Adult Health Nursing Clinical (2 ) First Semester (2020

The University of Jordan/ School of Nursing /Clinical Nursing Department

Adult Health Nursing Clinical (2 )

First Semester (2020/ 2021)

Student log Book

Content

Clinical evaluation form (Appendix 1)

Nursing Care Plan ( Appendix 2)

Oral Clinical exam (Appendix 3)

Orientation program

Time Table

Clinical Area Related objective

(Appendix4)

Clinical Area Orientation checklist (

Appendix 5)

Evidence Base Research Article

guidelines (Appendix6)

Weekly objective (Appendix8)

Procedure manual list (template )

Procedure manual checklist evaluation

Clinical Training Instructions

(Appendix 10)

Evidence Base Research Article form

Clinical Rotation

Focus assessment

Common diseases and drugs

Course Coordinator

Tagreed Osama Shawashi RN, MSc

The University of Jordan Student Log

Distribution of clinical course marks

First rotation Second rotation

15% clinical evaluation 15% clinical evaluation

10% procedure exam 10% NCP

10% Oral exam 10% oral exam

Total = 35% Total = 35%

Written exam =30%

اسم المدرس رقم المكتب البريد الالكتروني الساعات المكتبية

م. تغريد شواشي [email protected] 126 ح 10-11 ,ن خ 3-2

م. ريم جراد [email protected] 118 ن / ث 3-2

ا. خالد وليد [email protected] 337 ن / ث 3-2

م. شيماء سعيد [email protected] 220 ن / ث 3-2

م. ايمان الحاج [email protected] 225 ن 2-3,ح 9- 10

ا. سليمان أحمد [email protected] 233 ن / ث 3-2

م. دانية بني هاني [email protected] 233 ن / ث )2-3 (

م. منار عليمات [email protected] 233 ن / ر )2-3 (

ا. ايسر الحرايزة [email protected] 233 ث /خ )2-3 (

م. اسيل عبد الله [email protected] 233 ث/ خ )2-3 (

ا. محمد القبالي [email protected] 233 ن/ ر )2-3 (

م. أ ريج البداوي [email protected] 233 ث/ خ )2-3 (

م. رزان الصعابنة [email protected] 233 ن/ ر )2-3 (

م. روان العكة [email protected] 233 ن/ ر )2-3 (

أ. ايمن عطا [email protected] 233 ث/ خ )2-3 (

mailto:[email protected]
















Adult Health Nursing (2) Clinical

First Semester (2021/2022)

Orientation Weeks )البرنامج التعريفي( لمساق تمريض صحة بالغين )2( العملي

الاسبوع الاول )11/ 10- 10/14(

(10/ 21 – 10/ 18) الاسبوع الثاني

الموضوع وقت المحاضرة التاريخ والوقت والمكان الشعبة

شعبة ن ر

Group A (6 قاعة)

Group B (7 مختبر)

10 /11

م. منار عليمات

ا. سليمان أحمد

10-8.30

10.30 -10

1.30-11.15

Arterial blood gases analysis

Break

Mechanical ventilators

شعبة ث خ



10/12

م. اريج البداوي

ا. سليمان أحمد

10-8.30

10.30 -10

1.30-11.15

Arterial blood gases analysis

Break

Mechanical ventilators

شعبة ن ر



13/10

ا. خالد وليد

م. ريم جراد

10-8.30

10.30 -10

1.30-11.15

(ECG) Arrhythmias

Break

Emergency medications

شعبة ث خ



10/14

ا. خالد وليد

م. ريم جراد + م. اسيل

10-8.30

10.30 -10

1.30-11.15

(ECG) Arrhythmias

Break

Emergency medications

شعبة ن ر



10/18

م . شيماء سعيد

م. محمد القبالي

10.00 -8.30

10.30-10.00

12.30-10.30

CPOT ,RASS, GCS

Break

Hemodynamic

عيد المولد النبوي 10/19 الثلاثاء

الشريف

شعبة ن ر


10/20

م. تغريد اسامة

م. ايمان الحاج

10.00-8.30

10.30 -10.00

10.30-.3021

Course papers

Break

Infection control + COVID 19

شعبة ن ر


10/20

م. دانية بني هاني


10.00-8.30

10.30 -10.00

10.30-12.30


Break

Course papers


*اعزائي الطلبة اود اعلامكم بان حضور البرنامج التعريفي للمساق لجميع الشعب الزامي وسيتم احتسابه

المجموعات حسب الرقم التسلسلي للطالب في قائمة التسجيل

ن ر

Group A (from student no. 1-50) (6 قاعة)

Group B (from student no. 51-93) (7 مختبر)

ث خ

Group A (from student no. 1-50) (6 قاعة)

Group B (from student no. 51-94) (7 مختبر)

شعبة ث خ


10 /21


م. شيماء سعيد

م. ايمان الحاج

10.00 -8.30

10.30 -10.00

10.30-00.12

12.00-12.15

12.15-13.30

Course papers

Break

CPOT ,RASS, GCS, Hemodynamic

Break



10 /21

م. دانية بني هاني

م. تغريد الشواشي

أ. ايسر الحرايزة

10.00 -8.30

10.30 -10.00

10.30-12.00

12.00-12.15

12.15-13.30

CPOT ,RASS, GCS, Hemodynamic

Break

Course papers

Break



Appendix (1)



Clinical Evaluation Tool

Student name: ………………………. Evaluation Grade System (Rating Scale *)

Instructor name:……………………...... Zero: Unsafe clinical practice, continuous assistance

Clinical area /rotation:………………… 1: Needs Improvement, mostly unsafe and regularly need assistance

Evaluation mark (15 )……………. 2: Performs as expected for this level, safe but still need infrequent assistance

3: Exceptional performance - consistently exceeds expectation, safe, rarely need assistance

N/A Not applicable or Performance Criteria not appropriate for this clinical setting

I .Knowledge Base and cognitive skills

(bed side discussion)

score

0 1 2 3

A) Define disease process

B) Summarize Pathophysiology of the disease process

C) Interpret diagnostic criteria

D) List risk factors and manifestations

E) Explain the rationale for therapy e.g., medication;

its action, side effect, nursing implications.

F ) Interpret changes in the client's condition:

Laboratory data.

Diagnostic (CT SCAN, ERCP….).

G) List the potential complications associated with the

patient's diagnoses and describe preventive measures.

H) Relate the patient's condition to the evidence-based

practice (with NCP) Appendix (6)

II. Nursing process (bed side discussion)

Score

0 1 2 3

A) Formulate a complete nursing data via Subjective

and objective data

B) Formulate nursing diagnoses a according to

NANDA using PES (problem related to etiologic

evidenced by signs and symptoms)

C) Prioritize nursing diagnoses according to ABC

system (airway, breathing, circulation

D) Formulate short-term goal for each nursing

diagnosis. Using SMART criteria

E) List and apply appropriate nursing intervention

for his/her client with rationale.

G) use appropriate medical terminology in clinical

training settings


Evaluation Grade System (Rating Scale *)

Zero: Unsafe clinical practice, continuous assistance

1: Needs Improvement, mostly unsafe and regularly need assistance

2: Performs as expected for this level, safe but still need infrequent assistance



III. Interpersonal Relationships Score

0 1 2 3

A) Build a collaborative and therapeutic relationship

with patient and family / instructor and colleagues

(Bedside )

B) Adhere to clinical training rules (see attached papers

Appendix (10, 11)

C) Prepare weekly clinical objectives using SMART

criteria, including 3 domains of learning (physical exam,

knowledge and skills)

Appendix (8 )

D) Apply patient health education related to disease

process, therapeutic regimen, life style modification.

Appendix (7 )

E) Show commitment to the course (videos ,assignment

submission ,attendance teams meeting ) if on line

activated . (note book )

IV. Professional behaviour and sense of

responsibility

Score

0 1 2 3

A) Show evidence of preparation for clinical

assignments. (Assignments )

B) Prove initiatively for independent learning

activities (group leader )

C) Identify strengths, weakness and learning needs

with the instructor (objectives )

D) Discuss and participate in learning activities

during bed side discussions and conferences.

(preparation ,bedside discussion )

E) Apply all of the delegated responsibilities.

F) Improve performance according to suggested

instructions and accept instructor notes

(feedback )

G) Show commitment to notify instructor in

advance about tardiness or absenteeism

After the second absent discount 1.25 mark from

total )

H). Adhere to hospital policies, Jordanian nurses'

code of ethics and safety measures

( CPR ,Client Confidentiality, )


Evaluation Grade System (Rating Scale *)

Zero: Unsafe clinical practice, continuous assistance

1: Needs Improvement, mostly unsafe and regularly need assistance

2: Performs as expected for this level, safe but still need infrequent assistance



V . Psychomotor Skills (as medications, suction, oral care feeding,

CVP monitoring, withdraw blood sampling, ECG,)

Score

0 1 2 3

A)Show evidence of preparation ,participation during the skills

discussion and application

B) Show adequate environment preparation (privacy, clean

surrounding, proper lights, patient positioning

C) Verified the correct patient using two identifiers.

D) Introduce yourself to the client

E) Explain the procedure for the client

F) Prepare equipment correctly and adequately

G) Adhere to safety measures such as infection control (hand

washing, sterility, proper disposal of equipment)

H) Demonstrate competent and safe performance of the procedures

I) Document procedures appropriately.

Instructor comments

……………………………………………………………………………………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………………………………………………

(Student score -----*15 /105) Instructor signature


Appendix (2)



Nursing Care Plan

Instructions

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

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

3. Using abbreviations not allowed

4. Using symbols not allowed (- ,_ ,/ , X )

5. Heath assessment describe finding don’t use normal, good bad, abnormal terminology

6. Diagnostic Evaluation (Lab results, MRI, CT, ECG, etc….) according to the hospital polices

7. Add References for medications profile

8. Write at least (3) nursing diagnosis completely with Functional Health Pattern, Evidenced By/Defining

Characteristics, goal planned interventions, actual interventions & out com in order of priority.

9. For emergency students the focus infilling physical exam part will be on the affected system only

10. Attach Evidence Base Research Article related to Client Critical Health Problem

11. Submit in the due date as mentioned in the time table

*Second rotation

Due date for NCP (27/12 Mon/wed )

Due date for NCP (28/12 Tue /Thu)

12. Submission late for more than two clinical days not allowed you will get (zero mark)




Student Name: Date:

Clinical Area / rotation no: Evaluator:

Student mark out of 10 ( )

*****************************************************

Nursing Admission Data Base (5%)

Client ........................................... Age : ................ Sex: ..........................

Date of Admission (Transfer) : ..........................Via : .................................

Condition on arrival : Wheelchair.............. Walking............ Stretcher..........

Source of Data:

Spoken language:

Patient education: (1 Mark)

Reasons for Hospitalization and history of present illness: (1mark)

Confirmed Diagnosis: (1 mark)

Past medical history: (1Mark)

Past surgical history: (1 Mark)

ASSESSMENT ( Describe ) (10 Marks)

1. Health Maintenance - Perception Pattern . (2 Mark )

A : Smoking :

B : Alcohol :

C : Allergies (drugs, food, tape, dyes):

2. Activity / Exercise Pattern (Describe activity, feeding, bathing, dressing, toileting, mobility, & using assistive devices): -

( 2 Mark)

3. Nutrition / Metabolic Pattern (Describe): ( 2 Mark)

A : Prescribed diet :

B : Appetite :

C : Nausea :

D : Vomiting :

F : Dysphagia:


4. Elimination Pattern: ( 2 Mark)

A :

Last bowel motion date

B : Urinary Habits :-

Device

Colour

Frequency

Intake

Out put

Net balance

5. Cognitive / Conceptual Pattern: -

Discomfort / pain (OLDCART): ( 2Mark)

PHYSICAL EXAMINATION: (OBJECTIVE DATA): - (15%) based in focus assessment

1. A) General Survey: ( 2 Marks )

- Level of consciousness:

- General Appearance:

B) Vital signs with interpretation: (2 Marks)

C) CPOT /RASS if applicable (1Mark)

2. Nutritional - Metabolic Pattern (Describe): (4 Marks)

A : Skin : (1 mark)

Inspection

Palpation


B : Oral Cavity : (1 mark)

Lips

Mucous membranes

Tongue

C: Neck: (1 mark)

Carotid

jugular

D: Abdomen: (1 mark)

Inspection

Auscultation

Palpation / percussion

3. Activity- Exercise Pattern: (4.5 Marks)

A: Lung and Thorax ((2 Marks)

Breathing pattern

Palpation / percussion

Auscultation

Mechanical ventilators / oxygen therapy type


B: Cardiovascular: ( 2 Marks (

Peripheral pulses

Apical pulse

C: Musculoskeletal: (0.5Mark)

Range of motion

Joints assessment

4. Cognitive- Perceptual Pattern:- (1.5Marks )

A:Mental status: (able to calculate, thinking abstractly, memory, etc..):

B: Neurological status:

12 cranial nerves

Sensory

Motor

Refluxes


MEDICATION PROFILE ( 10% )

Allergies : ................................................................................................

