Psychomotor Skills Review

Question 1

Donning & Doffing PPE

Answer 1

Don (Put on)

1. Hand hygiene
2. Gown - tie to secure
3. Mask - cover nose & chin
4. Eye protection
5. Gloves - cover cuff of gown

Doff (Take off)

1. Gloves
2. Eye protection
3. Gown
4. Mask
5. Hand hygiene
6. (Avoid touching outside of anything; considered contaminated.)

Question 2

Sterile Field: Best Practices

Answer 2

• ever turn your back to sterile field or leave unattended.
• Do not reach over sterile field.
• Do not cough, talk or sneeze over sterile field.
• Check packaging & expiration dates.
• The 1” border of a sterile field is considered contaminated.
• Keep waist-level. Below waist? No longer sterile.
• Sterile may touch sterile.
• STERILE IS ABSOLUTE - IT EITHER IS OR IT ISN’T!

Question 3

Emptying Closed Drain

(JP Drain, Hemovac)

Answer 3

• Open cap away from self to avoid fluid splashing on you.
• Pour contents into measuring container.
• Note amount, color, consistency, odor.
• Alcohol port before closing.
• Fully compress container & replace cap.
• Discard fluid in toilet.
• Empty drain before half full to ensure adequate suction while decompressed.
• Document output on I&O.
• Secure device to clothing to prevent pulling at insertion site.

Question 4

Difference between enteral & parenteral nutrition.

Answer 4

• Enteral feeding = using the gut/GI tract to feed
• Parenteral feeding = using the IV route (example = TPN)
• IF THE GUT WORKS, USE IT!

Question 5

What are the two reasons a nasoenteral tube is inserted?

Answer 5

1. To feed the patient who will not, cannot or should not eat (sometimes referred to as “gavage”)
2. To remove the gastric contents (sometimes referred to as “lavage”).

The reason why the patient is getting the tube will determine which type you will choose to insert.

Question 6

Tube Feeding: Checking Residual & Best Practices

Answer 6

• Bolus vs. intermittent
• Before feeding (if bolus): perform abdominal assessment, confirm presence of bowel sounds, confirm tube placement
• Aspirate gastric contents with a syringe & measure gastric residual volume (if any). Follow agency policy re: holding feeding for large residual amount (250-500 ml) and return residual to stomach.
• Keep HOB 30-45 degrees to decrease aspiration risk during feedbaing & for an hour after feeding. At all times, if continuous.

Question 7

NG insertion is a sterile procedure. True or False.

Answer 7

FALSE. NG insertion is a clean technique.

Question 8

What is a “salem sump”? And purpose of air vent/blue pigtail?

Answer 8

It is a large-bore single lumen nasogastric tube that includes an air vent (blue “pigtail”) - that is inserted for the purpose of decompressing (suctioning) the stomach.

Purpose of air vent/pigtail = equalizes pressure in the abdominal cavity. Since the stomach is a closed cavity - without the air vent, the tip of the catheter would like be sucked up against the gastric mucosa & cause irritation/ulceration.

Low wall suction = 80-100 mm Hg

High wall suction = 100-120 mm Hg

(Follow agency policy)

Question 9

• *You are assessing your patient with an NG, and find the abdomen is distended and
  painful. What actions are you going to take?**

Answer 9

• Assess patency of tube. NG tube may be occluded or no longer in stomach.
• Irrigate tube.
• Verify that suction is on as ordered.

Question 10

Midstream Clean Catch

Answer 10

• Provide instructions regarding wipes:
  
  • Male: If uncircumcised, retract foreskin. Clean tip of penis starting at urethral meatus in concentric circles.
  • Female: Separate the labira & wipe front to back. Continue to hold labia apart during urination.
• Urinate into toilet initially, then pause urination.
• Urinate 15-30 ml into sterile container.
• Withdraw container from stream & finish urinating into toilet.
• Close & label container.
• Take to lab immediately.

Question 11

Collecting urine specimen from a foley catheter

Answer 11

• If ordered, collect urine specimen from drainage bag immediately after insertion. Otherwise, do NOT use drainage bag.
• Clamp tubing below the specimen collecting port for 10-15 minutes.
• Scrub the specimen port with antiseptic swab.
• Access specimen port using a 10 ml syringe (or device used at agency) & aspirate at least 3 ml of urine.
• Deposit urine in sterile container - & unclamp tubing.
• Label container & send to lab asap.

Question 12

What are the three types of feeding tubes that may be inserted?

Answer 12

• nasoenterally (used for short-term feeding; less than 1 month); inserted by the RN at the bedside
• via endoscopy (used for long-term feeding; PEG- and PEJ tubes); inserted by the HCP
• via surgery (used for long-term feeding; G- and J-tubes); inserted by the HCP

Question 13

Large Volume Cleansing Enema Administration

Answer 13

• Warm enema solution to room temp; prime tubing.
• With tubing clamped, elevate solution 18 inches above patient.
• Place patient in modified left lateral recumbent position (ie., Sims).
• Lubricate enema tip & insert 3-4 inches into anus, angling toward umbilicus.
• Administer enema slowly over 5-10 minutes.
• Lower container of solution (or clamp tubing) if cramping.
• After administration, patient to remain on side, retain contents & resist toileting for 10 minutes if possible.

Question 14

When should the nurse empty an ostomy bag?

Answer 14

When it is 1/3 to 1/2 full.

Question 15

Do you cut the gauze when you are placing a new dressing on the patient’s trach faceplate?

Answer 15

• No! (strings may fray & pReviewatient may inhale). Use pre-split gauze only.

