skills checkoff Flashcards
Trach suctioning supplies
Trach suction kits
Stethoscope
Trach care kit
Normal saline/hydrogen peroxide
Face shield, mask, goggles, gown
Pulse ox
Trach suctioning assess for signs and symptoms
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
Trach suctioning pre sterility
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)
Trach suctioning: preparing to suction
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
Trach suctioning: suctioning
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)
Trach suctioning: post suctioning
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
Trach care: equipment
Trach care kit
Face shield, mask, goggles
Trach care: pre assess
Stoma
Trach care: prepare sterile field
Open kit and set up
1/2 peroxide and 1/2 NS (with brush), NS, NS
Trach care: sterility
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
Trach care: document
Stoma/skin condition, respiratory status before, during, and after, pt tolerance
IV start equipment
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
IV start pre assessment
tenderness, pain, infection, wounds, bruising, ask for pt preference of location
adjust bed height, lower side rail
IV start pre stick
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
IV start prepare equipment
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
IV start stick
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
IV start document
date, time, catheter gauge, location, site assessment, patency, pt tolerance
CLDC equipment
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
CLDC safety
allergies to CHG/iodine
CLDC pre assessment
remove old dressing with clean gloves (pull towards insertion site)
assess for erythmea, exudate, catheter migration (measure)
CLDC sterile set up
apply sterile gloves, unfold sterile drape, open all supply packages and drop on sterile field
CLDC skill
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
CLDC document
date/time, disinfectant used, site assessment, catheter length, pt tolerance
IVPB equipment
med, secondary tubing with J hook, MAR, tape/label, alcohol caps, clean gloves
IVPB med chekcs
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
IVPB skill
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
IV Push med checks
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
IV push equipment
med (check expiration), alcohol caps, clean gloves, syringes, needles, NS or approved diluent, NS flushes, MAR, watch with second hand
IV push skill
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