Drugs and

Classification

( 1 Mark )

Indication for my

Patient

( 2 Mark )

Dose /Route/

Frequency

(1 Mark )

Contra-Indications

( 1 Mark )

Expected side

effects

( 2 Mark )

Nursing

Implications

( 3 Marks )

References:


Diagnostic Evaluation ((Lab results, MRI, CT, ECG, etc….)

References:

Date Test Performed

( 1 Mark )

Normal Value

( 2 Marks )

Patient

Value

( 2 Marks )

Interpretations & Nursing

Implications

(5 Marks)


Nursing Care Plan (write 3 complete nursing diagnosis according to priority )

Priority nursing

diagnosis

(6marks)

Functional Health

Pattern

(1mark)

Nursing Diagnosis

( 10 Marks)

Evidenced By/Defining

Characteristics

( 10 Marks )

Short-Term Goals

(5 Marks)

Planned Intervention

(With Rationale )

(10 Marks)

Actual Intervention

(5Marks)

The Outcome

(With Rationale)

( 3 Marks)

References:

Instructor comments for Nursing Care Plan

Mark out of 10 submitted once only

Student mark *10/100= total mark

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


Appendix (3)



Name of Student: ………………………………… Evaluator:…………………………...

Clinical Area / rotation no. :……………………………………... Date: / /20

Rating Scale *

3. Exceptional performance - consistently exceeds expectation

2. Performs as expected for this level

1. Needs Improvement

0. Unsafe clinical practice


Student score *10/75 = student score out of 10

Items Student Score

0 1 2 3 NA

I Medical diagnosis and Pathophysiology

1 discuss the client's medical diagnoses and chief complain , history of

present illness ,Family history ,medications history& Verbalizes accurate

information about surgical procedure if present

2 Discuss the definition and Pathophysiology of the disease.

3 Discuss the causes, risk factors, manifestations

4 Discuss diagnostic criteria, complications and medical interventions.

5 Relates Pathophysiology of disease(s) to patients’ assessment findings.

II Assessment

1 Perform comprehensive client assessments including history, subjective

(smoking allergy , ADL ,diet, elimination ,sleep and pain )

2 List abnormal Objective data in a systematic manner (focus assessment )

3 Demonstrates correct techniques for physical assessment based on

patient characteristics (bed side )

4 Recognizes abnormal client data during assessment( using correct terms

and description ) ( bed side )

III Medication

1 Recall client medication information including classification, route,

frequency& dosage.

2 Discusses the rationale for therapy ( indication)

3 Discuss the side effect of the medications

4 Calculate drug dosages correctly

5 States the nursing implications of the medications by performing

appropriate assessments prior to, during, and after medication

administration

IV Diagnostic tests

1 Recognize normal and abnormal data with unit of measurement

2 Interprets significance of lab and diagnostic tests

3 States the nursing implications of the diagnostic tests


V Needs and diagnosis (3 according to priority )

(Work only in one nursing diagnosis )

1 Formulates appropriate ND with correct problem statement and

Pathophysiology for client needs (Develops comprehensive list of ND

referring to NANDA ) three ND at least

2 Supports ND and problem statement with appropriate abnormal data

obtained from subjective and objective.

3

Establishes priorities of care in meeting identified needs of patients

VI Client Goal

1 Goal stem congruent with problem

2 Goal stem contains all components (SMART criteria)

VII Nursing interventions

1 Prepare clients for interventions/ during assessment

Safety measures (privacy .patient ID ,positioning , hand hygiene ,gloves

,mask)

communication (introduce self ,explain the procedure )

(Evaluate student at bed side part )

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

& diagnostic tests (5 different interventions )

3 Gives rationale for intervention

Comments……………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………

…………………………

…………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………

…………………………

…………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………

…………………………

……………………………………………………………………………………………………

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


Time Table Clinical Area


Semester Week Date Topic

First 11-14/10

Beginning of the orientation program and explanation of the course objectives and

papers in faculty labs. (Arterial blood gases analysis, Mechanical ventilators,

Emergency drugs, ECG analysis)

Second 18-21/10

Continuing the orientation program & seminars in the faculty labs Course (RASS,

CPOT and GCS , hemodynamic (video), Infection control, COVID- 2019

Hospital day /Skills Hospital day / Nursing care

Third 25-28/10

Orientation to different clinical unites in

the hospital According to orientation

tool paper

Application of (RASS, CPOT, GCS)

physical examination

demonstration(ICU ,CCU ,ER )

Triage (ER)

Handle client in critical care units and

emergency department.

Case Discussion for patient with

pneumonia (ICU)

Case Discussion for patient with ACS

(ER +CCU)

Medications discussion (antibiotics)

Anti platelets aggregation

,anticoagulant, antihypertensive )

Fourth 1-4/11

Training and Application of oral care

Training and Application of enteral

feeding

Handle medications (regular and

continuous infusion ) appropriately in

critical care .

Submission of assignments determined

by clinical instructor in each area


septic shock. (ICU)


Decompensate Heart Failure (CCU)


DKA (ER)

Medications discussion (narcotic

,sedatives ,high alert drugs)

Fifth

8-11/11

Training and Application of

eye care , close suction for

unconscious patient


hemodynamic monitoring

Handle medications appropriately in

critical care

Medication discussion (narcotic,

sedation, high alert, anticonvulsant )


CVA (ICU )

Case Discussion for patient with AKI

(CCU +ER)

Sixth

15-18/11

Procedure exam

First rotation oral exam

Case discussion for patient with

COPD ( ER ,CCU ,ICU )

Seventh 22-25/11 First rotation oral exam

Eighth

Beginning Of

The Second

Rotation

29/11-2/12

Orientation to different clinical unites in

the hospital According to orientation

tool paper

Application of (RASS, CPOT, GCS)

physical examination demonstration

Triage (ER)

Handle client in critical care units and

emergency department.


pneumonia (ICU)

Case Discussion for patient with ACS

(ER +CCU)

Medications discussion (antibiotics,

bronchodilators ,anti inflammatory )

Medications discussion (anti platelets

aggregation ,anticoagulant

,antihypertensive )


Ninth

6/12-9/12

Training and Application of oral care

Training and Application of enteral

feeding

Handle medications (regular and

continuous infusion) appropriately in

critical care.

Submission of assignments determined

by clinical instructor in each area


septic shock. (ICU)


Decompensate Heart Failure (CCU)


DKA (ER)

Medications discussion (Medications

discussion (narcotic ,sedatives ,high

alert drugs)

Tenth

13-16/12


eye care , close suction for

unconscious patient


hemodynamic monitoring

Handle medications appropriately in

critical care

Medication discussion (narcotic,

sedation, high alert, anticonvulsant )


CVA (ICU )

Case Discussion for patient with AKI

(CCU +ER)

Eleventh 20-23/12

Handle patient for NCP

Assign date for NCP (20/12 Mon/wed )

Assign date for NCP (21/12 Tue /Thu)


Head injury ( ICU ,CCU , ER )

Revision for all medications

Twelfth 27-30/12

Due date for NCP (27/12 Mon/wed )

Due date for NCP (28/12 Tue /Thu)

Second rotation oral exam

Thirteenth 3/1/2022-6/1/2022

Second rotation oral exam

Fourteenth

10/1/2022-13/1/2022

Final written exam

13/1/2022 Thursday


Appendix (4)

Adult Health Nursing (2) clinical


Clinical Areas Related Objectives

Write your objectives from the following list

ICU Objectives:

1- Identity unit equipment, machines capacity& health team members

2- Review pathophysiology of common diseases in the unit

3- Ascertain professional behaviour in dealing with client, their families' instructor, and health team members.

4- Interpret full intake and output charting interpret results and take appropriate Nursing interventions.

5- Interpret ECG for critically ill clients

6- Demonstrate hemodynamic monitoring for client with cardiac alterations critically

7- Operate different machine in the unit (cardiac monitor, infusion pump & ECG)

8- Demonstrate suctioning through (oral, ETT, and TT),

9- Analyse arterial blood gases (ABG) readings for critically ill clients

10- Apply pre-post-operative care for client with surgical intervention

11- Apply full physical assessment for assigned client

12- Assess level of consciousness using GCS for critically ill clients

13- Care for client on a mechanical ventilator.

14- Report accurately the condition of one assigned patient.

15- Handle medications appropriately in the units

16- Initiate and effectively assist in resuscitation. (CPR)

17- Provide post- mortem care

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

CCU Objectives:

1- Identity unit equipment, machines capacity& health team members

2- Review pathophysiology for cardiovascular alterations common in the unit


4- Interpret full intake and output charting interpret results and take appropriate Nursing interventions.

5- Interpret ECG for critically ill clients

6- Demonstrate hemodynamic monitoring for client with cardiac alterations critically

7- Apply full physical assessment for assigned client

8- Report accurately the condition of one assigned patient

9- Operate different machine in the unit (cardiac monitor, infusion pump & ECG)

10- Handle medications appropriately in the units

11- Formulate Nursing Care Plan (NCP) for critically ill clients in order of priority

12- Initiate and effectively assist in resuscitation. (CPR)

ER Objectives:

1- Identity emergency equipments, locates them, and how to operate them

2- Clarify the triage system used in emergency department

3- Describe pathophysiology of common emergency conditions.

4- List anticipated complications of the patient and intervenes accordingly


6- Handle correctly a client arriving to the ER.

7- Apply full physical assessment for assigned client within a reasonable period.

8- Complete the routine paperwork for accidents suicide cases.

9- Provide support to the patient's family.

10- Formulate appropriate presentation for the case of assigned client.

11- Assist in patient resuscitation( CPR)

12- Assist in transferring the client to their units

13- Handle medications appropriately.


Appendix (5)



Clinical Area Orientation Checklist

Student name: ………………………………………………

Instructor name: …………………………………………..

Clinical Area /Rotation no.: ……………………………………………….

Instructor Signature Student signature items No

Medical, nursing staff, and clerk 1-

Unit capacity 2-

Patient room(oxygen-suction-bed- ambu-bag) 3-

Linen cupboard 4-

Emergency trolley 5-

Defibrillator 6-

Dressing trolley 7-

Procedure sets (dressing set-cath set-cvp set-LP set) 8-

Narcotics+ controlled drugs & High alert 9-

Store supplies and IVF 10-

Refrigerator content 11-

ECG machine 12-

Cardiac monitor and central monitor(with all cables

and alarm system)

13-

Infusion pump-I vac- vascular decompression device 14-

Medical records 15-

Code system (CPR-Fire) 16-

laryngoscope 17-

Stylet 18-

Megil forceps 19-

Mouth gag 20-

Stethoscope 21-

Torch 22-

Waste disposable (sharp container) 23-

Computer system ( print out diagnostic test ) 24-


Appendix (6)

Evidence Base Research Article guidelines



Student name --------------------- Clinical instructor ----------

Clinical area ---------------------------- rotation no. ----------------

Mark ( / 3)--------------------------

Summary of the Research Article (2) :

Evidence base research article Updated for the last seven years at least (2015 & above)

Related to the client condition adopted in the NCP (disease process medical management nursing

intervention or any related research topic to the critical care setting)

Provide hand writing summary for the topic using your own words rather than author words.

Summary should include (sample, setting, aim of the study, design of the research, result)

Citation APA Style (1):

Citation of the reference should be included as the following styles:

Name of the research author (s), research topic, name of the journal (Italic ), year of publication,

volume: issue number of pages.

Font size (12) Times new roman

Example of APA style

Amre, H., Safadi, R., Jarrah, S., Al‐Amer, R., & Froelicher, E. S. (2008). Jordanian nursing students'

knowledge of osteoporosis. International journal of nursing practice, 14(3), 228-236.

