legal rights
        c. Limb holder
        d. Chemical restraints
10. Explain the Bill of Rights regarding consent of the client,
    family, or guardian and written medical orders for use of restraints.

11. Discuss the procedure for applying various physical restraints.

        CONTENT:

                 A.      Define vocabulary related to hospital/client environment.

                 B.      Definitions:
                         1. Air Pollution
                         2. Carbon Monoxide
                         3. Carcinogen
                         4. Decibels
                         5. Relative humidity
                         6. Sensory overload
                         7. Pathogens and parasites

                 C       Purpose of Space
                         1. Importance of space
                         2. Nurse's role in protecting client space

                 D.      Maintaining the client's right to    privacy
                         1. Screening
                         2. Requesting family/friends to leave the room
                         3. Draping
                         4. Client consent to view procedures

                 E.      Environmental factors related to comfort & safety

                                                             29
      1. Temperature of room
      2. Relative humidity
      3. Physical hazards
      4. Carcinogens
      5. Pathogens
      7. Pollution
      8. Developmental factors

F.    Effects of Sensory Deprivation
      1. Cognitive
               a. Decreased learning
               b. Bizarre thinking
      2. Affective
               a. Boredom
               b. Restlessness
               c. Increased anxiety
      3. Perceptual
               a. Decreased attention span
               b. Confusion

G.    Personnel for Maintaining Client Environment
             a. Nursing staff
             b.House-
               keeping
             c.Engineering

F.    Common Hospital Injuries
      1. Falls
      2. Client-Incurred Accidents
      3. Procedure-Related Accidents
      4. Equipment-Related Accidents

G.   Fire Safety

I.   Earthquake Safety

J.   Disaster Preparedness

K.    Patient Safety
      1. Fall Precautions
      2. Restraints
          a. Reasons to use restraints
          b. Title XXII and legal rights of the elderly
               i. Necessity for family or client written consent
              ii. Written medical orders for use of any restraint
      3. Physical Restraints
          a. Wrist
          b. Vest
          c. Side rails
          d. Wheel chair safety
          e. Hand mitts
                                      30
C – VI BODY MECHANICS AND PATIENT MOBILITY


A.   PRINCIPLES OF PROPER BODY MECHANICS

OBJECTIVES:

1.   Define the following terms: body mechanics, body alignment, gravity, center 0 muscle tone., leverage, friction,
     base of support

2. State the purpose for maintaining good body alignment in all activities of daily [ADL].


CONTENT:

                 A.      Correct Posture
                         1. Sitting
                         2. Standing
                         3. Lying down

                 B.      Principles of body mechanics
                         1. Base of support
                         2. Use of knees & thigh muscles
                         3. Straight back
                         4. Use of rolling, wheels, other devices

                 C.    Terminology

                         1. Gravity
                         2. Energy
                         3. Balance
                         4. Center of gravity
                         5. Base of support
                         6. Alignment
                         7. Pivot
                         8. Leverage

                 D.      Risk of poor body mechanics
                         1. Strains/Sprains
                         2. Dislocations
                         3. Fracture
                         4. Client injuries




                                                         31
B. IMMOBILIZED CLIENT

OBJECTIVES:

1.   List causes of immobility
2.   Discuss the effects of immobility on each body system
3.   Identify and discuss risk factors associated with immobility
4.   List nursing diagnoses for the risks of immobility
5.   State the major nursing goals for the immobilized client
6.   Outline nursing interventions for the completely or partially immobilized client
7.   Summarize nursing interventions for the prevention and treatment of decubitus ulcers

CONTENT:
                A.      Conditions Causing Immobility
                        1. Cardiovascular conditions
                        2. Neurological conditions
                        3. Musculoskeletal conditions
                        4. Respiratory conditions
                        5. Other conditions

                B.      Risks and Effects of Immobility
                        1. Physiological
                                 a. Metabolic system
                                 b. Respiratory system
                                 c. Cardiovascular system
                                 d. Integumentary system
                                 e. Musculoskeletal system
                                 f. Urinary
                                    system
                        2. Psychological
                           stress

                 C.     Nursing Diagnosis of the immobilized client

                 D.     Goals of immobilized clients
                        1. Promote optimum mote function
                        2. Prevention of disability and deformities
                        3. Increased mobility
                        4. Increased circulation
                        5. Increased systemic function

                E.       Nursing interventions for the immobilized clients

                F.      Nursing care for decubitus ulcers
                        1. Pressure-relieving beds and mattresses
                        2. Stages of ulcer development
                        3. Body positioning
                        4. Universal precautions
                        5. Topical medications
                        6. Dressings


