learning_guide fall 2006

Central Texas CollegeDepartment of Nursing

RNSG 1105

Nursing Skills I

Learning Guide

Fall 2006

Fall 2006

Learning Guide Unit I: Scientific Basis for Nursing Practice: AsepsisA. Hand Washing

Isolation PrecautionsFunctional Health Pattern (FHP): Health Perception/Management

Learning ActivitiesRequired Learning Activities:

1. Perry & Potter (2005) pp. 772—8202. Procedure Performance: Hand washing; Donning and Removing Personal Protective

Equipment

ObjectivesAfter completion of this unit, the student will be able to:

1. Perform proper steps for hand washing and the rationale for each step2. State the action of soap, friction and rubbing in hand washing..3. List and demonstrate the 5 surfaces that need to be included in hand washing.4. Describe how hand washing prevents infection and protects clients and nurses from

developing infections.5. Perform the following assessments:

a. Client's risk for extent of infection; e. g., immunosuppressed, invasive procedure, open wound, etc.

b. Client's knowledge of benefits of proper hand washing.6. Don and remove Personal Protective Equipment7. Correctly implement Standard Precautions

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Unit I: Basic Human Needs B. Basic Safety Issues

FHP: Activity-Exercise

Learning ActivitiesArticle: “Nurse Fatigue: The Human Factor”Texas Nursing 2004 at Library Reference DeskPerry & Potter (2005) pp. 959—1000Complete falls assessment (p.13) on two elderly adults (due Sept 12/14)Student Presentation on Bioterrorism/National Patient Safety GoalsProcedure Performance: applying restraintsObjectivesAfter completion of this unit, the student will be able to:

1. State safety measures to be implemented in the laboratory setting2. Describe safety issues to note in the client’s room; include lighting,

temperature, obstacles, hazards, bathroom hazards.3. Describe safety issues involved with the use of restraints.4. Discuss the influence JCAHO and OBRA have had on the use of restraints.5. Describe the restraint free environment and the alternatives to traditional

restraints.6. List measures to prevent falls; specify measures to use for older adults and

the physiological conditions associated with aging that put these clients at risk.

7. State measures employed to reduce risk of injury in the client with seizures; with procedure—related accidents; with the use of equipment.

8. Perform the following assessments:a. Muscle strength of legs and upper arms, comparing right with left.b. Joint mobility and limitations caused by contractures or discomfort;

assess for history of osteoporosis.c. Vision, hearing, and altered sensation (numbness or tingling of the feet).d. Ability to follow verbal instructions and appropriateness of response to

verbal commands.e. Need for medication before transfer.f. Position and functioning of IV tubing and poles, need for O2 therapy,

Foley catheter, and surgical drains.9. Discuss threats to patient/client safety resulting from fatigued nurses (article)

10. Describe fatigue (article) 11. State what nurses can do to improve safety of care (article) 12. Demonstrate understanding and application of National Patient Safety Goals 13. Discuss bioterrorism and the nurses role in treatment

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Unit I: Basic Human NeedsB. Hygienic Care: Bed Bath, Partial Bath, Shower, Back Rub, Perineal C. Care

FHP: Nutrition-Metabolic, Elimination

Learning ActivitiesRequired Learning Activities

1. Perry & Potter (2005) pp. 1001--10652. 2. Video: Bathing (Mosby)3. Procedure Performance: Bed bath; perineal care; hygiene procedure

for oral care 4. Complete Braden scale on two older adults (due on 3/5th Oct)

Wear pants to class.ObjectivesAfter completion of this unit, the student will be able to:

Describe hygienic care that nurses provide to clients.Identify factors influencing personal hygiene.Identify normal and abnormal assessment findings while providing hygiene care.Apply the nursing process to common problems related to hygienic care of the

skin.Identify the purposes of bathing.Describe various types of baths.

a. Describe and demonstrate the correct procedure for giving a bed bath; state the rationale for each step.

b. Describe and demonstrate the correct procedure for a partial bath.c. Describe the correct procedures for giving a shower.

Explain specific ways in which nurses help hospitalized clients with hygiene.Describe steps for identified hygienic-care procedures – eye care; hearing aids.9. Describe and demonstrate perineal care for a male and female client; state

rationale for each step.10. Perform hygiene procedure for oral care 11. Perform the following assessments:

a. Degree of assistance needed for bathing (limitations of activity or positioning) .

b. Client's tolerance of activity, level of discomfort with movement, and presence of shortness of breath or chest pain with exertion.

c. Client's preferences for time of bath, products used, and frequency of bathing.

d. Problems related to condition of the skin:

1. Drainage or excretions from lesions or body cavities2. External devices (catheters, drains, dressings, restraints).3. Rashes or skin damage related to pruritus and scratching.