***Use Google scholar for citation

Google scholar https://scholar.google.com/

Comments of clinical instructor:

Note (submission with NCP only in second rotation)

https://scholar.google.com/


Appendix (7)

Adult Health Nursing (2) clinical Second Semester (2019/ 2020)

Health Education

Name of Student: ………………………………… Evaluator:…………………………... Clinical Area:/rotation no.……………………………………... Date: /

Items Student Score

0 1 2 3 NA

Health Education

1 Assess clients’ learning needs

2 Written information(brochures) in Arabic language revised by instructor

3 Use appropriate teaching and learning principles when implementing the health education (videos ,pictures )

4 Develops and implements a teaching plan according to assessment findings, and level of understanding

5 Provides patient education related to disease, Medications, lifestyle changes that needed to achieve optimal health

6 Presents information in a clear, professional manner

7 Estimated time for health education about 10-15 minutes

8 Evaluate clients’ attainment of learning outcomes.

Instructor comments …………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………... Mark out of 3 added to the evaluation form (interpersonal relationship) in both rotations Student mark *3/24= total mark Instructor signature: ………………. Student signature: …………………… Course coordinator Tagreed shawash


Appendix (8)

Adult Health Nursing (2) clinical Second Semester (2021/ 2022)

Weekly Objectives Clinical area /rotation no.: …………….......... Clinical instructor: ………… Student’s Name: …………………………… Objectives No……………... Date: (Student mark) -------------------------------- Weekly Objectives SMART criteria (3 marks)

1-

2-

3- .

Planned and unplanned learning activities: (3 marks) Planned learning activities Unplanned learning activities

(3marks) Patient condition submitted only with week (3-4) first rotation week 9-10 second rotation ) Chief complain, Past medical /past surgical history Medical diagnosis Invasive Devices Abnormal objective findings (lab + health assessment) Priority nursing diagnosis (1) Goal Interventions (2) Student's impression (weak & strong points) ………………………………………………………………………… ………………………………………………………………………… …………………………………………………………………… (Student mark*3/9) Note (write from Clinical Areas Related Objectives Appendix 5)


Instructor’s feedback for weekly objectives & / Clinical performance :

1) Knowledge :

2) Nursing process :

3) Interpersonal relationship :

4) Professional behavior :

5) Psychomotor skills: Instructor signature: ………………. Student signature: …………………… Date:……………………………..


The University of Jordan

School of Nursing

Clinical Health Nursing Department

Adult Health Nursing (2) - Clinical (0702309)

Nursing Procedures Manual

Student Name: ………………………

University No.: ……………………...



School of Nursing



Procedure Manual List

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

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

Skill

Instructor

Name and

signature

Date Student

Signature

1. Enteral Nutrition via a Nasogastric Feeding Tube

2. Oral Hygiene for Unconscious or Debilitated Patient

3. Eye Care for Unconscious Patients

4. Measuring and Monitoring Central Venous Pressure

Dressing refer to fundamental procedure manual

5. Measuring and Monitoring blood pressure through Arterial

Catheter.

6. Open and Closed Suction Technique

7. Preparation & Administration of continuous infusion drugs

8. Preparation & Administration of drugs in the Emergency

department


Procedure #1: Enteral Nutrition via a Nasoenteric Feeding Tube

Purpose (s): To provide nutrients to patients who are not able to meet their nutritional requirement orally

To decrease the risk for aspiration.

To enhance absorption of nutrients

Preparation

1. Assemble equipment and supplies:

Disposable feeding bag, tubing, and formula or ready-to-hang System

60-mL or larger catheter-tip syringe ( Salem syringe )

Stethoscope

Enteral infusion pump for continuous feedings

pH indicator strip (scale 0.0 to 11.0) if available

Prescribed enteral feeding formula

Clean gloves.

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

3. Explain to the patient what you are going to do, why it is necessary, how she or he can cooperate

4. Inform the client that feeding should not cause any discomfort but may cause a feeling of fullness.

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

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

Procedure

1. Assess tube placement :

Attach the syringe to the open end of the tube and aspirate check the PH (1 to 5)

Position of nasogastric tube can be confirmed by X-ray

Place stethoscope over the client`s epigastrium & inject 10to 30 ml of air into the tube while listening

for whooshing sound

2. Help the client to assume high fowler`s position

3. Assess residual feeding content :

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

administering the feeding.

If 100 ml (or more than half the last feeding ) is withdrawn , check with the senior nurse

4. Administer the feeding :

Before administering feeding :

Check the expiration date of the feeding.

Provide formula at room temperature.

When an open system is used, clean the top of the feeding container with alcohol before opening it.

Feeding bag (open system ):

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

client.

2. Clamp the tubing and the formula to the bag.

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

4. Attach the bag to the feeding tube and regulate the drip by adjusting the clamp to the drop factor on the bag

(e.g 20drops /ml) if not placed on pump.

Syringe (open system):

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

2. When an open system is used, clean the top of the feeding container with alcohol before opening it

3. Add the feeding to the syringe barrel. Permit the feeding to flow in slowly at the prescribed rate .Raise or

lower the syringe to adjust the flow as needed .Pinch or clamp the tubing to stop the flow for a minute if the

client experiences discomfort.

Prefilled bottle with drip chamber (closed system)

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

tubing.

2. Close the clamp on the tubing.

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

client.

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

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


6. Attach the feeding set tubing to the feeding tube and regulate the drip rate to deliver the feeding over the

desired length of time or attach to a feeding pump.

7. If another bottle is not to be immediately hung, flush the feeding tube before all of the formula has run

through the tubing.

Instill 50to 100 ml of water through the feeding tube or medication port.

Be sure to add the water before the feeding solution has drained from the neck of a syringe or from the

tubing of an administration set.

8. Clamp the feeding tube

9. Ensure client comfort and safety & Secure the tubing to the client’s gown.

10. Ask the client to remain sitting upright in fowler’s position or in a slightly elevated right lateral position for

at least 30 minutes.

11. Check the agency’s policy on the frequency of changing the nasogastric tube and the use of smaller lumen

tubes if a large – bore tube is in place.

12. Dispose of equipment appropriately.

If the equipment is to be reused, wash it thoroughly with soap and water so that it is ready for reuse.

Change the equipment every 24 hours or according to agency policy.

13. Document all relevant information.

Document the feeding, including amount and kind of the feeding, and assessment of the client.

Record the volume of the feeding and water administered on the client’s intake and output record.

14. Report any unusual findings to the practitioner

15 .Clamp the tubing at least every 4to 6 hours, or as indicated by agency protocol or the manufacture, and

aspirate and measure the gastric contents. Then flush the tubing 30 to50ml of water.

16 .Determine agency protocols regarding withholding a feeding many agencies withhold the feeding if more

than 75to 100 ml of feeding is aspirated.

17. To prevent spoilage or bacterial contamination, do not allow the feeding solution to hang longer than 4 to 8

hours. Check agency policy or manufacturer’s recommendations regarding time limits.


Procedure # 2: Oral Hygiene for Unconscious or Debilitated Patient

Purpose (s): Proper oral and to reduce the risk for aspiration.

Preparation


•Small soft-bristle toothbrush or a foam stick applicator

•Antimicrobial rinse (e.g., chlorhexidine)

•Fluoride toothpaste

•Water-based mouth moisturizer

•Small bulb syringe or suction equipment (optional)

•Oral airway

•Water-soluble lip lubricant

•Water glass with cool water

•Face towel

•Paper towels

•Emesis basin

•Clean gloves

2. Provide privacy for the patient.

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

Do not assume that an unconscious person is unable to hear; always explain procedures to the patient

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

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

Procedure

1. Perform hand hygiene.

2. Verify the correct patient using two identifiers.

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

4. Unless contraindicated (e.g., head injury, neck trauma), position the patient on side (Sims position) with

head turned well toward dependent side and head of bed lowered.

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

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

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

8. Insert an oral airway if the patient is unable to cooperate or keep the mouth open. Insert it when the patient

is relaxed, if possible. Insert the airway upside down, then turn it sideways and position it over the tongue to

keep the teeth apart. Do not use force.

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

brushing. A water-moistened foam stick applicator may be used if the patient has sensitive gums

10. Apply toothpaste or use anti-infective solution first to loosen crusts.

11. Clean chewing and inner tooth surfaces first, outer surfaces next, using an up-and-down gentle motion.

12. Use toothbrush or foam stick applicator to clean roof of mouth, gums, and inside of cheeks. Gently brush

tongue but avoid stimulating gag reflex.

13. Rinse with water and repeat as needed.

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

antimicrobial rinse with all oral cavity structures.

15.Repeat antimicrobial rinsing several times if needed

16. Suction secretions as they accumulate, if necessary.

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

18. Inform the patient that the procedure is completed.

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

20. Reposition the patient comfortably, and return the bed and side rail to original positions.

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

22. Report any unusual findings to the practitioner.


23.Document the procedure in the patient’s record

24. Acknowledge the client


Procedure # 3: Eye Care for Unconscious Patient

Purpose (s): To protect the cornea

To decrease the risk of or prevent damage to the cornea

Preparation


••Gloves

•Water or normal saline solution

•Clean washcloth

•Cotton balls •Eye pads or patches

•Paper tape

•Sterile lubricant or eye preparations as ordered

•Cling wrap or gel cover

2. Perform hand hygiene before patient contact.


4. Assess the eye for swelling, drainage, and pain during each shift. Facial trauma, facial surgery,

administration of large amounts of fluids, and prone positioning increase a patient’s risk for orbital eye

swelling.

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

injury.

This assessment is especially important in neurologically impaired patients or those with cranial nerve

dysfunction.

Procedure

6. Perform hand hygiene and don gloves.


8. Position patient in supine position, unless contraindicated.

*9.Use clean washcloth or cotton balls moistened with water or saline solution, and gently wipe each eye from

inner to outer canthus. Use a separate, clean cotton ball or corner of the washcloth for each eye.

10. Cover the eye with the appropriate product or administer the appropriate ointment or drops as

prescribed. (Artificial tears and LACRI-LUBE are two common lubricants

11. If the blink reflex is absent, gently close the patient’s eyes and apply eye patches or pads. Secure each patch

or pad, being careful not to tape onto the surface of the patient’s eyes as that may cause further irritation and

skin breakdown.

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

13.Document the procedure in the patient’s record

14.Acknowledge the client


Procedure # 4: Measuring and Monitoring Central Venous Pressure (CVP)

Purpose (s): CVP monitoring

Preparation


Disposable CVC ( three lumen )

% lidocaine solution without epinephrine, 3 to 5 ml

5-ml syringe with heparinized flush

#11 blade (scalpel)

2-in (5-cm) tape

3-ml syringe with a 25-G needle

Antiseptic solution

Chlorhexidine-impregnated sponge

Disposable pad

PPE (face-shield mask or eye protection, gown, head covering, gloves, sterile gloves, and gown)

Full sterile drape

Nonvented caps for stopcock

Single-pressure transducer system, including the following: flush solution recommended according to

organization practice, pressure bag or device, pressure tubing with flush device, transducer, and

monitor cable

Sterile 4 × 4-in (10.1 × 10.1-cm) gauze pads

Sterile-strips AND Sterile towels

Standardized supply cart or kit

Transducer holder

Preparation


2. Preparation

a. Check physician’s order.

b. Identify client using two descriptors.

c. Explain procedure to client.

d. Provide privacy.

Procedure


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

peripheral neuropathies.

5. Review the patient's medication profile for current anticoagulation therapy and the laboratory profile,

including complete blood count (CBC), platelet count, Prothrombin time (PT), bleeding time, international

normalized ratio (INR), and partial thromboplastin time

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

7. Comply with Universal Protocol.

Use a standardized list to verify that all required items, including informed consent, are available.

8. Prepare and prime a single-pressure disposable transducer system.

When preparing the flush solution, follow organization practice for adding heparin to the IV bag, if

heparin is not contraindicated. Label the flush bag, indicating the date and time the solution was hung and

the nurse's initials.

Turn the stopcock toward the port. Place an occlusive sterile cap or a sterile needleless cap on the top port

of the stopcock.

Label the tubing, indicating the date, time, and nurse's initials

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

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

protection.

11. Verify the correct patient using two identifiers

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

procedure.

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

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

stabilized sufficiently.


15. Use sterile barrier precautions during insertion.

16. Cleanse the area of insertion.

a. If the skin needs cleansing, use soap and water first, then allow it to dry.

Prepare the insertion site with chlorhexidine-based antiseptic 0.5% or higher using a back-and-

forth motion for at least 30 seconds.

If chlorhexidine is contraindicated, use tincture of iodine, an iodophor, or 70% alcohol.