                                                        32
C. RANGE OF MOTION EXERCISES

OBJECTIVES:

1.   Define terms related to positioning
2.   State the purpose of exercise
3.   State at least two purposes of Range of Motion Exercises
4.   Discuss at least two major contraindications for ROM
5.   List types of joints
6.   Name the two types of ROM
7.   Describe the procedure and sequence for exercising joints
8.   Explain the frequency of ROM and the best times for the nurse to perform ROM
9.   Create an example of charting ROM including all data

CONTENT:

                A. Purposes
                B. Contraindications
                C. Types of ROM
                D. Procedure
                E. Frequency
                F. Scheduling for ROM
                G. Examples of charting ROM




                                                      33
D. ANTI- EMBOLIC DEVICES

OBJECTIVES:

1.   Define anti-emboli devices.
2.   Describe at least 2 methods of preventing embolism in the immobilized client.
3.   Explain the procedure for applying TEDS.
4.   Discuss the usual safety measures related to the use of anti-embolism devices.

CONTENT:

                 A. Anti-embolism devices
                 B. Methods for preventing embolism on partially immobilized client.
                 C. Procedure for applying TEDS
                 D. Safety measures related to the use of anti-embolism devices




                                                        34
E. POSITIONING

OBJECTIVES:

1. Explain at least four reasons for changing a client's position
2 State the frequency for changing position
3. Discuss the dangers of maintaining the same position for the immobilized or partially immobilized
   client
4. Describe the use of different assistive devices for positioning clients
5. List the most common position used to promote client comfort
7.Create a sample of charting after repositioning a client including the pertinent data.


CONTENT:

                A.      Reasons for changing the position of the client
                B.      Frequency for changing positions
                C.      Devices used for repositioning
                D.      Positions of comfort
                E.      Examples of charting of repositioning




                                                       35
F.    ASSISTING WITH MOBILITY

          1. TRANSFERS

OBJECTIVES:


     1.   Describe the procedure for transferring the client moving up in bed, bed to chair, bed to
          stretcher, chair to bed
     2.   Explain at least three safety factors practiced while performing a transfer
     3.   List common hazards encountered during a transfer
     4.   Explain the importance of knowing the diagnoses and capabilities of the client


CONTENT:

                  A.      Procedure for transfer
                          1. Moving up in bed
                          2. From bed to chair
                          3. From bed to stretcher
                          4.From chair to bed
                  B.      Safety factors involved in transfers
                  C.      Common hazards involved in transfers
                  F.      Rationale for knowing the client’s diagnoses and capabilities




          2. AMBULATION

OBJECTIVES:


     1.   List common hazards of ambulation and of using assistive devices
     2.   Explain the importance of knowing the diagnoses and capabilities of the client
     3.   Describe methods to support the client during ambulation
     4.   Discuss various gaits used for walking with a cane, walker or crutches
     5.   Create a sample of charting after ambulating a client including the important data

CONTENT:

                  A.      Common hazards of ambulation and assistive devices
                  B.      Rationale for knowing the client's diagnoses and capabilities
                  C.      Methods to support the client while ambulating
                  D.      Gaits used with assistive devices
                          1. Canes
                          2. Walkers
                          3. Crutches
                  E.      Examples of charting ambulation




                                                          36
C – VII   PATIENT HYGIENE AND ENVIRONMENTAL CARE

A.   COMPONENTS OF PATIENT HYGIENE
B.   BED SIDE ENVIROMENT
C.   BED BATH


OBJECTIVES:

1. Discuss factors influencing hygienic practices: body image, economic level,
   knowledge, socio-cultural variables, personal preferences, physical conditions
2. Describe AM. Care including use of the bedpan and hand washing

3. Explain procedures for after meal care

4. State the procedure for P.M./H.S. care

5. List equipment needed for bed baths

6. Explain the procedure for forming a "hand-mitt"

7. State the correct temperature for bath water

8. Differentiate between procedures for cleansing male and female genitalia

9. Describe the procedure and the usual times for giving a back rub

10. Explain proper nail and foot care

11. Discuss different types of oral hygiene needs

12. Describe hair care procedures for clients of various cultures and physical needs

13. State methods to remove the gown from the client with an intravenous infusion or other hindering

     device

14. Explain the bed bath procedure

15. Discuss specific alterations in the bath procedure for clients from at least two different ethno-

     cultural groups

16. List the items to be recorded concerning the bath procedure




                                                          37
CONTENT

     1. Factors Influencing Hygienic Practices
                      a. Body image
                      b. Economic status
                      c. Knowledge
                      d. Socio-cultural variables
                      e. Personal preferences
                      f. Physical conditions
     2. A.M. Care
                      a. Bedpan
                      b. Mouth care
                      c. Hand washing
     3. After meal Care
     4. Equipment used during the bath
                      a. Bath towels
                      b. Wash cloths
                      c. Liquid soap or soap with dish
                      d. Lotion or cream
                      e. Deodorant/powder
                      f. Bath basins
                      g. Personal toilet articles (make-up, etc.)
                      h. Bath blanket
                      i. Clean linens & gown
                      i. Bedpan & or urinal,
                          toilet paper
                      k .Linen bag
                      l. Disposable gloves m.New
                      trash
                         bag
     5.Procedure for forming a "hand-mitt"

