HOSA CN 22-23 Skills

Administering Medication - Intramuscular

  1. Washed hands
  2. Prep equipment
  3. Check physician’s order
  4. Prep medication
    • Check expiration
    • clease port
    • put medication dose of air
    • tap needle after
  5. Greet patient
    • introduce self
    • identify patient
    • explain skill
    • obtain privacy
  6. Wash hands
  7. Make sure the patient is comfortable and check the injection site
  8. Cleanse site with alcohol outward from 5cm to 2 inches
  9. Administer medication
    • 90º angle
    • apply gauze first before capping and throwing away needle
    • discard needle
    1. remove gloves and wash hands
    2. record medication and assessment in nurses notes
    3. make sure patient is comfortable

Administering Medication - Subcutaneous

  1. Wash hands
  2. Prep equipment
  3. Check physician’s order
  4. Prepare medication
    • Check expiration date
    • Cleanse port
    • put medication dose of air
    • tap the needle
  5. Greet patient
    • introduce self
    • identify patient
    • explain skill
    • obtain privacy
  6. Wash hands
  7. Make sure the patient is comfortable and tell the to relax and check the injection site
  8. Cleanse site with alcohol outward from 5cm to 2 inches
  9. Administer medication
    • 45-90º angle
    • apply gauze first before capping and throwing away needle
    • discard needle
    1. remove gloves and wash hands
    2. record medication and assessment in nurses notes
    3. make sure patient is comfortable

Administering Medication - Intradermal

  1. Wash hands
  2. Prep equipment
  3. Check physician’s order
  4. Prepare medication
    • Check expiration date
    • Cleanse port
    • put medication dose of air
    • tap the needle
  5. Greet patient
    • introduce self
    • identify patient
    • explain skill
    • obtain privacy
  6. Wash hands
  7. Put on gloves
  8. Make sure the patient is comfortable and tell the to relax and check the injection site
    • 3-4 finger widths below the elbow
  9. Cleanse site with alcohol outward from 5cm to 2 inches
    1. Administer medication
    • 5-15º angle
    • note small bleb
    • apply gauze first before capping and throwing away needle
    • discard needle
    1. Remove gloves and wash hands
    2. Record medication and assessment in nurses notes
    3. Make sure patient is comfortable

Inserting a Nasogastric Tube

  1. Wash hands
  2. Check physician’s order for type, size, and purpose of tube
  3. Assemble equipment and tubing based on tube feeding or suctioning
  4. Greet patient
    • introduce self
    • identify patient
    • explain skill
    • obtain privacy
  5. Wash hands
  6. Put on gloves
  7. Place patient in full Fowler’s
  8. Put bib on chest
  9. Measure tubing and mark with tape
    1. Use damp washcloth without soap to wipe patient’s face
    2. Test for nose obstruction and pick the one that is unobstructed
    3. Apply lubricant to the tube
    4. Flex the head forward and tilt face upward
    5. Insert the tube
    • When it reaches the throat instruct the patient to lower their hand
    • Ask the patient to drink water/swallow to advance the tube and breathe through their mouth
    • Remove tubing if they are coughing or gagging
    • Place temporary piece of tape across nose
    • Check the back of the throat
    1. Secure the tubing to gown
    2. Ensure comfort of patient
    3. Dispose of materials and gloves
    4. Wash hands
    5. Document procedure

Urinary Catheterization - Straight

  1. Wash hands and apply gloves
  2. Assemble equipment
  3. Check physician’s order
  4. Greet patient
    • introduce self
    • identify patient
    • Determine patient mobility
    • Ask if they are allergic to latex or Betadine
    • Explain skill
    • Obtain privacy
  5. Raise bed and lower side rail on working side
  6. Put patient in the correct position
    • Male: thighs abducted
    • Female: Feet apart knees flexed
  7. Place waterproof pad under patient and drape them
  8. Position light
  9. Apply new gloves
    1. Clean the perineal area with soap
    2. Remove and discard gloves
    3. Wash hands
    4. Prepared biohazard bag
    5. Prepare catheterization kit
    6. Put on sterile gloves
    7. Draped the genitals and maintained sterility
    8. Opened supplies
    9. Apply antiseptic and opened cleansing solution
    10. Lubricate the catheter
    • Female: 1-2 in
    • Male: 5-7 in
    1. Cleanse the meatus
    • Male: Hold the genitals with non-dominant hand the entire insertion, cleanse outworld with antiseptic 3 times
    • Female: Spread labia minora with thumb and index the entire insertion, cleanse with antiseptic on the furthest, closest, and then down the middle
    1. Inserting the catheter
    • Pick up catheter in non-dominant hand 3-4 inches from the tip and placing other end in the urine receptacle
    • Ask the patient to bear down
    • Insert it gently until bladder is empty. Female: 2-3 in; Male: 7-9 in.
    • Remove catheter with dominant hand
    1. Remove drape and wash/dried perineum as needed
    2. Dispose of equipment
    3. Remove gloves
    4. Wash hands
    5. Document skill and patient tolerance in notes

