Adult Health Lab

Dosage calc (flow rate), practice med admin checks

5 Point Intro:

  1. Knock on door

  2. Introduce yourself

    1. “Hi, my name is Emma, I will be your student nurse today”

  3. Hand hygiene and PPE

  4. Identify patient

    1. Name and DOB

    2. Patients MAR, compare with arm band

    3. Verify allergies

  5. Provide privacy

    1. Close door, curtain

  6. Explain procedure

  7. Raise bed, lower side rail

3 Med Label Checks:

  1. Pull (dispensing system)

    1. Read the MAR and select the proper med from the med supply system

  2. Prepare (before prep)

    1. After retrieving med from drawer, compare med label with MAR

  1. Prior to admin (beside after verifying patient identity OR before leaving med room OR both!)

    1. Recheck labels with MAR after identifying before administration OR recheck the label with MAR before taking the med to the patient

Lab 1

Admin Meds by IV Push through an IV Infusion

  1. Gather supplies

    1. 2 saline syringes, med supplies, 4 alcohol wipes

  2. Check chart

    1. Check for allergies

    2. Check admin rate

  3. Hand hygiene

  4. First med check (pull)

  5. Second med check (before preparing)

    1. Check expiration dates, perform calculations

  6. Prepare med (check list)

  7. Third check of med (prior to admin)

  8. Transport med and supplies to bedside

  9. 5 point intro

    1. Rights of med admin:

      1. Right patient

      2. Right route

      3. Right time

      4. Right amount

      5. Right med

  10. Assessments before meds

  11. Assess IV site (inflammation, infiltration, complication signs)

    1. Redness, swelling, leaking, pain, cool, dislodgement, infiltration

  12. Pause pump

  13. Unclamp roller clamp + extension clamp

  14. Clean inject port with alcohol swab, dry (30 seconds)

  15. Insert 3-5 cc of saline flush syringe SLOWLY (verbalize)

    1. VERBALIZE: “Line is patent”

  16. Clean inject port with NEW alcohol swab, dry (30 seconds)

  17. Insert med syringe to injection port

    1. Time the admin rate

  18. Clean inject port with NEW alcohol swab, dry (30 seconds)

  19. Insert SECOND saline flush syringe to injection port

    1. Instill the flush solution at same rate of med given (3-5 cc)

  20. Clean inject port with NEW alcohol swab, dry (30 seconds)

  21. Unclamp roller clamp

  22. Restart infusion pump

  23. Discard syringes + needles (SHARPS)

  24. Remove PPE + hand hygiene

  25. Lower bed and raise side rail

  26. “Is there anything else I can do for you?” “Please hit your call button if you need anything.”

Admin Meds by IV Through a Lock

  1. Gather supplies

    1. 2 saline syringes, med supplies, 5 alcohol wipes

  2. Check chart

    1. Check for allergies

    2. Check admin rate

  3. Hand hygiene

  4. First med check (pull)

  5. Second med check (before preparing)

    1. Check expiration dates, perform calculations

  6. Prepare med (check list)

  7. Third check of med (prior to admin)

  8. Transport med and supplies to bedside

  9. 5 point intro

    1. Rights of med admin:

      1. Right patient

      2. Right route

      3. Right time

      4. Right amount

      5. Right med

  10. Assessments before meds

  11. Assess IV site (inflammation, infiltration, complication signs)

    1. Redness, swelling, leaking, pain, cool, dislodgement, infiltration

  12. Clean inject port with alcohol swab, dry (30 seconds)

  13. Unclamp extension connector

  14. Insert 3-5 cc of saline flush syringe SLOWLY (verbalize)

    1. VERBALIZE: “Line is patent”

  15. Clean inject port with NEW alcohol swab, dry (30 seconds)

  16. Insert med syringe to injection port of the med lock

    1. Time admin rate

  17. Clean inject port with NEW alcohol swab, dry (30 seconds)

  18. Insert 3-5 cc of SECOND saline flush syringe SLOWLY (verbalize)

    1. Instill flush solution at same rate as med

  19. Clamp the extension connector (saline lock)

  20. Clean inject port with NEW alcohol swab, dry (30 seconds)

  21. Discard syringes + needles (sharps)

  22. Remove gloves + hand hygiene

  23. “Is there anything else I can do for you?” “Please hit your call button if you need anything.”