12. identify common bed positions and uses

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Unit I: Basic Human NeedsD. Bed Making

FHP: Nutrition-Metabolic


1. Perry & Potter (2005), pp.10562. Video: Bed making (Mosby)3. Procedure Performance: Occupied bed making; Surgical Bed

Wear pants to class.ObjectivesAfter completion of this unit, the student will be able to:

1. Identify safety and comfort measures, underlying bed-making procedures.2. Describe and demonstrate the correct procedure for making an occupied bed;

state the rationale for each step.3. State procedure and rationales for making an unoccupied bed, surgical bed .4. Perform the following assessments:

a. Client’s mobility status b. Client’s self-toileting ability/incontinence c. Note the presence of any wounds, drainage, tubes etc.

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Unit II: Promoting Physiologic Health Activity and Exercise FHP: Activity-Exercise


1. Perry & Potter (2005), Chapter 36 pp 930-9582. Video: Body Mechanics, Exercise and Activity (Mosby)3. Article: Tabone S. (2005). Safe patient handling. Texas Nursing March 2005 at

Library reference desk. Performance Procedure: Assistive DevicesObjectivesAfter completion of this unit, the student will be able to:

1. Describe the assessment the nurse must perform in preparation for ambulating a client.

2. Describe and demonstrate the correct procedure for assisting a client to walk.3. Describe and demonstrate the correct procedure for assisting a client who

begins to fall when walking.4. Describe assistive devices utilized for ambulation and the safety factors for

proper use indicated for each one.5. State and demonstrate the steps utilized in crutch walking, walking up and

down stairs and sitting and arising from a chair.6. Perform the following assessments:

a. Client's most recent activity experience, including distance ambulated and tolerance of activity.

b. Best time to ambulate, considering other activities such as bathing and physical therapy.

c. Environment for obstacles and safety hazards. If client has IV, a rolling IV pole is needed.

d. Client's motivation and ability to cooperate.e. Medications that may alter stability.f. Client’s need for a place to sit and rest during ambulation.7. Consider alternative methods of patient handling and legislation

pertaining to this topic (article)

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Unit II: Promoting Physiologic HealthMobility and ImmobilityPositioningTransfers

FHP: Activity-Exercise


1. Perry & Potter (2005) Chapter 46 pp. 1421-1480 2. Video: ROM Exercise (MED COM), Positioning (HSC)3. Procedure Performance: transfers, positioning

Bring 2 bed pillows to class. Wear pants to classObjectivesAfter completion of this unit, the student will be able to:

1. Demonstrate correct body alignment and body mechanics during all procedures.

2. List the principles of body mechanics.3. State the assessment needed prior to lifting an object and the technique to

follow when lifting4. Differentiate between active ROM (AROM)and passive ROM (PROM) 5. Identify nursing precautions used when performing PROM.6. Perform AROM exercises correctly; demonstrate the correct technique for

performing PROM.7. State the main purpose for PROM.8. Describe and demonstrate correct body alignment for the immobile client

lying in bed.9. Perform the following assessments:

a. Client's weight, age, level of consciousness, and ability to cooperate.b. Strength of muscles and mobility of joints. Compare strength in arm and

legs.c. Need for analgesic medication 30 - 60 minutes before position changes

10. Describe the following positions and indicate the correct steps for positioning clients and appropriate support measures for each; state the rationale for each step:a. prone/supineb. dorsal recumbent c. Sims and side lying

d. orthopneic e. supported Fowler’s position

11. Describe and demonstrate the correct procedure for:a. turning a client from his back to side.b. moving a client up in bed.

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c. Log rolling a client from back to side.12. Describe devices utilized in proper positioning.13. Describe and demonstrate the steps for transferring a client from bed to chair

and bed to stretcher utilizing proper body mechanics; state the rationale of each step.

14. Describe the use of a transfer device to assist in the transfer of a client from bed to stretcher.

15. State the safety considerations necessary in transfer of the client.16 Perform the following assessments:

a. Physician's orders, client's history and progress.b. Client's readiness to learn.c. Client's level of comfort (scale 0 to 10) before exercising.d. Level of activity/mobility.