When using povidone-iodine for children younger than 2 months of age or for children with

compromised skin integrity, allow it to dry and then remove it with sterile normal saline wipes or

sterile water.

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

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

a. Trace tubing or catheter from the patient to point of origin (1) before connecting or reconnecting any

device or infusion, (2) at any transition (e.g., new setting), and (3) as part of the hand-off process.

b. Label the tubing at a site close to the patient and at a site close to the source when there are different

access sites or several bags.

c. Rationale: Tubing should be labeled to reduce the chance of misconnection, especially in circumstances

where multiple IV lines or devices are in use.

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

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

Hold the catheter in place while the connections are made.

18. Secure the catheter in place with tape or adhesive strips and apply an impregnated sponge and an

occlusive sterile dressing over the site.

Apply a sterile dressing to the site. Use either a transparent, semipermeable dressing alone or a gauze

dressing with tape. If the patient is diaphoretic or if the site is bleeding or oozing, gauze dressing is

preferred. Label the dressing per organization practice with the date and time of application and the

nurse's initials.

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

19. Connect the transducer cable to the bedside monitor.

20. Levelled the CV catheter air-fluid interface (zeroing stopcock) to the phlebostatic axis, or the

practitioner performed this step.

21. Zeroed the system connected to the CV catheter by turning the stopcock off to the patient, opening the

stopcock to air, and zeroing the monitoring system.

Opening the stopcock to air, and zeroing the monitoring system.

To confirm that the system is zeroed, take off the cap. Squeeze the transducer, and look for fluid coming out

of the port.

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

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

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

25. Discard supplies; remove personal protective equipment (PPE).

26. perform hand hygiene

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



Procedure # 5: Arterial Catheter Insertion (Assisting), Care and Removal

Purpose (s): To continuously monitor blood pressure

To titrate vasoactive agents

To obtain serial blood gases or other laboratory specimens in patients with critical illnesses

Preparation


1% lidocaine solution without epinephrine, 3 to 5 ml

1- to 2-in (2.5- to 5-cm) over-the-needle catheter (14- to 20-G for adults) or prepackaged kit with catheter,

introducer, and guidewire

5-ml syringe with heparinized flush

#11 blade (scalpel)

2-in (5-cm) tape

3-ml syringe with a 25-G needle

Antiseptic solution

Chlorhexidine-impregnated sponge

Disposable pad

PPE (face-shield mask or eye protection, gown, head covering, gloves, sterile gloves, and gown)

Full sterile drape

Nonvented caps for stopcock

Single-pressure transducer system, including the following: flush solution recommended according to

organization practice, pressure bag or device, pressure tubing with flush device, transducer, and monitor

cable

Sterile 4 × 4-in (10.1 × 10.1-cm) gauze pads

Sterile-strips AND Sterile towels

Standardized supply cart or kit

Transducer holder

Pressure bag

Ultrasound machine with transmission gel

Procedure



3. Obtained the patient’s medical history for peripheral arterial disease, vascular grafts, atrioventricular fistulas

or shunts, arterial vasospasm, thrombosis, or embolism. In addition, obtained the patient’s history of prior

coronary artery bypass graft surgery in which radial arteries were removed for use as conduits.

4. Assessed the patient’s current anticoagulation therapy, history of blood dyscrasias, and pertinent laboratory

values before the procedure.

5. Assessed the patient’s allergy history.

6. Assessed the neurovascular and peripheral vascular status of the extremity to be used for arterial cannulation,

including assessment of color, temperature, presence and fullness of pulses, capillary refill, presence of bruit,

and motor and sensory function.

7. Ensured that the patient and family understood pre procedure teaching. Answered questions as they arose,

and reinforced information as needed.

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

9. Complied with Universal Protocol.

10. Use a standardized list to verify all required items, including informed consent, were available

11. Mark the procedure site when required.

12. Verify correct patient, correct site, and correct procedure.

13. Prepared to perform the procedure under strict sterile technique.

Assisting with Insertion

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

protection.

15. Prepared a single-pressure transducer system. Considered using a blood conservation arterial line system.

16. When preparing the flush solution, followed organization standard for adding heparin to the IV bag, if

heparin was not contraindicated.

17. Positioned the patient appropriately for the insertion, depending on the site to be used. Padded pressure

points.

18. If using the radial artery, placed a towel under the back of the wrist to hyperextend the wrist, and taped it in

place or had someone hold it.


19. If using the brachial artery, elevated and hyperextended the patient’s arm. Supported the arm with a pillow.

20. If using the femoral artery, positioned the patient in a supine position with the head of the bed at a

comfortable angle. The patient’s leg was straight, with the femoral area easily accessible.

21. Used sterile barrier precautions during insertion.

22. Once the catheter was positioned, connected the primed tubing with the Luer-Lok adapter to the arterial

catheter.

23. Connected the pressure cable from the arterial transducer to the bedside monitor.

24. Set the scale.

25. Leveled the arterial air-fluid interface (zeroing stopcock) to the phlebostatic axis, or the practitioner

performed this step.

26. Zeroed the system connected to the arterial catheter by turning the stopcock off to the patient, opening the

stopcock to air, and zeroing the monitoring system.

27. Turned the stopcock off to the top of the stopcock. Placed an occlusive sterile cap or a needleless cap on the

top port of the stopcock.

28. Observed the waveform and performed a dynamic response test.

29. Assisted with securing the catheter in place. Considered using a sutureless stabilization device as an

alternative to tape and sutures.

30. Cleansed the area of insertion.

31. If the skin needed cleansing, used soap and water first, then allowed to dry

32. Prepared the insertion site with chlorhexidine-based antiseptic 0.5% or higher using a back-and-forth motion

for at least 30 seconds

33. Assisted with securing the catheter in place

34. Considered using a suture less stabilization device as an alternative to tape and sutures.

35. Cleansed the area of insertion

36. If the skin needed cleansing, used soap and water first, then allowed to dry.

37. Prepared the insertion site with chlorhexidine-based antiseptic 0.5% or higher using a back-and-forth

motion for at least 30 seconds.

38. Applied a sterile dressing to the site.

39. Documented the date and time the dressing was applied and that initials were written on the external dressing.

40. Applied an arm board, if necessary. Joint stabilization devices were used to minimize complications and

maintain device patency.

41. Set the alarm parameters according to the patient’s current blood pressure and organization policy.

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

43. Recorded the manual (noninvasive) blood pressure and compared it to the arterial (invasive) blood pressure.

44. Assessed the neurovascular and peripheral vascular status of the cannulated extremity immediately after

catheter insertion.

45. Discard supplies; remove personal protective equipment (PPE).


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

48. Assess, treat, and reassess pain.


Arterial Line Dressing Change

1. Review the patient’s medication profile for current anticoagulation therapy and the laboratory profile,

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

2.Perform hand hygiene and donned gloves, gown, and face-shield mask or eye protection

3. Obtain the practitioner’s order for catheter removal. Referred to organization practice to determine from

which sites a nurse may remove an arterial catheter.

4. Turn off the arterial monitoring alarms.


5.Depressurize the pressure bag

6. Apply a new sterile dressing to the site. Used either a transparent, semipermeable dressing alone or a gauze

dressing with tape.

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


9. Discard supplies, remove gloves.


11. Document the procedure in the patient's record

12.Acknowledge the client

Removal of the Arterial Catheter

1. Review the patient’s medication profile for current anticoagulation therapy and the laboratory profile,

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

2. Perform hand hygiene and donned gloves, gown, and face-shield mask or eye protection..

(PPE)

3. Obtain the practitioner’s order for catheter removal. Referred to organization practice to determine from

which sites a nurse may remove an arterial catheter.

4. Turn-off the arterial monitoring alarms.

5. Depressurize the pressure bag.

6.Remove the dressing and chlorhexidine-impregnated sponge, if present

7. Remove the stabilizing device or clipped the sutures.

8.Turn the stopcock off to the flush solution

9.Apply pressure one to two finger widths above the insertion site

10. Pull out the arterial catheter in one smooth movement, using a sterile 4 × 4-in (10.1 × 10.1-cm) gauze pad to

cover the site as the catheter was removed.

11. Continue to maintain proximal pressure and immediately applied firm pressure over the insertion site as the

catheter was removed. Maintained pressure until hemostasis was achieved.

12. Apply a sterile pressure dressing to the insertion site.

13. Change the dressing and assessed the site frequently after catheter removal until the site was epithelialized

(bleeding had stopped).

14. Assess, treats, and reassess pain.

15. Discard supplies, remove PPE


17. Document the procedure in patient’s record.



Procedure # 6: Open and Closed Suction Technique

Purpose (s): To maintain the patency of the artificial airway

To remove secretion removal

Preparation

Equipment and supplies:

For the closed-suction technique:

Closed-suction setup

PPE (gloves, eye protection, and mask, or mask with eye protection and gown if necessary)

Source of suction (wall mounted or portable) with connecting tubing

Suction catheter (individually packaged) for oral and nasal suctioning

Sterile normal saline aliquots

Yankauer suction catheter

Pulse oximeter and stethoscope Connecting tubing (6 feet)

For the open-suction technique:

PPE (sterile gloves, eye protection, and mask, or mask with eye protection and gown if necessary)

Source of suction (wall mounted or portable) with connecting tubing

Sterile basin

Sterile normal saline solution or sterile water

Sterile suction catheter of appropriate size

Appropriate-size suction catheter

Nasal or oral airway (if indicated)

Pulse oximeter and stethoscope Connecting tubing (6 feet)

Assessment



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

a. Thick secretions in the airway that cannot be cleared with coughing

b. Decreased or absent breath sounds

c. Adventitious lung sounds (e.g., wheezes, rhonchi, crackles)

d. Restlessness or decreased level of consciousness

e. Acute respiratory distress

f. Tachypnea

g. Tachycardia or bradycardia

h. Cyanosis or pallor

i. Hypertension or hypotension

j. Shallow respirations

k. Use of accessory muscles

l. Decreased oxygen saturation

m. Increased peak airway pressure

n. Sawtooth pattern on the flow-volume loop on the monitor screen of the ventilator or the presence of

coarse crackles over the trachea, or both

Closed-Suction Technique




4. Ensure that the patient understood the pre procedure teaching. Answer questions as they arose and reinforced

information as needed.

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

6. Turn the suction apparatus on and set the vacuum regulator to less than 150 mm Hg. Used only the amount

of suction necessary to remove secretions effectively

7. Check the negative pressure of the suction apparatus by occluding the end of the suction tubing before attaching

it to the suction catheter. Follow the manufacturer’s directions for suction pressure levels when using a closed-

suction catheter system

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

*9. Perform hand hygiene and donned gloves, eye protection, and mask, or mask with eye protection and gown if

necessary

10. Connect the suction tubing to the suction port or unlocked the thumb valve, according to the manufacturer’s

directions.


12. With the dominant hand, gently but quickly inserted the catheter into the artificial airway with the control

vent of the suction catheter open. Used shallow suctioning.

13. Use the dominant thumb, depressed the control vent of the suction catheter to apply continuous suction while

completely withdrawing the catheter into the sterile catheter sleeve within 10 to 15 seconds. Using the non-

dominant thumb and forefinger, stabilized the airway while withdrawing the catheter

14. Perform one additional pass of the suction catheter if secretions remained in the airway and the patient was

tolerating the procedure. Provided 30 to 60 seconds of pre-oxygenation before and hyper-oxygenation after each

pass of the suction catheter. Did not exceed two passes per suctioning procedure.

15. Perform oropharyngeal suctioning after the lower airway had been adequately cleared of secretions. Used a

separate suction catheter for this step.

16. Rinse the catheter and connecting tubing with sterile normal saline solution or sterile water until clear.

17. Turn the suction device off and locked the thumb control.

18. Ensure the FIO2 was returned to the baseline level.

19. Assess the volume, consistency, and colour of the airway secretions. Notified the practitioner of any changes in

the airway secretions.

20. Report finding to the nurse.


22. Discard supplies, remove PPE, and perform hand hygiene.

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


Open suction Technique




4. Ensure that the patient understood the pre procedure teaching. Answer questions as they arose and reinforced

information as needed

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

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

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

8. Turn the suction apparatus on and set the vacuum regulator to less than 150 mm Hg. Used only the amount

of suction necessary to remove secretions effectively.

9. Check the negative pressure of the suction apparatus by occluding the end of the suction tubing before attaching

it to the suction catheter.