     6.Bath water temperature

     7.Female genitalia care

     8.Male genitalia care

     9. Back rub procedure and uses

     10.N ail and foot care

     11.Oral hygiene procedures
                     a. Regular mouth care
                     b. Denture care
                     c. Special mouth care




                                                     38
12.Hair care
13.Procedure for removing gown for client with intravenous infusion and other devices
14.Cultural and physiological responses to hospital bathing
                a. Adult Asian bathing and illness beliefs
                         i. Belief in "hot" versus "cold" illnesses
                         ii. Times of day for partial versus complete baths
                b. Alterations in the bath for persons of color
                         i. Use of special hair care products
                         ii. Special use of soap

15. Items for charting
                 a. Type of bath
                 b. Client's participation and need for assistance
                 c. Client's emotional and physical responses to the bathing process
                 d. Observations of skin, wound, etc. not previously noted




                                               39
D. BED MAKING


OBJECTIVES:




1.  Identify common types of beds.
2.  Identify the various parts of a hospital bed.
3.  State the purpose of side rails.
4.  Identify common bed positions.
5.  Identify pieces of linen used to make hospital beds.
6.  State the reason for using a draw sheet.
7.  Give the major advantage for the toe pleat
8.  Differentiate between the open, closed, occupied and unoccupied bed
9.  State the principles of safety utilized in bed making.
10. Describe the steps taken to prepare a closed bed for a newly admitted patient
11. Describe the different type of corner used for bed making.
12. State principles of infection control and body mechanics related to bed making
13. Give the purpose of the post-op bed and explain how it is made.
14. State in sequence the steps of the procedure for making a closed, open unoccupied and post-
    op bed.
15. Describe modifications to bed making procedures that might exist in a long-term facility.




                                                 40
CONTENT:




     A.    Common types of Beds
     B.    Parts of a Bed
     C.    Purposes of Side Rails
     D.    Common Positions for the Hospital Bed
           a. Fowler's
           b. Semi-Fowlers
           c. Trendelenberg
           d. Reverse Trendelenberg
           e. Flat
     E.    Bed Linens
           a. Mattress pad
           b. Bottom sheet (contour or flat)
           c. Draw sheet
           d. Top sheet
           e. Blanket
           f. Spread (or counterpane)
           g. Pillowcases Linen Bag i. Pillows

     F.    Purpose of Draw (pull) sheet
           a. Positioning
           b. Other

     G.    Purpose of Toe-pleat
           a. Prevention of foot drop
           b. Other



     H.    Define
           a. Open bed
           b. Closed bed
           c. Occupied bed
           d. Unoccupied bed
           e. Surgical bed

     I.    Principles of safety in bed making
           a.   Universal precautions
           b.   Body mechanics
           c.   Neat and clean environment
           d.   Conservation of time and energy
           e.   Proper disposal of linen
           f.   Position of bed & side rails
           g.   Prevention of wrinkles
           h.   Placement of call light
           i.   Draping & privacy of client
                                                  41
      j.   Proper positioning of client

J.    Description of corners
      a. Box
      b. Miter

K.    Opening a Bed
L.    Principles of infection control
M.    Body Mechanics in bedmaking
 N.   Purpose of the Post-op Bed
O.    Steps to Bedmaking
P.    Modifications for long-term care facilities




                                               42
C – VIII INTAKE AND OUTPUT, SPECIMEN COLLECTION AND DIAGNOSTIC TESTS



A. INTAKE AND OUTPUT

OBJECTIVES:

1.    State the purpose for measuring intake and output.
2.    List what is considered or included as "intake".

3.    State the procedure for measuring intake.

4.    Give the amount of fluid an average adult requires in a 24 hour period.

5.    Convert household measurements to the metric equivalents.

6.    Convert the metric system to household measurements.

8.    List fluids considered or included as "output".

9.    Describe the procedure for measuring output.

10.   List pertinent information that should be recorded at the client's bedside.

11.   List pertinent information that should be recorded on the patient's chart.

12.   State the average urine output for one day and minimum for one hour.

13.   State the purpose [s] for measuring intake and output.

14.   List the types of patients for whom intake and output is essential.

15.   Describe how to teach a client to measure intake and output.



CONTENT:




      A. Purposes for I/O
            a. Determine general fluid and electrolyte status of person
            b. Aid in the formation of a diagnosis
            c. Assess the need for fluid increase or restriction
            d. Gain early clues to potentially dangerous physical situations.