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Unit III: Assessing HealthB. Vital Signs

FHP: Nutrition-Metabolic

Learning Activities

Required Learning Activities:1. Perry & Potter (2005), pp. 617—6702. Video: Vital Signs (Mosby)2. Procedure Performance: Temperature, Pulse, Respirations, Blood Pressure3. Wear a short sleeve shirt to class

ObjectivesAfter completion of this unit, the student will be able to:

1. Describe factors that affect the vital signs and accurate measurement of them.

2. Identify the normal ranges for each vital sign.3. Identify the variations in normal body temperature, pulse, respirations, and

blood pressure that occur from infancy to old age.4. Describe factors influencing the body’s heat production and loss.5. Compare oral, tympanic, rectal, and axillary methods of measuring body

temperature.6. Describe appropriate nursing care for alterations in body temperature.7. Identify nine sites used to assess the pulse and state the reasons for their use.8. List the characteristics that should be included when assessing pulses.9. Explain how to measure the apical pulse and the apical-radial pulse.10. Describe the mechanics of breathing and the mechanisms that control

respirations.11. Assess respirations12. Differentiate systolic from diastolic blood pressure.13. Describe five phases of Korotkoff’s sounds.14. Describe various methods and sites used to measure blood pressure.15. Discuss measurement of blood oxygenation using pulse-oximetry.16. Identify when it is appropriate to delegate measurement of vital signs to

unlicensed assistive personnel.

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Department of NursingRNSG 1105 - PREPARATION FOR BASIC NURSING CARE

BASIC CLINICAL SKILLS

These forms must be turned in to the Professor at the final skill check-off.

Independently Practiced SkillsThe following skills must be independently practiced by the students. The expectation is that the students will be able to perform these skills in the clinical area.

1. Body mechanics 4. Ambulating a client 7. Grooming, dressing a client2. Range of motion 5. Oral care, care of eyes, ears3. Positioning 6. Nail and foot care

Supervised Practice SkillsThe following skills must be practiced independently and then an instructor will observe the student performing the skill during an assigned supervised lab period. If the student has not practiced sufficiently the instructor will not sign the clinical skill form. The practice will be rescheduled at the discretion of the instructor. If the student misses an appointment without the prior approval of the instructor, it will count as one of the three opportunities to have the practice supervised. The student may not schedule another skill check-off/practice until the skill is performed to the satisfaction of the instructor. If the supervised skill is not completed the student may not be able to go into clinical. PresentationsNational Pt. __________________________________________________________________Safety __________________________________________________________________GoalsSupervised Skills Date Instructor Signature

Personal Protective ____________________________________________________________Equipment ________________________________________________________________ _________________________________________________________________

Bed Bath ___________________________________________________________________________________________________________________________________________________________________________________________________

Transfer ___________________________________________________________________________________________________________________________________

Occupied Bed ___________________________________________________________________________________________________________________________________

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Skills Check-offs

The student will be given three (3) opportunities to pass each skill check-off. Remediation: Will be required for those not passing a skill on the first and second attempts. If the student is unsuccessful on any attempt, the student must have remediated and rescheduled the skill for the second and/or third time within 48 hours of the last attempt. If the student chooses not to show up for an appointment for a skill check-off without prior approval from the instructor, or if the student states he/she is not ready for the check-off, the student will receive a “Fail” and the missed appointment will count as one of three opportunities to perform the skill. The student will not be able to perform the next scheduled skill check-off or supervised practice until the previous skill has been successfully passed. The third attempt of a skill may be videotaped.

Failure to successfully complete check-off on any one of the skills by the third attempt is grounds for course failure. All RNSG 1105 skills check-offs and supervised practices must be completed satisfactorily (Pass) before the evaluation check-off.

Skills Grade S/U Date Instructor Signature

Hand washing 1. ____________________________________________________________

Remediator Date__________________

2. ____________________________________________________________

Remediator Date__________________

3. ____________________________________________________________

Temperature 1. ____________________________________________________________ Remediator

Date___________________ 2.

_____________________________________________________________ Remediator

Date___________________ 3.

_____________________________________________________________

Pulse 1. _____________________________________________________________ Remediator

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Date___________________ 2.

_____________________________________________________________ Remediator

Date___________________ 3.

_____________________________________________________________

Respirations 1. _____________________________________________________________

Remediator Date___________________

2. _____________________________________________________________

Remediator Date___________________

3. _____________________________________________________________

Blood Pressure 1. _____________________________________________________________ Remediator

Date___________________ 2.

_____________________________________________________________ Remediator

Date___________________ 3.