Performing a Sterile Wound Irrigation

  1. Wash hands
  2. Check physician’s order
  3. Assemble supplies
  4. Greet patient
    • introduce self
    • identify patient
    • explain skill
    • obtain privacy
  5. Put on protection
    • Put on gloves
    • Put on eye shield/face guard
  6. Prep the patient
    • Position them so the solution will run upwards to downwards
    • Place waterproof bed pad, basin, or irrigating pouch under the area
    • Drape them with bath blanket to only expose the wound
    • Remove their used dressing and discard
  7. Discard used gloves and repeat hand washing
  8. Prep irrigation tray
    • Open the tray using sterile technique
    • Opened irrigation solutions and placed them on table with inside facing upward
    • Poured solution from supply bottle to irrigation bottle (pour some out into trash if solution was already opened)
    • Left the cover off the supply bottle with inside pointing upward
    • Place bottle close to client on bed table
    • Dated and initialed the bottle after opening with patient name and ID number
  9. Opened sterile dressing
    1. Put on sterile gloves
    2. Prep other supplies
    • Prep irrigation tray
    • Put irrigation syringe in the bottle
    • Prep anything else needed
    1. Assess the wound
    2. Irrigation
    • Draw solution into syringe
    • Put syringe just above the top edge of the wound
    • Force fluid into the wound
    • Irrigate all portions of the wound
    • Continue irrigating until solution draining is clear
    1. Use 4x4 pads to pat the wound’s edges dry from the cleanest to most dirty area
    2. Apply new dressing
    3. Remove gloves
    4. Dispose of irrigation supply
    5. Ensure comfort of patient
    6. Wash hands
    7. Document procedure

Postmortem Care of the Body

  1. Wash hands
  2. Check physician’s orders
  3. Assemble supplies
  4. Put on protection
    • Put on two pairs of gloves
    • Put on a gown
  5. Identify the patient
  6. Caring for the body
    • Eyes:
      • Donated: close them and put ice packs on them
      • Not donated: close them and state that the eyes are not to be donated
    • Remove jewelry and other things in client property bag
    • Close their mouth with chin strap or towel
    • Remove IV lines and tubes
    • Remove linens except for sheet that covers them
    • Bath any part that has been soiled with discharge
    • Place a clean incontinence pad under them
    • Apply clean dressing if there are wounds
    • Pad the wrists and ankles with gauze squares
    • Label dentures or glasses for funeral home staff
  7. Attach identification to the patient
    • One tied to the right big toe
    • One tied to the hand/wrist
    • One attached to the covering sheet
  8. Use body bag to close up the body
    • Note if the patient had any communicable diseases on the bag
  9. Wash hands
    1. Document procedure

Assisting Patient with Postoperative Exercises

  1. Wash hands
  2. Check physician’s orders
  3. Assemble supplies
  4. Greet patient
    • introduce self
    • identify patient
    • explain skill
    • obtain privacy
  5. Put on gloves if there is drainage
  6. Splint the incision
    • Use blanket to distribute pressure across incision (assist in holding it if first days post-op)
  7. Turning Coughing and Deep Breathing (TCDB)
    • Take deep breath, hold for 3 seconds
    • Then do a double cough with the mouth open
    • Tell the patient they will repeat the exercise
  8. Huffing
    • Deep breath, force air out in quick and short breaths
    • Second deep breath, force air out in panting movement
    • Third deep breath, force air out in strong huff
    • Tell the patient they will repeat the exercise
  9. Incentive Spirometer
    • Place patient upright
    • Explain the spirometer and the goal for the patient
    • Instruct the patient to clear mucus by coughing
    • Instruct the patient to take slow breath and hold for 3 seconds after inhaling
    • Repeat 8-10 times
    1. Remove gloves if used
    2. Wash hands
    3. Document procedure