SUNY Orange Middletown, New York DEPARTMENT of NURSING GUIDE College Laboratory Nursing IV: Physical and Mental Illness 57202 Spring, 2007 Week 1 SKILL REVIEW LABORATORY I. BEHAVIORAL OBJECTIVES: At the completion of this unit, the student should be able to: 1. demonstrate previously learned selected nursing interventions R/T the care of the client. * a. demonstrate knowledge of standard precautions by donning and removing protective barrier clothing and gloves. * b. assess blood pressure and apical pulse. c. identify steps in care of intravenous therapy with selected IV infusion pump. d. demonstrate changing gown with client on IV infusion pump. * e. prepare equipment and deliver medication via IV piggyback. f. change an intravenous infusion to a peripheral IV access cap. * g. perform tracheostomy suctioning. h. assess proper functioning of closed chest drainage and review equipment. * i. demonstrate mixing two types of medication in one syringe. j. demonstrate placement and irrigation of nasogastric tube. * k. prepare equipment and apply a sterile dressing. * l. demonstrate insertion of Foley catheter. m. measure hourly urine from urometer and obtain a sterile urine sample. n. perform removal and replacement of antiembolic stockings. (* INDICATES SKILLS TO BE ASSESSED THIS SEMESTER.) 2. evaluate the effectiveness of expected outcomes. 3. document procedure appropriately on a nurse�s note. - 2 - II. ACTIVITIES: Activity 1 (5 minutes) (BT 206) Orientation to Nursing IV college laboratory sessions. a. Review ground rules. b. Discuss skill performance evaluation. Sign and hand in sheet. Activity 2 Data Collection a. Review performance evaluations guides on: (10 minutes) (1) Tracheostomy suctioning (BT 206 and BT 229) (2) Donning and removing protective barrier clothing (3) Blood pressure and apical pulse (4) Administration of an IV (5) Mixing two types of medication in one syringe (6) Sterile dressing change (7) Urinary catheterization b. Instructor demonstration: (20 minutes) (1) tracheostomy suctioning (closed and open method); demonstrate Ambu bag on tracheostomy. Review Nurses Note Activity 3 (65 minutes) Nursing Interventions Students will divide into groups of three or four, rotate to each station, and practice previously learned nursing skills. Practice the activities in any sequence that the individual student deems necessary and then document your care on a nurse�s note. Each group should allow themselves approximately 15 minutes at each station. Remember: You are responsible for competency of these skills in the clinical area. Station 1 -85 year old female, status post respiratory arrest, with permanent tracheostomy inserted 2 weeks ago. Positive sputum cultures for pseudomonas and MRSA. Subclavian triple lumen catheter. Order for Levaquin 500 mg q 24 hrs. Skills: (1) Standard precautions: donning and removing protective barrier clothing (2) Tracheostomy suctioning - open technique and dressing (3) Obtaining a sputum culture (4) Change T/L dressing (5) Prepare and administer Levaquin IVPB (6) Evaluate outcomes and document care - 3 - Activity 3 (continued) Nursing Interventions Station 2 - 18 year old female, status post MVA X 1 day with E/T tube to closed suctioning, chest tube. Skills: (1) Closed suctioning of E/T tube technique (2) Assessment of chest tube drainage and maintenance (3) Assessment of lung sounds (4) Insert Foley catheter and attach urinemeter (5) Obtain urine culture specimen from Foley (6) Evaluate outcomes and document care Station 3 - 50 year old male, 1 day P.O. for intestinal resection with N/G tube to intermittent suction. IV of D5/RL to infuse at 1000 mL q 8 h on pump. Foley to gravity drainage and A.E. hose. Skills: (1) Change sterile dressing (2) Irrigate N/G tube; assess bowel sounds (3) Program IV on pump; change gown with IV in place without disconnecting IV tubing (4) Apply A.E. hose (5) Evaluate outcomes and document care Station 4 - 45 year old female with hx of D.M., CHF and hypertension admitted for intractable vomiting. Initial orders include a stat injection of 20 U of NPH Humulin insulin with 5 U of Regular Humulin insulin and insertion of N/G tube. Skills: (1) Insert N/G tube (2) Prepare 2 meds in one syringe and inject in arm (3) Assess peripheral pulses with doppler (use a partner) (4) Assess blood pressure and apical pulse (use a partner) (5) Evaluate outcomes and document care FACULTY PREPARED MATERIALS: "Ground Rules" for Multisensory Laboratory Skill Performance Evaluation Policy Pharmacotherapy for Endocrine Dysfunctions Skill Performance Evaluation Sheets: Tracheostomy Suctioning Donning and Removing Protective Barriers Blood Pressure and Apical Pulse Administration of Intravenous Piggyback Mixing Two Types of Medication in One Syringe Sterile Dressing Change Urinary Catheterization ms lab wk1 NSG IV 1 07(41)