_____________________________________________________________

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Falls Assessment

Client A Client BYes No Yes No

Client has fallen 2 or more times in the last two monthsObserve client transferring or ambulating 20-40 feet. If stopping to rest, holding walls/furniture, stumbling or swaying present, mark yesClient’s physical impairment, related to balance and weight bearing, is less than 2 months oldClient has history of syncope’s or seizures within the past 6 monthsClient is disorientedClient has poor judgmentClient has CNS side effects of medication that is new or dosage has recently been modified. Or, client suffers from drowsiness, dizziness, or tremorsTotal

0—3: low risk4—6: moderate risk

7—12: high risk

Adapted from Metroplex Home Health

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Vital Signs

Client Pulse Respirations Temp (oral) Blood Pressure

1. 1.rate2. rhythm, 3. strength4. equality

1. .rate2. depth3. rhythm



















Turn this page in to your professor at the vital sign check-off

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RNSG 1105 Basic Nursing SkillsPatient Quality and Safety Indicators, Sources, and Organizations

Writing and Presentation Assignment

You will be assigned a topic and a partner for a written and oral presentation due on a specified date. Your presentation will be done with your partner but the written assignment must be your own original work. This is a pass/fail score. All components of the requirement must be satisfied to pass.

Written assignment – 2-3 typed pages, single spacedOral presentation -- 5-10 minute summary of written assignment.

Required components of written work:1) History of Organization/Work2) Mission of Organization/Work3) Is it a public or private organization/ Is it profit or not-for-profit4) What questions can the quality or safety indicators answer?5) Examples of some of the organizations indicators6) How is the information published or used?

Topics for assignment:1) AHRQ—Agency for Healthcare Research Quality2) IHI- Institute of Healthcare Improvement/Save 100K Lives Campaign3) NDNQI—National Database of Nursing Quality Indicators4) NQF/NAHQ—National Quality Forum/National Association of Healthcare Quality5) Healthgrades Report6) Leapfrog Group7) CMS- Centers for Medicare and Medicaid Services/Hospitals Quality Initiative8) JCAHO- Joint Commission on Accreditation of Healthcare Organizations Core Measures/Performance

Measurement Initiatives9) Six Sigma—Motorola project to decrease errors

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MONDAYTUESDAY WEDNESDAY THURSDAY

Aug 28Classes Start1. IntroductionHx of asepsis2. Textbook, Ch. 33- Infection Control

29SyllabusCourse GuidelinesSkill:Hand Washing-practicePPE supervised check off

30Classes Start1. IntroductionHx of asepsis2. Textbook, Ch. 33-Infection Control

31SyllabusCourse GuidelinesSkill:Hand Washing-practicePPE supervised check off

Sept 4Holiday: Labor Day

5

Skill: Hand Washing- check off

Library time

National Patient Safety Goal

Presentation (5min)

6

Open lab

7

Skill: Hand Washing- check off

Library time

National Patient Safety Goal

Presentation (5min)

11Textbook, Ch. 37, Safety

12

Skill:

Restraint supervised practice

Falls assessment Case Study

13Textbook, Ch. 37, Safety

14

Skill:

Restraint supervised practice

Falls assessment Case Study

18Exam I (Ch 33 & 37)Textbook, Ch. 38Hygiene

19

Skill:

Bathing, Bed making, oral care supervised practice

20Exam I (Ch 33 & 37)Textbook, Ch. 38, Hygiene

21

Skill:

Bathing, Bed making, oral care-supervised practice

25 Exam 1 Review

Text, Ch. 36

Activity and Exercise

26

Skill:

Turning/positioning Assistive devices

27 Exam 1 Review Text, Ch. 36

Activity and Exercise

28 Skill:Turning/positioning Assistive devices

Oct 2

Text, Ch. 46

Mobility and Immobility

3

Skill:

Pt. Transfer, PROM

Guest speaker

Braden scale Case Study

4

Text, Ch. 46

Mobility and Immobility

5Skill:

Pt. Transfer, PROM

Guest speakerBraden scale Case Study

9Exam II (Ch 36, 38, 46)

10

Skill:

Vital Signs-practice

11Exam II (Ch 36, 38, 46)Text, Ch. 31Vital Signs

12Skill:

Vital Signs-practice

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Text, Ch. 31

Vital Signs16 Exam 2 Review Vital sign check-off

VS sheet due

17

Final Exam

Comprehensive

18 Exam 2 Review

Vital Signs check-off

VS sheet due

19 Final Exam comprehensive

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learning_guide fall 2006

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