Admin a Piggyback Intermittent IV Infusion of a Med

  1. Gather supplies

    1. Secondary med bag, secondary lining, 1 alcohol wipe

  2. Check chart

    1. Check for allergies

    2. Check admin rate

  3. Hand hygiene

  4. First med check (pull)

  5. Second med check (before preparing)

    1. Check expiration dates, perform calculations

  1. Third check of med (prior to admin)

  2. Transport med and supplies to bedside

    1. 5 point intro

      1. Rights of med admin:

        1. Right patient

        2. Right route

        3. Right time

        4. Right amount

        5. Right med

  3. Assessments before meds

  4. Assess IV site (inflammation, infiltration, complication signs)

    1. Redness, swelling, leaking, pain, cool, dislodgement, infiltration

  5. Close clamp

  6. Spike bag

    1. Push + twist

  7. Back priming:

    1. Clean port above infusion pump

    2. Attach to port above infusion pump

    3. Lower secondary bag below primary

    4. Unclamp roller clamp

    5. Allow fluid to flow into drip chamber halfway

    6. Clamp roller clamp

    7. If chamber is full, squeeze while bag is upside down

    8. Place med on pole, higher than primary IV

  8. Open clamp

  9. Set rate and volume of secondary infusion on infusion pump

  10. Click start infusion

  11. Check that chamber is dripping (VERBALIZE)

  12. Remove PPE + hand hygiene

  13. “Is there anything else I can do for you?” “Please hit your call button if you need anything.”

Hanging a Primary IV Bag

  1. Gather supplies

    1. Primary IV bag, primary lining, 2 alcohol wipes, 1 saline syringe

  2. Check chart

    1. Check for allergies

    2. Check admin rate

  3. Hand hygiene

  4. First med check (pull)

  5. Second med check (before preparing)

    1. Check expiration dates, perform calculations

  6. Third check of med (prior to admin)

  7. Transport med and supplies to bedside

  8. 5 point intro

    1. Rights of med admin:

      1. Right patient

      2. Right route

      3. Right time

      4. Right amount

      5. Right med

  9. Assessments before meds

  10. Assess IV site (inflammation, infiltration, complication signs)

    1. Redness, swelling, leaking, pain, cool, dislodgement, infiltration

  11. Clamp lining

  12. Spike bag

    1. Push + twist

  13. Hang bag

  14. Squeeze drip chamber until half full

  15. Prime line

    1. Release roller clamp

    2. Look for bubbles

    3. Make sure med went to end of line

  16. Clamp line

    1. *DONT LET TUBING HIT ANYTHING

  17. System power = on button

    1. Channel select

    2. Rate, volume

  18. Open chamber

    1. Blue to blue

  19. Disinfect injection port with NEW alcohol pad, dry

  20. Flush catheter with saline flush syringe (3-5 cc over a min, VERBALIZE)

  21. Disinfect injection port with NEW alcohol pad, dry

  22. Connect line to IV

    1. Twist + push

  23. MAKE SURE NOTHING IS CLAMPED (ROLLER + EXTENSION)

  24. Start infusion

  25. Look for drips in chamber

    1. VERBALIZE: “Line is not kinked, drips in chamber”

  26. “Is there anything else I can do for you?” “Please hit your call button if you need anything.”

Med Admin

5-3 Removing Medication From an Ampule

  1. Gather equipment

    1. Ampule, filtration needle, syringe, safety needle, 1 alcohol wipe

  2. Tap the stem of the ampule

  3. Hand hygiene, gloves

  4. Scrub the neck of ampule using an alcohol pad, keep pad in place

  5. Breaking away from body, break off the top of the ampule

    1. DO NOT PUT IN SHARPS, only top in sharps

  6. Attach filter needle

  7. Remove the cap from the filter needle (hooty hoo)

  8. Withdraw entire medication

  9. Withdraw needle and tap the syringe

  10. Recap

  11. Check the amount of medication in the syringe with the medication dose and discard any surplus

5-4 Removing Medication From a Vial

  1. Gather equipment

    1. Vial, 1 mL syringe or insulin syringe, alcohol swaps, tape, pencil, work pad

  2. Remove cap on vial

  3. Scrub the top with antimicrobial swab and allow to dry

    1. 30 seconds

  4. Remove cap from needle (hooty hoo)

  5. Draw back an amount of air into the syringe = to the dose of medication to be withdrawn

  6. Pierce the vial at the center with the needle

  7. Inject air

  8. Invert vial

  9. Withdraw the medication

  10. Remove needle

  11. Tap syringe to remove air

  12. Recap

  13. Check the amount of medication in the syringe with the medication dose and discard any surplus over trash can

Lab 2

Inserting a Nasogastric Tube

  1. Gather supplies

    1. NG tube, emesis bin, water and straw, penlight, tape, stethoscope, sharpie, measuring tape, lubricate

  2. 5 Point Intro

    1. Explain procedure - this feeding tube will provide you with nutrition and drain your stomach contents

      1. Talk to pt throughout - tears and gagging are normal

    2. HOB 90 degrees

  1. Prepare:

    1. Emesis bin

      1. Lube in bin

    2. Water and straw

    3. Tape

      1. Tear half halfway

  2. “Close one nostril at a time, which one is easier to breath out of?”