*10.Use aseptic technique, opened the sterile catheter package on a clean surface, using the inside of the wrapping

as a sterile field; opened the package just enough to expose the connecting end and connected the catheter to

the suction tubing.

11. Obtain sterile normal saline solution or sterile water to irrigate the suction catheter.

12. Remove gloves, performed hand hygiene, and donned sterile gloves, eye protection, and mask, or mask with

eye protection and gown if necessary.

*13.With the dominant hand, picked up the suction catheter, taking care to avoid touching any nonsterile surfaces.

With the non-dominant hand, picked up the connecting tubing. Connected the suction catheter to the connecting

tubing.

14. Check the equipment for proper functioning by suctioning a small amount of sterile solution from the

container.

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

a. Use the non-dominant hand increased the baseline FIO2 level to 100% on the mechanical ventilator.

Returned FIO2 to the baseline level after completion of suctioning. Or

b. Use the non-dominant hand, pressed the suction hyper-oxygenation button on the ventilator.

16. With the dominant hand, gently but quickly inserted the catheter into the artificial airway with the control

vent of the suction catheter open.

17. Use the dominant thumb, depress the control vent of the suction catheter to apply continuous suction while

completely withdrawing the catheter into the sterile catheter sleeve within 10 to 15 seconds. Using the non-

dominant thumb and forefinger, stabilized the airway while withdrawing the catheter.

18. Perform one additional pass of the suction catheter if secretions remained in the airway and the patient was

tolerating the procedure. Provide 30 to 60 seconds of hyper-oxygenation before and after each pass of the suction

catheter. Did not exceed two passes per suctioning procedure.


19.If the patient did not tolerate open suctioning despite hyper-oxygenation, performed the following steps:

a. Ensured that FIO2 was set at 100%.

b. Maintained PEEP during suctioning.

c. Allowed longer recovery intervals between suction passes.

d. If the patient did not tolerate open suctioning after these steps, switched to a closed-suction technique.

20. Perform oropharyngeal suctioning using the same suction catheter or a Yankauer suction catheter when the

lower airway had been adequately cleared of secretions.

21. Rinse the catheter and connecting tubing with sterile normal saline or sterile water until clear. Suction up

unused solution until the tubing was clear.

22. Wrap the catheter around the dominant hand after the upper airway suctioning was complete. Pull the glove

off inside out so that the catheter remained in the glove. Pull the other glove off in the same fashion and discarded.

23. Turn the suction device off.


25. Assess the volume, consistency, and colour of the airway secretions.

26. Report finding to the nurse.


28. Discard supplies, remove PPE, and perform hand hygiene.




Procedure # 7: Preparing Medication Continuous Infusion

Purpose (s): To provide and maintain a constant level of medication in the blood.

To administer well diluted support medication at a continuous and slow rate

Preparation

1. Equipment

Medication Assessment Record (MAR).

Correct sterile medication.

Correct solution container.

Antiseptic swabs.

Sterile syringe of appropriate size (e.g. 5ml, 10ml) and a 1-to 1.5 inch, #20or 21#-gauge safety needle if

not using a needless system.

IV additives label.

Procedure

Implementation :

Preparation :

1. Check the medication administration record (MAR).

Check the label on the medication carefully against the MAR to make sure that the correct

Medication is being prepared.

Follow the three checks for administering medications .Read the label on the medication (1)

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

medication.

Confirm that the dosage and route is correct.

Verify which infusion solution is to be used with the medication.

Consult a pharmacist, if required, to confirm compatibility of the drugs and solutions being mixed.

2. Organize the equipment.

Performance :

1. Perform hand hygiene and observe other appropriate infection control procedures.

2.prepare the medication ampule for drug withdrawal

Flick the upper stem of the ampule several times with a finger nail Rationale this will bring all medication

down to the main portion of the ampule.

Use an ampule opener or place a piece of sterile gauze or alcohol wipe between your thumb and the

ampule neck or around the ampule neck, and break off the top by bending it toward you to ensure the

ampule is broken away from yourself and away from others .Rationale: the sterile gauze protects the

fingers from the broken glass, and any glass fragments will spray away from the nurse.

Place the antiseptic wipe packet over the top of the ampule before breaking off the top. Rationale: this

method ensures that all glass fragments fall into the packet and reduces the risk of cuts.

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

3. Withdraw the medication

Place the ampule on a flat surface

Attach the filter needle to the syringe .Rationale the filter needle prevents glass particles from being

withdrawn with the medication.

Remove the cap from the filter needle and insert the needle into the center of the ampule .Do not touch

the rim of the ampule with the needle tip or shaft .rationale this will keep the needle sterile .Withdraw the

amount of drug required for the dosage .

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

4. Add the fluid (ensure that there is sufficient fluid in the volume – control fluid chamber to dilute the

medication .check the directions from the drug manufacturer or consult the pharmacist.

5. Close the inflow to the fluid chamber by adjusting the upper roller above the fluid chamber; also ensure that

the clamp on the air vent of the chamber is open.

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

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

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

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

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

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


12. Convert the concentration of the solution to the same units of measure as the dose. all units of measure must

be the same to perform the mathematical functions

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

14. Enter the concentration and the dose into the formula and solve for flow rate. necessary for medication

calculation(variation for medication doses measured per minute (mg/min or µgm/min))

To determine unknown flow rate :

Dose mg/min or µgm/min ×60min/hr. / Concentration (mg/min), or (µgm/ml) ⁼ flow rate ml/ hr.

variation for weight based medication doses measured per minute (µgm/kg/min)


Dose µgm/kg/min ×60min/hr. × pt. weight (kg) / Concentration (µgm/ml) ⁼ flow rate ml/ hr.

Mg milligram

µgm microgram

15. States the nursing implications of the medications by performing appropriate assessments prior to, during,

and after medication administration

16. Double check the calculations.

17. check the patency of the IV infusion access

18. start medication in the presented flow rate (ml/hr)

19. Perform hand hygiene

20. Document relevant data and monitor the client and the infusion



Procedure # 8: Preparing Medication in Emergency department

Purpose (s): To prepare medication for administration of medication by sterilized method

Preparation

1. Equipment

Medication Assessment Record (MAR).

Correct sterile medication.

Correct solution container.

Antiseptic swabs.

IV additives label.

Sterile syringe (1)

Sterile needle (1)

-Size depends on medication being administration and client

Vial of medication prescribed

Spirit swabs

Second needle (optional)

-Size depends on medication being administration and client

Procedure

B. Performance

*1. Check the medication administration record (MAR).

Check the label on the medication carefully against the MAR to make sure that the correct

Medication is being prepared.

Follow the three checks for administering medications .Read the label on the medication (1)

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

medication.

Confirm that the dosage and route is correct.

Verify which infusion solution is to be used with the medication.

Consult a pharmacist, if required, to confirm compatibility of the drugs and solutions being mixed.

Performance :

*1. Perform hand hygiene and observe other appropriate infection control procedures.

*2.prepare the medication ampule for drug withdrawal

Remove the metal or plastic cap on the vial that

protects the rubber stopper

Swab the rubber top with the spirit swab.

3. Dilute the medication if its powder (with compatible fluids or solution) .check the directions from the drug

manufacturer or consult the pharmacist.

*4.Calculate the concentration of the medication per ml of fluid .necessary for medication calculation

Convert dose(mg/microgram /kg) to ml

5. Remove the cap from the needle by pulling it straight off.. Draw back an amount of air into the syringe that is

equal to the specific dose of medication to be withdrawn.

6. Withdraw the medication

Puncture the rubber stopper in the center with the needle tip and inject the measured air into the space above the

solution.

The vial may be positioned upright on a flat surface or inverted.

7. Invert the vial and withdraw the needle tip slightly so that it is below the fluid level.

*8. Draw up the prescribed amount of medication while holding the syringe at eye level and Vertically.

-Puncture the rubber stopper in the center with the needle tip and inject the measured air into the space

above the solution. The vial may be positioned upright on a flat surface or inverted.

-Invert the vial and withdraw the needle tip slightly so that it is below the fluid level.

❖Nursing Alert❖

Be careful to touch the plunger at the knob only.


9.Removal of air:

1) If any bubbles accumulate in the syringe, tap the barrel of the syringe sharply and move the needle past the

fluid into the air space to re-inject the air bubble into the vial.

2) Return the needle tip to the solution and continue withdrawing the medication

10. After the correct dose is withdrawn, remove the needle from the vial and carefully replace the cap over the

needle.

❖Nursing Alert❖

Some agencies recommended changing needles, if needed to administer the medication, before

Administering the medication.

11. If a multidose vial is being used, label the vial with the date and time opened, and store the vial containing the

remaining medication according to agency policy.

*12. States the nursing implications of the medications by performing appropriate assessments prior to, during,

and after medication administration

13. Double check the calculations

C. Implementation:

14. Introduce yourself and checks two form of client's identification (asks him to tell you his name and date of

birth

15.Assists the client to the appropriate position

16.Explains the procedure and the purpose of medication to client

*14. check the patency of the IV infusion access

*17.Performs the procedure with sterile technique

18.Discards equipments appropriately


20.Assesses effectiveness of medication at the time it is expected to act



References:

American Association of Critical – Care Nurses procedure manual for critical care by Debra J.Lynn- McHale, Karen K.

Carlson .4th edition

Kozier, B., Berman, S., & Erb, G., (2008). Fundamentals of Nursing Concepts, Process, and Practice. 8th edition, Audrey



School of Nursing



Nursing Procedures Evaluation Checklist

Student Name: ………………………

University No.: ……………………...



School of Nursing



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

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

Rating Scale

Score Description

0 Constant assistance, unsafe

1 Occasional assistance, occasionally unsafe

2 Rare assistance, usually safe

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

Procedure #1: Enteral Nutrition via a Nasoenteric Feeding Tube

Task Score

Comments 0 1 2

1. Assemble equipment and supplies

2. *verify the client’s identity using agency protocol Zero or 10

3. Introduce self

4. Explain to the patient what you are going to do, why it is necessary, how she

or he can Cooperate .inform the client that feeding should not cause any

discomfort but may cause a feeling of fullness.

5. Provide privacy for this procedure if the client desires it .Tube feeding is

embarrassing to some people.

6. perform hand hygiene and observe appropriate infection control

procedures (e.g, clean gloves )

7*Assess tube placement

a) Attach the syringe to the open end of the tube and aspirate check the PH

b) Position of nasogastric tube can be confirmed by X-ray

c) Place stethoscope over the client`s epigastrium & inject 10to 30 ml of air

into the tube while listening for whooshing sound

Zero or 10

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

Zero or 10

9. *Assess residual feeding content

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

amount before administering the feeding.

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

senior nurse.

Determine agency protocol regarding withholding a feeding many

agencies withhold the feeding if more than 75to 100 ml of feeding is

aspirated.

Zero or 10

Before administering feeding:

10. Check the expiration date of the feeding.

11. Provide formula at room temperature

12. When an open system is used, clean the top of the feeding container with

alcohol before opening it.

Feeding bag (open system ) Repeat steps from (1-11)

1. Hang the labelled bag from an infusion pole about 30cm (12in.) above the

tube’s point of insertion into the client.

2.Clamp the tubing and the formula to the bag

3. Open the clamp, run the formula through the tubing and re clamp

4. Attach the bag to the feeding tube and regulate the drip by adjusting the

clamp to the drop factor on the bag (e.g. 20drops /ml)

If not placed on pump.

5. Dispose of equipment appropriately

6. Document all relevant information


Evaluator Signature: -------------------------------- Student Signature: -----------------------------------

7. Hand hygiene post procedure


TOTAL (70)

Syringe (open system): Repeat steps from (1-12)

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

or clamped nasogastric.

2. Add the feeding to the syringe barrel.

3. Permit the feeding to flow in slowly at the prescribed rate .Raise or lower

the syringe to adjust the flow as needed .Pinch or clamp the tubing to stop the

flow for a minute if the client experiences discomfort.





TOTAL (70)

Prefilled bottle with drip chamber (closed system)

Repeat steps from (1-12)

1. Remove the screw –on cap from the container and attach the

administration set with the drip chamber and tubing.

2. Close the clamp on the tubing.

3. Hang the container on the intravenous pole about 30cm (12in.) above the

tube’s insertion point into the client.

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

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

the tube.

6. Attach the feeding set tubing to the feeding tube and regulate the drip rate

to deliver the feeding over the desired length of time or attach to a feeding

pump.