      B. Examples of fluid on the client's tray
            a. Water/coffee/tea
            b. Jell-O
            c. Ice cream
            d. Wine
            e. Consomme/broth/soups
            f. Carbonated drinks/juices
            g. Milk/milk shakes/eggnog
            h. Infant cereals
            i. Popsicles


                                                         43
C. Fluids included as Intake
       a. P.O. fluids
       b. Gastrostomy feeding
       c. Intravenous fluids
       d. Blood/blood component's
       e. Jejunostomy feeding
        f. Peritoneal dialysis fluid
        g.   Irrigation fluids

D. Procedures for measuring intake


E.Usual fluid requirements for adult in 24 hour period.
        1.       Intake
       2.        Output
                     a. Minimum hourly kidney production of urine
        3.       Rationale for Intake and Output balance



F.Conversions of household measurements to metric system and visa versa



G.Fluids considered as output
         a. Emesis
         b. Urine
         c. Liquid feces
         d. Blood loss
         e. Wound drainage
         f. Thoracentesis
         g. Paracentesis
         h. Drainage bags
H.Procedure for measuring output
I. Charting information
         a. Bedside recording
                  i. Time
                  ii. Fluid
                  iii.Amount
         b. Client chart
                  i. Total 8° I & 0
                  ii. Total 24° I & 0

J. Examples of clients requiring I/O to be recorded
       a. Post surgical
       b. Unstable conditions
       c. Febrile conditions
       d. Fluid restorations
       e. Diuretic therapy
       f. IV therapy
       g. Cardiac conditions
       h. Renal diseases
       i. Declined health status

                                                44
K. Methods to teach client to measure I &O.
L. Maintaining hydration
M. Assisting with nutrition




                                              45
B. ASSISTING WITH DIAGNOSTIC TESTS
C. SPECIMEN COLLECTION



OBJECTIVES:
List at least five specimen commonly collected by the nurse
1.   State two reasons for checking the medical order before collecting a specimen

2.   State the rationale for reviewing the procedure before collecting the specimen

3.   Discuss reason for explaining the procedure to the client before attempting to collect the specimen

5.   State the four "rights" of obtaining laboratory specimen

6.   Describe the observations made by the nurse before, during, and after the collection of any specimen

7.   List the information needed to label a specimen correctly

8. Describe special handling and preparation of the client related to collection of urine, blood, sputum,

     wound drainage, CSF, other aspiration procedures.




                                                         46
CONTENT:

1. Specimens commonly collected by nurses

2. Rationale for checking medical orders before collecting
   specimen

3. Reasons to review procedure manual before collecting
   specimen
4.Responsibilities for explaining procedures to client before attempting specimen collection

                     a.   Legal issues
                     b.   Informed consent
                     c.   Client preferences
                     d.   Four "rights" for obtaining specimens
5. Specimen labeling

                     a.   Date and time
                     b.   Site
                     c.   Name of client
                     d.   Name of health care provider
                     e.   Test to be performed




6. Specific observations and responsibilities of the nurse assisting with collection of:

                     a.   Urine
                     b.   Blood
                     c.   Sputum
                     d.   Wound drainage
                     e.   CSF
                     f.   Thoracentesis
                     g.   Paracentesis
                     h.   Feces
                     i.   Culture




                                                          47
LESSON D- BASIC VOCATIONAL NURSING INTERVENTIONS

D – I BASIC NEEDS ASSESSMENT

OBJECTIVES:

1. Define basic needs, self-actualization, self-esteem, love, security, physiologic needs, & belonging according
   to Maslow's Hierarchy of Needs.
2. Explain physiologic needs.
3. Discuss whether love and belonging are more important than safety and security.
4. Describe how self-actualization may be delayed when the areas of the Hierarchy of Needs are missing.
5. Explain who the Hierarchy of Needs affects care of the client.
6. Define terms associated with pain, agonist, analgesic, biofeedback, antagonist, relaxation, meditation, PCA,
   endorphins.
7. Assist clients to describe sensations of pain and discomfort accurately.
8. Describe various techniques for relieving pain.
9. Evaluate and document effectiveness of measures used to relieve pain.



