skills checkoff

Question 1

Trach suctioning supplies

Answer 1

Trach suction kits
Stethoscope
Trach care kit
Normal saline/hydrogen peroxide
Face shield, mask, goggles, gown
Pulse ox

Question 2

Trach suctioning assess for signs and symptoms

Answer 2

Increased restlessness or agitation
Increased respiratory rate and or effort, increased BP or HR, decreased O2 sat
Increased noisy congestion when encouraged to cough
Coarse/noisy breath sounds upon auscultation

Question 3

Trach suctioning pre sterility

Answer 3

Position in semi Fowler’s/fowler’s (remove pillow from under head)
Hyperoxygenate (100%, 10-15 L/min, humidifier 100%, > 30 seconds) and encourage 3-4 deep breaths
Unsnap Trach collar ties
Prepare suction: turn on wall suction, 10-120 mm/Hg, remove yankauer, place in easy reach
Apply face shield, mask, goggles, gown
Open NS and invert cap - (use cup in sterile glove package)

Question 4

Trach suctioning: preparing to suction

Answer 4

Apply sterile gloves, coil trach suction catheter in dominant hand, pick up suction tubing with non dominant hand (now non-sterile), attach suction tubing to catheter, place catheter tip in NS, check suctioning and lubricate with NS, remove trach colar with non dominant hand

Question 5

Trach suctioning: suctioning

Answer 5

Insert catheter with open thumb port, advance until you meet resistance and pull back 1 cm, apply suction with removal (twist), encourage patient to cough, no longer than 10 seconds
Assess amounts, color and consistency of secretions
Replace trach colar
Rinse catheter and tubing with NS before completing another pass
Assess between passes: RR and effort, HR, O2 sat, presence of secretions
1 min between passes (2-3 at one time)

Question 6

Trach suctioning: post suctioning

Answer 6

Return oxygen flow rate/humidifier to prescribed setting
Dispose of equipment and remove gloves (wash hands)
Document: amount, color, consistency, number of passes, pt tolerance, VS, lung sounds/respiratory status before and after

Question 7

Trach care: equipment

Answer 7

Trach care kit
Face shield, mask, goggles

Question 8

Trach care: pre assess

Answer 8

Stoma

Question 9

Trach care: prepare sterile field

Answer 9

Open kit and set up
1/2 peroxide and 1/2 NS (with brush), NS, NS

Question 10

Trach care: sterility

Answer 10

Remove trach dressing and discard (could have done earlier), remove trach collar, remove inner cannula and place in 1/2 and 1/2 solution, replace trach collar
Use brush to clean cannula and place in NS (agitate), inspect at eye level, tap on edge to remove excess fluid
Reinsert cannula
Clean face plate and around stoma with cotton tipped applicators (around stoma) and 4x4s (faceplate)
Change securement if necessary (with help from other nurse!)
Place clean trach dressing under face plate (with help!)
Replace trach collar
Position pt and discard supplies

Question 11

Trach care: document

Answer 11

Stoma/skin condition, respiratory status before, during, and after, pt tolerance

Question 12

IV start equipment

Answer 12

IV catheter, tegaderm, tape, tourniquet, chloraprep or OH, male adaptor with extension tubing, NS flush (3 checks), gloves, chux, alcohol wipes, alcohol caps for ports

Question 13

IV start pre assessment

Answer 13

tenderness, pain, infection, wounds, bruising, ask for pt preference of location
adjust bed height, lower side rail

Question 14

IV start pre stick

Answer 14

adjust bed height, lower side rail
apply tourniquet 4-6 inches above site, check distal pulse, palpate vein, select vein, release tourniquet, place chux under arm, clip hair where tape will be

Question 15

IV start prepare equipment

Answer 15

bump air out of syringe, open extension tubing, connect to syringe and prime, prepare tape
open tegaderm, open catheter, apply gloves, cleanse site , reapply tourniquet and check distal pulse

Question 16

IV start stick

Answer 16

anchor vein with non dominant hand by placing thumb 2-3” below insertion site, stretch skin against direction of insertion, hold bevel up, insert at 10-30 degrees, stop when you see blood, advance catheter and release tourniquet, place pressure and withdrawal needle, add extension tubing, aspirate, flush, remove syringe, tape, tegaderm, label with date, time, initials

Question 17

IV start document

Answer 17

date, time, catheter gauge, location, site assessment, patency, pt tolerance

Question 18

CLDC equipment

Answer 18

dressing change kit, sterile gloves, sterile drape, chlorohexidene prep, biopatch, masks for everyone in the room, injection/access cap, stat lock if picc line, clean gloves

Question 19

CLDC safety

Answer 19

allergies to CHG/iodine

Question 20

CLDC pre assessment

Answer 20

remove old dressing with clean gloves (pull towards insertion site)
assess for erythmea, exudate, catheter migration (measure)

Question 21

CLDC sterile set up

Answer 21

apply sterile gloves, unfold sterile drape, open all supply packages and drop on sterile field

Question 22

CLDC skill

Answer 22

disinfect with chlorohexidine prep (30 seconds, side to side and up and down)
apply biopatch
secure with stat lock, place wings and lock, peel off backing
apply tegaderm
sterility done - remove gloves and wash hands
label date, time, length of lumen, initials

Question 23

CLDC document

Answer 23

date/time, disinfectant used, site assessment, catheter length, pt tolerance

Question 24

IVPB equipment

Answer 24

med, secondary tubing with J hook, MAR, tape/label, alcohol caps, clean gloves

Question 25

IVPB med chekcs

Answer 25

verify order, reference book, confirm compatibility, allergies, med math, med checks
tubing expiration, iv solution expiration, free from air bubbles, confirm iv solution to MAR

Question 26

IVPB skill

Answer 26

open secondary tubing, close roller clamps, connect tubing to IVPB bag, pause pump, scrub hub (15 seconds), attach, completely open secondary roller clamp, prime tubing, hang primary lower, change pump settings, start pump

Question 27

IV Push med checks

Answer 27

verify order, reference book, confirm compatibility, allergies, med math, med checks
tubing expiration, iv solution expiration, free from air bubbles, confirm iv solution to MAR
NS checks

Question 28

IV push equipment

Answer 28

med (check expiration), alcohol caps, clean gloves, syringes, needles, NS or approved diluent, NS flushes, MAR, watch with second hand

Question 29

IV push skill

Answer 29

scrub hub on NS vial and med vial, draw up med, inject into syringe, verify correct amount in syringe, label syringe (name, med, strength, quantity, preparation, date, time, initials)
assess site for infiltration/phlebitis, pause pump, scrub hub closest to pt, bump air from flush, attach, occlude, aspirate, detach, scrub hub, attach and admin med (pinch and release), scrub hub, flush at same rate, restart IV