  3. Measure + mark tube

    1. Nose to tip of earlobe then to tip of xiphoid process

  4. Open kit

  5. Lubricate 2-4 inches of tube

  6. Place end of tube in emesis bin

  7. Have pt flex head back and insert tube upward and back against nose until tube hits back of throat

    1. DO NOT LET GO OF NG TUBE

  1. Ask pt to lower head, chin to chest

    1. Drink water through straw

  2. Advance tube downwards and backwards as they swallow

    1. Don’t force tube

    2. Rotate tube if met with resistance

  3. Stop advancement when met with marking

    1. “On a real pt I would insert to the mark”

  4. Secure NG tube with tape to nose

  5. Check placement

    1. X-ray

    2. Check CO2

  6. Clamp end of tube

  7. Measure length of exposed NG tube

    1. Cm or in

  8. Secure to gown with tape or safety pin

  9. Lower bed, raise side rails, lower HOB

  10. Remove gloves + hand hygiene

  11. “Is there anything else I can do for you?” “Please hit your call button if you need anything.”

Irrigating a Nasogastric Tube Connected to Suction

  1. Gather supplies

    1. Absorbent pad, STERILE WATER, container, syringe

    2. Check expiration dates

  2. 5 Point Intro

    1. Explain procedure

      1. This will make sure your NG tube is working

    2. Pt will already be in suction

    3. HOB 90 degrees

  1. Pour 60 cc of sterile water into container

  2. Place absorbant pad

  3. Clamp NG tube

  4. Disconnect NG tube for suction apparatus, lay on pad

  5. Confirm placement of NG tube

    1. X-ray

    2. CO2

  6. Draw up solution into syringe (30 cc)

  7. Insert irrigation solution into tube

  8. Remove 30 cc of fluid

  9. Discard into emesis bin

  10. Repeat steps 6-9

  11. Connect NG tube to suction unit

  12. Remove PPE + hand hygiene

  13. Lower bed, raise side rails, lower HOB

  14. “Is there anything else I can do for you?” “Please hit your call button if you need anything.”

Suctioning a Tracheostomy: Open System

  1. Gather supplies

    1. Sterile gloves, suctioning kit, container, catheter, ambu bag, suction tubing, STERILE SALINE

  2. 5 Point Intro

    1. Explain procedure - removes contents from airway to help you breathe better

    2. HOB 90 degrees

  3. Assess lung sounds - listen for ronchi

    1. 4 anterior thorax landmarks

    2. Pulse ox

  4. Select correct pressure for suction

    1. 80-120 mmHg

    2. O2 flow meter = 15 L/min

  5. Assess site

  6. Check suction

  7. Hand hygiene

  8. Open suctioning kit

    1. Remove container only touching outside surface

      1. Set closest to patient

    2. Pour sterile saline into container

  9. Sterile gloves

  10. Connect catheter and tubing

    1. Dominate hand - catheter = sterile (keep wrapped)

  11. Suction up saline to lubricate catheter

  12. Attach ambu bag to trach

    1. Give 3 breaths

  13. Remove bag

  14. Insert catheter until pt coughs/gags

  15. Apply suction while coming out with circular motion

    1. NEVER SUCTION GOING DOWN

  16. Provide 3 breaths again

  17. Flush catheter with saline

  18. Wait 1-2 mins before suctioning again

  19. Repeat steps 12-17

  20. Assess lung sounds - listen for ronchi

    1. 4 anterior thorax landmarks

    2. Pulse ox

  21. Dispose of supplies

  22. Remove gloves + hand hygiene

  23. Lower bed, raise side rails, lower HOB

  24. Turn oxygen and suction off

  25. “Is there anything else I can do for you?” “Please hit your call button if you need anything.”

Providing Care of a Tracheostomy Tube and Site

  1. Gather supplies

    1. Sterile gloves, NORMAL SALINE, care and cleaning kit, inner cannula, trach collar, split gauze, regular gauze, q-tips

  2. 5 Point Intro

    1. HOB to 90 degrees

  3. Take out inner cannula

  4. Assess site

  5. Remove split gauze

  6. Remove gloves + hand hygiene

  7. Gloves

  8. Open inner cannula supply

  9. Remove gloves + hand hygiene

  10. Sterile gloves

  11. Insert inner cannula

    1. Sterility is now over

  12. Open ALL packaging

    1. Fill container with saline

  13. Dip q-tips into saline

    1. Clean around stoma (above and under face plate)

    2. Use each q-tip only once

    3. Pat dry with gauze

  14. Apply new split gauze under face plate

  15. Replace collar

    1. Secure new before old

    2. Verbalize - “secure one side, around pt neck, secure other side, 2 finger, remove old collar”

  16. Lower HOB, lower bed, raise side rails

  17. Remove gloves + hand hygiene

  18. “Is there anything else I can do for you?” “Please hit your call button if you need anything.”