CONTENT:

       A. Definitions

                a. Basic Needs
                b. Self- Actualization
                c. Self- Esteem
                d. Love
                e. Security
                f. Physiologic Needs
                g. Belonging
                h. Maslow’s Hierarchy of Needs

       B. Physiologic needs

       C. Importance and relevance of the needs as presented in the Hierarchy

                a. Delay of self actualization
                b. Effects of the hierarchy of needs on the care of the client.

       E.Comfort Measures



                a. Methods to teach clients to describe sensations of pain and discomfort accurately

                b.Definitions
                         1. Pain
                                                         48
        2. Agonist
        3. Analgesic
        4. Biofeedback
        5. Antagonist
        6. 6. Relaxation
        7. Meditation
        8. PCA
        9. Endorphins

c. Techniques for relieving pain

d. Evaluation and documentation of effectiveness of measures to relieve pain.




                                      49
D – II PHYSICAL ASSESSMENT


OBJECTIVES:

1. Discuss the importance of performing an assessment at the beginning of the assignment for

  each assigned client

2. Define medical terminology associated with assessment.

3. Describe data collected during the assessment necessary for the nurse to perform safe

  nursing care

4. Outline methods for gathering information

4. Explain the procedure for performing the initial assessment of the client at the beginning of the

 assignment

6. Discuss how the assessment enables the nurse to make a nursing care plan



CONTENT:

        A. Importance of performing the initial assessment
        B. Definitions of medical terminology associated with assessment
                1. Auscultation
                2. Stethoscope
                3. Otoscope
                4. Edema
                5. Guaiac
                6. Pulse deficit
                7. Quadrant
                8. Turgor
                16.Wheeze
                17.Tremors
                18.Sputum
                19.Serosanguineous

        C. Data collected during the assessment necessary for safe nursing care
        D. Methods for gathering information
        F.Assessment procedure for the client at the beginning of the assignment
        G.Assessment in developing nursing care plans.
        H.Nursing health history
                1. Biographical data
                2. Reason for seeking health care
                3. Present illness/concerns
                4. Past medical history
                5. Family medical history
                6. Environmental history
                7. Psychosocial and cultural history
        I.System Assessment

                                                         50
D – III BASIC NUTRITIONAL THERAPY

OBJECTIVES:

1. Describe the 4 Basic Food Groups compared with the 6 groups of the Power Pyramid
   stating how these are essential for good nutrition
2.   Discuss nutritional needs throughout the life span

3.   List and discuss factors influencing client's dietary pattern & nutritional status

4.   Outline factors in the environmental affecting appetite

5.   Describe the optimal position for eating

6.   Explain measures/nursing actions which help reduce or relieve anorexia, nausea, & gas,

     and help the dysphagic client with swallowing

7.   List adverse reactions toward eating &/or being fed

8.   State the importance of monitoring the client's food intake

9.   Describe procedures for feeding adults clients safely
10. Write an example of dietary data to be recorded in client's chart




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 CONTENT:

A. Compare the Basic Four food groups with the Six Foods of the Power Pyramid
         a.   Milk & dairy
         b.   Meat versus meat & proteins
         c.   Fruit & vegetables versus separation of fruit
         d.   Bread & cereals
         e.   Non-foods

B. Nutrition through the life span
         a. Fetus
         b. Infancy
         c. Toddler
         d. Pre-School
         e. School Age
         f. Adolescence
         g. Early Adulthood
         h. Middle
              Adulthood
         i. Older Adulthood

C. Factors affecting client's nutrition
D. Environmental factors affecting client's appetite
E. Optimal position for eating

F. Measures/actions which help reduce or relieve anorexia, nausea, & gas, & help the dysphagic client with

     swallowing

G. Adverse reactions to eating &/or being fed

H. Importance of monitoring the client's food intake

I. Procedure for feeding adult clients

J.   Dietary data to be recorded in client's chart

K. Therapeutic diets

L. Nutritional supplementation

M. Age-related dietary modifications.




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D - IV MEDICATION ADMINISTRATION


OBJECTIVES:


1. Define key terms
2. Know the school policy on medication administration.
3. Identify the principles of safe medication administration.
4. Discuss potential liabilities for the nurse administering medications.
5. Explain procedures for the various methods of medication, including choice of route and site.

CONTENT:
                                a. Mathematics Review
                                b. Review of the metric system
                                c. Review of the apothecary system
                                d. General principles of medication
                                   administration
                                e Medication administration
                                          5.   PO
                                          6.   IM
                                          7.   SQ
                                          8.   Topical
                                f. Methods of positive patient identification with age related concerns
                                g. Age related Concerns




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