Question 16

How to Tracheal Suction

Answer 16

• Hyperoxygenate patient.
• Set wall suction to 100-150 mmHg.
• Open/prepare suction kit (sterile); don sterile gloves.
• Pick up sterile suction catheter w/ sterile (dominant) hand & connect it to suction with (now clean) nondominant hand.
• Occlude the hole & suction catheter to check function w/ nondominant hand.
• Insert until meets resistance/coughing occurs (no suction going down).
• Intermittently apply suction while rotating cathether during withdrawal. Limit pass to 10 second.
• Reoxygenate patient for 1 minute; encourage cough/deep breathing.
• Suction sterile saline to clear tubing between passes; maximum = 3 passes.
• Oral care afterward.

Question 17

Central Line Removal

Answer 17

• Place patient supine/don clean gloves.
• Remove dressing while stabilizing catheter w/ one hand.
• Have patient take a deep breath & hold it. If they can, instruct them to bear down (can you explain the “why” behind that?).
• Withdraw catheter slowly & gently, keeping it parallel to the skin.
• Apply pressure to the site w/ sterile gauze for 1 minute then apply a sterile occlusive dressing (such as petroleum gauze).
• Measure the length of the catheter to ensure it matches the documented length & is intact.
• Document.
• Have patient remain supine for 30 minutes following procedure.

Question 18

Technique for giving opthalmic drops

Answer 18

• Don clean gloves & offer patient a tissue.
• Have patient tilt head back & look up.
• With non-dominant hand, pull down the lower lid down to gently to expose the conjunctival sac.
• Drop med into sac without touching the eye with dropper.
• Apply gentle pressure to inner canthus for 1 minute to prevent systemic absorption.
• Wait 5 minutes between administration of different optic meds.

Question 19

Technique for Giving Otic Meds

Answer 19

• Position patient on unaffected side.
• Pull the pinna up & back for adults - or down & back for children < 3 years old.
• Hold dropper over ear canal without touching ear.
• Instill drops by allowing them to hit the side of the canal and run into the ear.
• Let go of the pinna and gently press on the tragus several times.
• Have patient remain on their side for 5 minutes.

Question 20

Technique for Inhalation Medications

Answer 20

• Meter-dosed inhaler (MDI):
  
  • Shake inhaler & attach a spacer.
  • Exhale completely.
  • Place the mouthpiece between lips and inhale slowly/deeply (> 3 seconds).
  • Hold breath for 10 seconds.
  • Remove inhaler from mouth and exhale slowly.
  • Wait 1 minute between puffs of same medication.
• Dry-Powder inhaler (DPI):
  
  • Do not shake device or use a spacer.
  • Place device between lips & sharply inhale to activate.
  • Hold breath for 10 seconds.
  • Remove inhaler from mouth & slowly exhale.
  • Wait 1 minute between puffs of same medication.

Question 21

Technique for NG/PEG Med Administration

Answer 21

• Verify tube placement & place in semi-fowler’s or higher.
• Use liquid forms of meds when possible. Crush & dissolve tables in 15-30 ml of water.
• Flush tube with 30 ml of water.
• Administer meds per agency policy:
  
  • Gravity:
    
    • Remove plunger from 60 ml syringe & connect it to the tube. Pour prepared meds into open end of syringe.
  • Push:
    
    • Draw up dissolved med with syringe and connect to the tube. Push slowly to deliver.
  • Flush tube with 30 ml of water.
• Final flush is 60 mls unless fluid restricted.
• When administering more than one med, administer each med separately & flush with water between each med.

Question 22

Intradermal Injections:

Needle Size, Volume, Administration

Answer 22

• Needle Size: 25-27 gauge, 1/4-1/2 inch needle
• Volume: < 0.5 ml
• Administration:
  
  • Select site/cleanse w/ antiseptic swab.
  • Spread skin taut using thumb & index finger of non-dominant hand.
  • Insert needle bevel up at 5-15 degree angle. Advance needle until the bevel is under the skin. Do not aspirate.
  • Inject med to form a small bled (bubble) or wheal.
  • Remove needle at same angle as inserted.
  • Do not massage the site.

Question 23

Subcutaneous Injections:

Needle Size, Volume, Administration

Answer 23

• Needle size: 25-30 ga, 3/8-5/8 in needle
• Volume: < 1 ml
• Administration:
  
  • Select injection site in a fatty area (eg, abdomen, lateral upper arms, top of thighs).
  • Cleanse site with swab.
  • Pinch skin to create a skin fold using the nondominant hand.
  • If you can grasp 2 inches of tissue, insert needle at 90-degree angle. If you can grasp 1 inch of tissue, insert the needle at 45-degree angle.
  • After needle is inserted, (release the pinched skin if applicable) & inject med with dominant hand.
  • Remove the needle at same angle as insertion.
  • Do not massage site.

Question 24

IM Injections:

Needle Size, Volume, Administration, Z-track Method

Answer 24

• Needle Size: 22-25 ga, 1-1.5 inches
• Volume: < or = 1 ml (deltoid); < or = 3 ml (vastus lateralis, ventrogluteal)
• Z-Track Administration:
  
  • Select injection site & cleanse area.
  • Prior to administratoin, use ulnar side of non-dominant hand to laterally displace the skin by 1 inch.
  • Insert needle at 90 degree angle using dominant hand. Stabilize the syringe with non-dominant hand.
  • Do not aspirate.
  • Inject the med at a slow/even pace & allow for med to disperse into muscle for 10 seconds.
  • Remove needle at same angle as insertion, and THEN release skin.
  • Apply bandage or gauze; do not massage site.

Question 25

How long after you give a med via NG (that is ordered to wall suction) should you wait before reattaching the suction?

Answer 25

30 minutes to one hour

Question 26

What are the preferred IM injection sites for adults?

Answer 26