7. Clamp the feeding tube





TOTAL Out Of (76 )


Procedure # 2: Oral Hygiene for Unconscious or Debilitated Patient

Task Score

Comments 0 1 2

*1.Perform hand hygiene before patient contact. Zero or 10

2. *Verify the correct patient using two identifiers. Zero or 10

3. Provide privacy for the patient.

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

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

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

7. Unless contraindicated, position the patient on side (Sims position) with head

turned well toward dependent side and head of bed lowered.

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

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

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

11. Insert an oral airway if the patient is unable to cooperate. Insert it when the

patient is relaxed, if possible. Insert it upside down, then turn it sideways and

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

12. Clean the mouth/teeth using a small, soft-bristle toothbrush moistened in water

if the patient can tolerate brushing. Use a water-moistened foam stick applicator if

the patient has sensitive gums

13. Apply toothpaste or use anti-infective solution first to loosen crusts.

14. Clean chewing and inner tooth surfaces first, outer surfaces next, using an up-

and-down gentle motion.

15. Use toothbrush or foam stick applicator to clean roof of mouth, gums, and

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

16. Moisten toothbrush with antimicrobial mouth rinse and cleanse oral cavity,

ensuring contact of the antimicrobial rinse with all oral cavity structures and

repeat if needed

17. Rinse with water and repeat as needed.

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

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

positions.

20. Clean equipment and return it to its proper place

21. Discard supplies, remove gloves

22. Assess, treat, and reassess pain

23. Report any unusual findings to the practitioner.


25. Document the procedure in the patient’s record


Total OUT OF (76)

Evaluator Signature: -------------------------------- Student Signature: ------------------------------


Procedure #3: Eye Care for Unconscious Patient

Task Score Comment

s 0 1 2

*1.Perform hand hygiene before patient contact. Zero or 10

2. *Verify the correct patient using two identifiers. Zero or 10

3. Assess the eye for swelling, drainage, and pain during each shift. Facial

trauma, facial surgery, administration of large amounts of fluids, and prone

positioning increase a patient’s risk for orbital eye swelling.

4. Assess for blink reflex, which lubricates the eye. If the blink reflex is absent,

the patient is at risk for eye injury.

5. Position patient in 15-30 degree position,

*6. Perform hand hygiene and done gloves Zero or 10

*7.Use clean washcloth or cotton balls moistened with water or saline solution,

and gently wipe each eye from inner to outer canthus. Use a separate, clean

cotton ball or corner of the washcloth for each eye.

Zero or 10

8. Cover the eye with the appropriate product or administer the appropriate

ointment or drops as prescribed. (Artificial tears and LACRI-LUBE are two

common lubricants.)

9. If the blink reflex is absent, gently close the patient’s eyes and apply eye

patches or pads. Secure each patch or pad, being careful not to tape onto the

surface of the patient’s eyes as that may cause further irritation and skin

breakdown.

10. Discard supplies, remove gloves




Total out of (50)



Procedure #4: Measuring and Monitoring Central Venous Pressure (CVP)

Preparation

Score Comments

0 1 2

1.Assemble equipment and supplies:

2. Preparation

a. Check physician’s order.

b. Identify client using two descriptors.

e. Explain procedure to client.

f. Provide privacy.

g. Determine client’s previous CVP parameters. _

Procedure


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

abnormalities, and peripheral neuropathies.

5. Review the patient's medication profile for current anticoagulation therapy and the

laboratory profile, including complete blood count (CBC), platelet count, prothrombin

time (PT), bleeding time, international normalized ratio (INR), and partial

thromboplastin time

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

for insertion.

7. Comply with Universal Protocol.

Use a standardized list to verify that all required items, including informed consent, are

available.

8. Prepare and prime a single-pressure disposable transducer system.

-When preparing the flush solution, follow organization practice for adding heparin

to the IV bag, if heparin is not contraindicated. Label the flush bag, indicating the

date and time the solution was hung and the nurse's initials.

-Turn the stopcock toward the port. Place an occlusive sterile cap or a sterile

needleless cap on the top port of the stopcock.

-Label the tubing, indicating the date, time, and nurse's initials

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

*10. Performed hand hygiene and donned sterile gloves, head covering, gown, and face-

shield mask or eye protection.

Zero or 10


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

correct site, and correct procedure.

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

14. Administer sedation as prescribed if the patient is restless or combative or if the

extremity cannot be stabilized sufficiently.

15. Use sterile barrier precautions during insertion.

16. Cleanse the area of insertion.

-If the skin needs cleansing, use soap and water first, then allow it to dry.

-Prepare the insertion site with chlorhexidine-based antiseptic 0.5% or higher using a

back-and-forth motion for at least 30 seconds.

-If chlorhexidine is contraindicated, use tincture of iodine, an iodophor, or 70%

alcohol

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

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

-Trace tubing or catheter from the patient to point of origin (1) before connecting

or reconnecting any device or infusion, (2) at any transition (e.g., new setting), and

(3) as part of the hand-off process.

- Label the tubing at a site close to the patient and at a site close to the source when

there are different access sites or several bags

-Rationale: Tubing should be labeled to reduce the chance of misconnection,

especially in circumstances where multiple IV lines or devices are in use.

-Check vital signs immediately after making any connection per organization

practice

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


Evaluator Signature: -------------------------------- Student Signature: -------------------------------

- Hold the catheter in place while the connections are made.

19. Secure the catheter in place with tape or adhesive strips and apply an impregnated

sponge and an occlusive sterile dressing over the site.

-Apply a sterile dressing to the site. Use either a transparent, semipermeable

dressing alone or a gauze dressing with tape. If the patient is diaphoretic or if the

site is bleeding or oozing, a gauze dressing is preferred.

-Label the dressing per organization practice with the date and time of application

and the nurse's initials.

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

20. Connect the transducer cable to the bedside monitor.

*21. Levelled the CV catheter air-fluid interface (zeroing stopcock) to the phlebostatic

axis, or the practitioner performed this step.

Zero or 10

*22. Zeroed the system connected to the CV catheter by turning the stopcock off to the

patient, opening the stopcock to air, and zeroing the monitoring system.

Opening the stopcock to air, and zeroing the monitoring system.

To confirm that the system is zeroed, take off the cap. Squeeze the transducer, and look

for fluid coming out of the port.

Zero or 10

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

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

25. Discard supplies, remove personal protective equipment (PPE)


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


Total out of (80)


Procedure #5: Arterial Catheter Insertion: Assisting with Insertion& measuring

Task Score Comments

0 1 2

1. *Performed hand hygiene before patient contact. Zero or 10

2. Verified the correct patient using two identifiers.

3. Reviewed the patient’s medical record for a history of coagulopathies,

vascular abnormalities, peripheral neuropathies, and the presence of

atrioventricular fistulas or shunts.

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

therapy and the laboratory profile, including CBC, platelet count, PT,

bleeding time, INR, and PTT.

Zero or 10

5. Assessed the neurovascular and peripheral vascular status of the extremity

to be used for arterial cannulation, including an assessment of color,

temperature, presence and fullness of pulses, capillary refill, presence of bruit

(in larger arteries such as the femoral artery), and motor and sensory

function (compared with the opposite extremity).

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

protocol for insertion.

7. Complied with Universal Protocol.

8. Prepared and primed a single-pressure disposable transducer system.

Considered using a blood conservation system.

9. Performed hand hygiene and donned sterile gloves, head covering, gown,

and face-shield mask or eye protection.

10. Complied with Universal Protocol: Performed a time-out to verify correct

patient, correct site, and correct procedure.

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

pressure points.

12. Used sterile barrier precautions during insertion.

13. Cleansed the area of insertion.

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

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

the catheter.

Zero or 10

16. Secured the catheter in place with tape or adhesive strips and applied an

impregnated sponge and an occlusive sterile dressing over the site.

17. Connected the transducer cable to the bedside monitor.

18. Set the scale.

19. *Leveled the arterial air-fluid interface (zeroing stopcock port) to the

phlebostatic axis at the midaxillary line and fourth intercostal space just

above the nipple line.

Zero or 10

20. *Zeroed the system connected to the arterial catheter by turning the

stopcock off to the patient, opening the stopcock to air, and zeroing the

monitoring system.

Zero or 10

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

organization practice.

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

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

the arterial (invasive) blood pressure.

24. Assessed, treated, and reassessed pain.

25. Discarded supplies, removed PPE

26. performed hand hygiene

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


Total out of (96)

Evaluator Signature: -------------------------------- Student Signature: -----------------------------------


Procedure #6: Open and Closed Suction Technique

Task

Closed Suction Technique

Score Comments

0 1 2

*1. Perform hand hygiene before patient contact.

*2. Verify the correct patient using two identifiers. Zero or 10

3. Assess the patient for signs of airway compromise or inadequate

oxygenation.

4. Ensure that the patient understood the pre procedure teaching. Answer

questions as they arose and reinforced information as needed.

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

Fowler position.

6. Turn the suction apparatus on and set the vacuum regulator to less than

150 mm Hg. Used only the amount of suction necessary to remove

secretions effectively

7. Check the negative pressure of the suction apparatus by occluding the

end of the suction tubing before attaching it to the suction catheter. Follow

the manufacturer’s directions for suction pressure levels when using a

closed-suction catheter system.

*8. Hyper oxygenate the patient for 30 to 60 seconds. Zero or 10

9. Connect the suction tubing to the suction port or unlocked the thumb

valve, according to the manufacturer’s directions.

*10. Perform hand hygiene and donned gloves, eye protection, and mask,

or mask with eye protection and gown if necessary.

Zero or 10

11. With the dominant hand, gently but quickly inserted the catheter into

the artificial airway with the control vent of the suction catheter open.

Used shallow suctioning.

12. Use the dominant thumb, depressed the control vent of

the suction catheter to apply continuous suction while completely

withdrawing the catheter into the sterile catheter sleeve within 10 to 15

seconds. Using the non-dominant thumb and forefinger, stabilized the

airway while withdrawing the catheter

13. Perform one additional pass of the suction catheter if secretions

remained in the airway and the patient was tolerating the procedure.

Provided 30 to 60 seconds of pre-oxygenation before and hyper-

oxygenation after each pass of the suction catheter. Did not exceed two

passes per suctioning procedure.

14. Rinse the catheter and connecting tubing with sterile normal saline

solution or sterile water until clear.

15. Turn the suction device off and locked the thumb control.

16. Hyper oxygenate the patient for 30 to 60 seconds if needed, and then

ensure the FIO2 was returned to the baseline level.

17. Assess the volume, consistency, and colour of the airway secretions and

Report finding to the nurse.


19. Discard supplies, remove PPE, and perform hand hygiene



Total out of (78)

Open suction Technique 0 1 2

*1. Perform hand hygiene before patient contact. Zero or 10

*2. Verify the correct patient using two identifiers Zero or 10

3. Assess the patient for signs of airway compromise or inadequate

oxygenation.

4. Ensure that the patient understood the pre procedure teaching. Answer

questions as they arose and reinforced information as needed

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

Fowler position

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

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


8. Turn the suction apparatus on and set the vacuum regulator to less than

150 mm Hg. Used only the amount of suction necessary to remove

secretions effectively.

9. Check the negative pressure of the suction apparatus by occluding the

end of the suction tubing before attaching it to the suction catheter.

*10. Hyper oxygenated the patient for 30 to 60 seconds using one of the

following methods:

a. Use the non-dominant hand increased the baseline FIO2 level to

100% on the mechanical ventilator. Returned FIO2 to the baseline level

after completion of suctioning. Or

b. Use the non-dominant hand, pressed the suction hyper-oxygenation

button on the ventilator.

Zero or 10

*11. Put on PPE (personal protective equipment) and use aseptic

technique, opened the sterile catheter package on a clean surface, using the

inside of the wrapping as a sterile field; opened the package just enough to

expose the connecting end and connected the catheter to the suction tubing.

Zero or 10

*12.With the dominant hand, picked up the suction catheter, taking care to

avoid touching any non sterile surfaces. With the non-dominant hand,

picked up the connecting tubing. Connected the suction catheter to the

connecting tubing

Zero or 10

13. Obtain sterile normal saline solution or sterile water to irrigate

the suction catheter, check the equipment for proper functioning by

suctioning a small amount of sterile solution from the container.

14. With the dominant hand, gently but quickly inserted the catheter into

the artificial airway with the control vent of the suction catheter open.

15. Use the dominant thumb, depress the control vent of

the suction catheter to apply continuous suction while completely

withdrawing the catheter into the sterile catheter sleeve within 10 to 15

seconds. Using the non-dominant thumb and forefinger, stabilized the

airway while withdrawing the catheter.

16. Perform one additional pass of the suction catheter if secretions

remained in the airway and the patient was tolerating the procedure. Did

not exceed two passes per suctioning procedure.

17. Provide 30 to 60 seconds of hyper-oxygenation before and after each

pass of the suction catheter. If the patient did not tolerate open suctioning

despite hyper-oxygenation, performed the following steps:

e. Ensured that FIO2 was set at 100%.

f. Maintained PEEP during suctioning.

g. Allowed longer recovery intervals between suction passes.

h. If the patient did not tolerate open suctioning after these steps,

switched to a closed-suction technique.

18. Rinse the catheter and connecting tubing with sterile normal saline or

sterile water until clear. Suction up unused solution until the tubing was

clear.

19. Wrap the catheter around the dominant hand after the upper airway

suctioning was complete. Pull the glove off inside out so that the catheter

remained in the glove. Pull the other glove off in the same fashion and

discarded.

20. Turn the suction device off.


22. Assess the volume, consistency, and colour of the airway secretions.

And report finding to the nurse


24. Discard supplies, remove PPE, and perform hand hygiene



Total out of (102)



Procedure (#7): Preparing Medications Continuous Infusion

Task Score

Comments 0 1 2

A. Preparation:


-Check the label on the medication carefully against the MAR to

make sure that the correct Medication is being prepared.

-Follow the three checks for administering medications .Read the

label on the medication (1) When it taken from medication cart,

(2) before withdrawing the medication, and (3) after withdrawing

the medication.

-Confirm that the dosage and route is correct.

-Verify which infusion solution is to be used with the medication.

-Consult a pharmacist, if required, to confirm compatibility of the

drugs and solutions being mixed..

Zero or 10

B. Performance:

2.* Perform hand hygiene and observe other appropriate infection control

procedures.

Zero or 10

3.prepare the medication ampule for drug withdrawal

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

-Use an ampule opener or place a piece of sterile gauze or alcohol wipe

between your thumb and the ampule neck or around the ampule neck

and break off the top by bending it toward you to ensure the ampule is

broken away from yourself and away from others.

- Place the antiseptic wipe packet over the top of the ampule

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

*4. withdraw the medication (Draw up the prescribed amount of

medication while holding the syringe at eye level and Vertically.

-Place the ampule on a flat surface

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

prevents glass particles from being withdrawn with the medication.

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

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

needle tip or shaft .rationale this will keep the needle sterile .Withdraw

the amount of drug required for the dosage .

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

Zero or 10

5. Add the fluid (ensure that there is sufficient fluid in the volume – control

fluid chamber to dilute the medication .check the directions from the drug

manufacturer or consult the pharmacist.

6. Close the inflow to the fluid chamber by adjusting the upper roller above

the fluid chamber; also ensure that the clamp on the air vent of the

chamber is open.

7. Clean the medication port on the volume – control fluid chamber with

an antiseptic swab.

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

set.

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

10. Open the line’s upper clamp, and allow the mixed fluid to reach at the

tip of the volume –control set.

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

12. Connect the infusion system to the intended IV line or catheter.

13. Convert the concentration of the solution to the same units of measure

as the dose. All units of measure must be the same to perform the

mathematical functions


*14.calculate the concentration of the medication per ml of fluid. Necessary

for medication calculation

Zero or 10

*15.enter the concentration and the dose into the formula and solve for

flow rate. Necessary for medication calculation(variation for medication

doses measured per minute (mg/min or µgm/min))


Dose mg/min or µgm/min ×60min/hr. / Concentration (mg/min) or

(µgm/ml) ⁼ flow rate ml/ hr.

variation for weight based medication doses measured per minute

(µgm/kg/min)


Dose µgm/kg/min ×60min/hr.× pt. weight (kg) / Concentration (µgm/ml )⁼

flow rate ml/ hr.

Mg milligram

µgm microgram

Zero or 10

*16. States the nursing implications of the medications by performing


administration

Zero or 10


*18. Verify the correct patient using two identifiers Zero or 10

*19. Explain the procedure to the patient, even if he or she is unconscious. Zero or 10

* 20.Check the patency of the IV infusion access Zero or 10

21. start medication in the presented flow rate (ml/hr)




Total out of (120)



Procedure # 8: Preparing Medication in Emergency department

Task Score

Comments 0 1 2

A. Preparation:


-Check the label on the medication carefully against the MAR to

make sure that the correct Medication is being prepared.

-Follow the three checks for administering medications .Read the

label on the medication (1) When it taken from medication cart,

(2) before withdrawing the medication, and (3) after withdrawing

the medication.

-Confirm that the dosage and route is correct.

-Verify which infusion solution is to be used with the medication.

-Consult a pharmacist, if required, to confirm compatibility of the

drugs and solutions being mixed.

Zero or 10

B. Performance:


*3. Calculates the dosage.

(if this point is wrong point # 7 is already wrong)

Zero or 10

*4. prepare the medication ampule for drug withdrawal

Remove the metal or plastic cap on the vial that protects the rubber

stopper Swab the rubber top with the spirit swab.

Zero or 10

5. Dilute the medication if its powder (with compatible fluids or solution) .

-check the directions from the drug manufacturer or consult the

pharmacist.

-Add the fluid (ensure that there is sufficient fluid in the volume

control fluid chamber to dilute the medication .

6. Remove the cap from the needle by pulling it straight off.. Draw back an

amount of air into the syringe that is equal to the specific dose of

medication to be withdrawn.

*7. Draw up the prescribed amount of medication while holding the syringe

at eye level and Vertically.

-Puncture the rubber stopper in the center with the needle tip and

inject the measured air into the space above the solution. The vial may

be positioned upright on a flat surface or inverted.

-Invert the vial and withdraw the needle tip slightly so that it is below

the fluid level.

Zero or 10

8. Removal of air:

1) If any bubbles accumulate in the syringe, tap the barrel of the syringe

sharply and move the needle past the fluid into the air space to re-inject the

air bubble into the vial.

2) Return the needle tip to the solution and continue withdrawing the

medication

9. After the correct dose is withdrawn, remove the needle from the vial and

carefully replace the cap over the needle.

❖Nursing Alert❖

Some agencies recommended changing needles, if needed to administer the

medication, before Administering the medication.

10. If a multidose vial is being used, label the vial with the date and time

opened, and store the vial containing the remaining medication according

to agency policy.


*11. States the nursing implications of the medications by performing


administration

Zero or 10


*C. Implementation:

13. Introduce yourself and checks two form of client's identification (asks

him to tell you his name and date of birth).

Zero or 10

14. Assists the client to the appropriate position.

15. Explains the procedure and the purpose of medication to client

*16. check the patency of the IV infusion access Zero or 10

*17. Performs the procedure with sterile technique

(if the student performs any behavior that break or risks the sterility all

over the procedure (hand washing, touch the plunger,do not clean site or

port with antiseptic swab, or breaking infection control measure)

Zero or 10

18. Discards equipments appropriately


20. Assesses effectiveness of medication at the time it is expected to act



Total out of (108)



Appendix (10)

أسس التدريب العملي

تسمى هذه الأسس أسس التدريب العملي المنبثقة عن تعليمات التدريب العملي.

مواصفات الزي الرسميأولاً:

-الطالبات :

=======

, التنورة ,البلوزة)المريول أبيض ) نظيف ومكوي ( ومغلق فوق الملابس ذات اللون الكحلي الغامق الزي الرسمي هو الزي المعتمد من الكلية من حيث التصميم. .1

البنطلون( ولا يسمح بارتداء الجينز

. تعتبر بطاقة الاسم , شعار الجامعة , وشعار الكلية جزء من الزى الرسمي ويجب ان توضع على الجيب العلوي للمريول الأبيض .2

حجاب الأميرة ابيض اللون غير براق وان يكون داخل المريول الأبيض .الحجاب على نمط .3

تصفيف الشعر بحيث يكون مرفوعاً ومنظماً وبدون استعمال أية كريمات أو إضافات . .4

الحذاء ابيض أو اسود ونظيف ويمُنع ارتداء الكعب العالي,الباليرينا, أو حذاء الرياضة. .5

لي باستثناء دبلة الخطوبة أو الزواج. يمنع ارتداء أي نوع من أنواع الح .6

سها.في حال الاضطرار لاستخدام الزى الخاص بالوحدات المتخصصة )إذا اقتضت سياسة المستشفى بذلك ( يمنع التجول في هذا الزى خارج الوحدة نف .7

دة.درس المايعة التدريب غير ذلك وبموافقة ميجب ارتداء الزى الرسمي في جميع أماكن التدريب العملي بما في ذلك المختبرات إلا إذا اقتضت طب .8

*** في حال عدم الالتزام بالزى الرسمي يمنع الطالب من الدوام و يعتبر غائبا في ذلك اليوم

الطلبة الذكور :

===========

البنطلون كحلي المريول أبيض ) نظيف ومكوي ( ومغلق فوق الملابس ذات اللون الكحلي الغامق )الزي الرسمي هو الزي المعتمد من الكلية من حيث التصميم. .1

ابيض أو أزرق سادة فاتح( ولا يسمح بارتداء الجينز غامق او اسود , القميص كحلي سادة غامق او لون

ان توضع على الجيب العلوي للمريول الأبيض تعتبر بطاقة الإسم , شعار الجامعة , وشعار الكلية جزء من الزى الرسمي ويجب .2

الشعر مرتب، قصير وبدون أية تسريحات تُظهره بطريقة غير مهنيه .3

عدم وضع جل الشعر أو الكريمات .4

الحذاء اسود او كحلي ويمنع ارتداء حذاء الرياضة .5

ها.ى بذلك ( يمنع التجول في هذا الزى خارج الوحدة نفسفي حال الاضطرار لاستخدام الزى الخاص بالوحدات المتخصصة )إذا اقتضت سياسة المستشف .6

ســـاق. ميجب ارتداء الزى الرسمي في جميع أماكن التدريب العملي بما في ذلك المختبرات إلا إذا اقتضت طبيعة التدريب غير ذلك وبموافقة مدرس ال .7

ائبا في ذلك اليوم. *** في حال عدم الالتزام بالزى الرسمي يمنع الطالب من الدوام و يعتبر غ

الحضور والغيابثانياً:

( من الساعات المقررة للمادة دون عذر مرضي او قهري يقبلهما عميد الكلية15%إذا غاب الطالب أكثر من ) يحرم من المادة )ام عملي)اكثر من أربعة أيام دو ،

وتعتبر نتيجته في تلك المادة )صفراً (.

( 15%إذا غاب الطالب أكثر من )مادة وتطبق ر منسحبا" من المن الساعات المقررة للمادة وكان هذا الغياب بسبب المرض أو لعذر قهري يقبله عميد الكلية، يعتُب

عليه أحكام الانسحاب.

ن ردنية ، وأجامعة الأاليشُترط في العذر المرضي أن يكون بشهادة صادرة من طبيب عيادة الطلبة في الجامعة الأردنية أو معتمدة منه أو صادرة من مستشفى

يثبت عذره دم الطالب مالأخرى يقتقدم هذه الشهادة إلى عميد الكلية خلال مدة لا تتجاوز أسبوعين من تاريخ انقطاع الطالب عن المواظبة ، وفي الحالات القاهرة ا

القهري خلال أسبوع من تاريخ زوال أسباب الغياب .

ملية.لا يجوز التعويض عن غياب الأيام الع

عملي . لدوام الايعتبر الأسبوعين الأولين للتعريف بالدوام العملي إجباري لحضور الطلبة ، ويحتسب الغياب عن أي جلسه تعريفية يوم غياب كامل عن

( وفي حال الدوام خارج اعة معتمس 2( للمادة العملية ) 8-12ساعات معتمدة( ومن الساعة ) 3( للمادة العملية ) 8-2الالتزام بالدوام العملي من الساعة )دة

صباحا 7:30مستشفى الجامعة على الطالب التواجد في الحافلة الساعة

يسمح للطالب بالتخر


(دقيقة فقط على ان يحدد ساعتها اعتمادا على طبيعة العمل 20-30التقيد بفترة الاستراحة خلال الدوام العملي من )

ك اليوم.الدوام العملي بدون عذر مقبول من قبل المشرف المسؤول لا يسمح له بالدوام ويعتبر غائباً لذل إذا تأخر الطالب نصف ساعة عن بدء

.ًإذا تأخر الطالب عن بدء الدوام العملي لمدة خمسة عشر دقيقة يعطى تنبيهاً شفهيا

.إذا تكرر التأخير لغاية ثلاث مرات يعتبر غياباً لذلك اليوم

ضور الامتحان العملي او الكتابي النهائي او التقيم العملي النهائي بدون عذر رسمي يطبق عليه اذا تغيب الطالب عن ح

الشروط المتعلقة بالغياب عن الامتحان النهائي المنصوص عليها في تعليمات الامتحانات في الجامعة الاردنية الصادرة عن مجلس العمداء بموجب الفقرة )أ( من

المادة )3( من نظام منح الدرجات العلمية والدرجات الفخرية والشهادات في الجامعة الأردنية المادة )16( والتي تنص على:

ام لاثة أيثكل من يتغيب بعذر عن امتحان معلن عنه، عليه أن يقدم ما يثبت عذره لمدرس المادة خلال (أ طالب.امتحان معوض للمن تاريخ زوال العذر، وفي حالة قبول هذا العذر على مدرس المادة إجراء

س لتي تدراكل من يتغيب عن الإمتحان النهائي المعلن عنه في مادة ما بدون عذر يقبله عميد الكلية (ب تلك المادة، تعتبر علامته في ذلك الإمتحان )صفراً(.

حافلات النقل ) الباصات (ثالثاً:

لجامعة. امتلكات تعتبر حافلة النقل )الباص( قاعة من قاعات التدريب العملي وتعتبر من ممتلكات الجامعة وبالتالي أي تخريب فيها يعتبر اعتداءً على م

-وبناءً على ذلك يجب على الطالب / الطالبة أثناء وجوده في الحافلة )الباص(. التقيد بما يلي:

العملي بمرافقة المشرف السريري او عضو هيئة التدريس الذهاب الى اماكن التدريب .1

رئيس الشعبة أو المشرف السريري هما المخولان فقط بتحريك الحافلة. .2

التقيد بأوقات الحضور والمغادرة للحافلة في الوقت المحدد. .3

يمنع الالتحاق أو مغادرة الحافلة قبل وصولها الى وجهتها النهائية. .4

العامة وعدم إساءة استخدام الحافلة.مراعاة أسس السلامة .5

عدم تناول الأطعمة والاشربة والتدخين داخل الحافله. .6

عدم التصفيق أو الغناء او التصرف بشكل غير لائق في الحافلة . .7

وليته الخاصةعلى مسؤوفي حال عدم تمكن الطالب لأي سبب كان من الإلتحاق بالحافلة للذهاب للدوام العملي يجوز له أن يلتحق بالدوام العملي

على أن لا تتجاوز مدة التأخير عن نصف ساعة ويجب إعلام المشرف المسؤول بذلك.

السلوك المهنيرابعاً:

الالتزام بالمظهر المهني العام والهندام ) النظافة والترتيب( حسب تعليمات التدريب العملي .1

ت المحدد.الوصول والمغادرة من والى منطقه التدريب العملي بالوق .2

الالتزام بدليل آداب وأخلاقيات المهنة .3

على ألطلبه تعريف أنفسهم على رئيس القسم في منطقة التدريب العملي قبل البدء بالتدريب العملي .4

ألمحافظه على سلامة, وخصوصية وسريه المريض إثناء التدريب العملي .5

عدم تصوير المريض لاي سبب كان .6

هادة تطعيم يالا باحضارشام العملالمتعلقة بالسلامة العامة و سياسات منع انتقال العدوى إثناء التدريب العملي وعدم السماح للطلبةبالدوالالتزام بالسياسات .7

تثبت حصوله على الجرعات الثلاث لمطعوم الكبد الوبائي ب.

ممرض القانوني في مكان التدريب العملي.لا يسمح للطلبة بالتدريب العملي بدون إشراف مباشر من قبل المشرف ألسريري أو ال .8

الالتزام بالسلوك المهني في جميع أماكن التدريب العملي والمتضمن الأتي: .9

عدم مضغ العلكة

التحدث بصوت منخفض

.عدم وضع الأيدي في الجيوب عند الوقوف أو أثناء التحدث مع المرضى والفريق الصحي وتجنب المزاح

النقال اثناء الدوام العمليعدم استخدام الهاتف

عدم الوقوف في بلكونات المستشفيات أو التجمع في محطة التقاء الممرضين ) Nursing Station( .

.عدم الجلوس على أسرة المرضى أو الطاولات الموجودة في غرف المرضى


عدم ارتداء الحلي والمجوهرات باستثناء خاتم الخطوبة والزواج

الأظافر نظيفة وقصيرة وعدم وضع طلاء الأظافرالمحافظة على بقاء

. عدم التدخين في منطقة التدريب العملي

لا يسمح للطلبة بالتواجد في منطقة التدريب العملي خارج الأوقات المخصصة للتدريب العملي بدون موافقة رسمية مسبقة .10

العملية ج المادة. مكان التدريب العملي مخصص فقط للتدريب العملي لتحقيق الأهداف التعليمية العملية ولا يسمح للطلبة تحقيق أهداف أخرى خار10

تعليمات عامة

على الجميع الالتزام بالتعليمات والأنظمة والسياسات الخاصة بالتدريب العملي

الالتزام بمواعيد التدريب العملي حسب العبء التدريسي المقرر

حضور الاجتماعات الدورية الخاصة بالشعبة مع منسق المادة العملية

الالتزام بتطبيق البرنامج التعريفي المقرر من قبل أماكن التدريب العملي

ن والى أماكن التدريب.عدم التدخين في المختبرات أو أماكن التدريب العملي ووسائط النقل م

. يمنع استعمال الهاتف الخلوي أثناء التدريب العلمي

.الالتزام بموعد انطلاق وعودة الحافلات من والى أماكن التدريب العملي

توزيع العلامات

يتم توزيع العلامة الكلية للطالب على الشكل الأتي:

ض الامتحان لهذا الغر وتتضمن العلامات المرصودة للتقييم المستمر باستخدام النماذج المعدة % من العلامة الكلية للمادة لأعمال الفصل50ترصد نسبة .1

%30النهائي الكتابي ويرصد له

% ويكون على شكل لجان في اماكن التدريب العملي 20الامتحان النهائي العملي ويرصد له .2

المجتمعي لمرض كوروناتعليمات التدريب العملي لطلاب كلية التمريض خلال فترة التفشي

تعليمات التدريب العملي اثناء الدوام في المختبرات :

الإلتزام بإرتداء الكمامة و القفازات و واقي الوجه خلال فترة الدوام العملي في المختبر .1

الإلتزام بترك مسافة أمان لا تقل عن متر أثناء التعامل مع الزملاء و المدرسين في المختبر .2

المصافحة و التقبيل الإبتعاد عن .3

مع ارتداء المريول الأبيض فوقه او سوداء بيجامه كحلي –الإلتزام بزي التدريب العملي .4

عدم لمس أي دمية لتدريب العملي دون استخدام قفازات .5

إحضار معقم أيدي جيب للإستخدام الشخصي .6

دة الطلاب اب لعيافي حالة الإصابة بأعراض مثل رشح، سعال، ارتفاع بدرجة الحرارة أو أي أعراض مرضية أخرى الرجاء عدم الحضور للمختبر و الذه .7

للحصول على إجازة مرضية

على الهاتف المحمول لكل طالب سند تنزيل تطبيق .8

قلام و أي أغراض شخصية الالتزام بعدم تبادل الأدوات مثل السماعة و الساعة و الأ .9

إبلاغ المدرس بشكل خاص في حال كان لدى الطالب أي أمراض مزمنة .10

تعليمات التدريب العملي اثناء الدوام في المستشفى :

الإلتزام بإرتداء الكمامة و القفازات وواقي الوجه خلال فترة الدوام العملي. .11

غسل اليدين بشكل متكرر. .12


تخدام الشخصي. إحضار معقم أيدي جيب للإس .13

الإلتزام بترك مسافة أمان لا تقل عن متر أثناء التعامل مع الزملاء و الكادر و المرضى. .14

بيجامه كحلي مع ارتداء المريول الأبيض فوقه. –الإلتزام بزي التدريب العملي .15

يب. و خلع الزي العملي في منطقة التدريمنع ارتداء زي التدريب العملي خارج منطقة التدريب العملي بحيث يجب على الطالب ارتداء .16

تعقيم الأدوات الشخصية مثل السماعة، المتر، الهاتف قبل الخروج من مكان التدريب العملي .17

الذهاب لعملي وافي حالة الإصابة بأعراض مثل رشح، سعال، ارتفاع بدرجة الحرارة أو أي أعراض مرضية أخرى الرجاء عدم الحضور لمكان التدريب .18

لعيادة الطلاب للحصول على إجازة مرضية.

تنزيل تطبيق أمان على الهاتف المحمول لكل طالب . .19

استلام حالة مرضية واحدة خلال اليوم العملي وعدم التنقل بين المرضى تفاديا لنقل العدوى. .20

التعامل بحذر شديد مع أي مريض يعاني من ارتفاع في درجة الحرارة أو أية أعراض في الجهاز التنفسي . .21

. الالتزام بعدم تبادل الأدوات مثل السماعة و الساعة و الأقلام و أي أغراض شخصية .22

الإلتزام بالبرتوكول الخاص بمنع العدوى في منطقة التدريب العملي .23

إبلاغ المدرس بشكل خاص في حال كان لدى الطالب أي أمراض مزمنة .24


form Evidence Base Research Article



Student name --------------------- Clinical instructor ----------

Clinical area ---------------------------- rotation no. ----------------

Mark ( / 3) --------------------------

Summary of the Research Article (2) :

Citation (1):

Comments of clinical instructor:


Focus Assessment (Health assessment)

Skin

Color, turgor, moisture, texture except (lesions), assessment of surgical site), drains, edema, all tubes, capillary

refill, profile sign.

Cardiovascular:

Inspection: peripheral cyanosis or central if present

Palpation: for peripheral pulses (strength, rhythm) focus on radial pulse (rate, rhythm, strength). Apical pulse

(localization) rate rhythm from monitor

Blood pressure (MAP) interpretation (invasive, noninvasive).

Auscultation: S1, S2

Neck:

Jugular veins assessment, carotid pulse, and presence of devices (tracheostomy).

Respiratory:

Inspection: description of breathing, rate, rhythm, character.

Auscultation: describe air entry bilateral equal or not, normal breathing sounds and adventitious sounds

(crackles, wheezes).

SPO2, Oxygen therapy (devices).

Mechanical Ventilator (mode, settings)

Palpation and percussion if applicable

Abdomen: bowel sounds, contour, umbilicus

Palpation if not contraindicated

Palpation and percussion if applicable

Musculoskeletal system:

Muscle strength (Range of motion active or passive motion).

S&S of inflammation, Crepitation.

Neurologic system:

GCS, CPOT, RASS, pupils.

Motor, sensory & refluxes if applicable

Oral Cavity:

Signs and symptoms of dehydration (lips, mucous membrane) if devices present (ETT).

All devices (NG tube, arterial line, CVP line, Foleys catheter, Drains)

Common Diseases

Cardiac vascular: ACS, Decompensate Heart failure

Circulatory: Septic shock.

Respiratory: COPD exacerbation, Pneumonia

Renal: Acute Kidney Injury.

Endocrine: DKA.

Cognitive (neuro): CVA (haemorrhagic, ischemic), Head Trauma


Important drugs in clinical areas

Nursing

implications

Side

effect

Administration Indication Classification Drug name

Emergency Drugs

Adrenaline

Atropine

Dopamine

Dobutamine

Norepinephrin

Naloxone

Adenosine

Amiodarone

Narcotic drugs

Pethidine

Morphine

Fentanyl

Controlled drugs ( sedated )

Medazolam

Propofol

Tramal

Diazepam

High alert drugs

KCL

MgSO4

Insulin

Heparin

Warfarin

Antibiotics

Vancomycin

Tienam

Rocephine

Tazocin

Flagyl

Tavanic

Anti platelets ,anti coagulants Thrombolytic

Aggrastat

ASA

Inohep

Clexan

Common drugs

Omeprazol

Epanutin

Hydrocortisone

Beta blockers

Angiotensin converting enzyme

Inhibitor/blockers

Calcium channel Blockers

Diuretics

Nitro-glycerine

Digitalis ( digoxin)

Documents

Adult Health Nursing Clinical (2 ) First Semester (2020