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Central Texas College

Department of Nursing

RNSG 1105

Nursing Skills I

Learning Guide

Fall 2006

Fall 2006
Learning Guide Unit I: Scientific Basis for Nursing Practice: Asepsis
A. Hand Washing
Isolation Precautions
Functional Health Pattern (FHP): Health Perception/Management

Learning Activities
Required Learning Activities:
1. Perry & Potter (2005) pp. 772—820
2. Procedure Performance: Hand washing; Donning and Removing Personal Protective
Equipment

Objectives
After completion of this unit, the student will be able to:

1. Perform proper steps for hand washing and the rationale for each step
2. State the action of soap, friction and rubbing in hand washing..
3. List and demonstrate the 5 surfaces that need to be included in hand washing.
4. Describe how hand washing prevents infection and protects clients and nurses from
developing infections.
5. Perform the following assessments:
a. Client's risk for extent of infection; e. g., immunosuppressed, invasive procedure,
open wound, etc.
b. Client's knowledge of benefits of proper hand washing.
6. Don and remove Personal Protective Equipment
7. Correctly implement Standard Precautions

RNSG 1105 2
Unit I: Basic Human Needs
B. Basic Safety Issues
FHP: Activity-Exercise

Learning Activities
Article: “Nurse Fatigue: The Human Factor”
Texas Nursing 2004 at Library Reference Desk
Perry & Potter (2005) pp. 959—1000
Complete falls assessment (p.13) on two elderly adults (due Sept 12/14)
Student Presentation on Bioterrorism/National Patient Safety Goals
Procedure Performance: applying restraints
Objectives
After completion of this unit, the student will be able to:

1. State safety measures to be implemented in the laboratory setting


2. Describe safety issues to note in the client’s room; include lighting,
temperature, obstacles, hazards, bathroom hazards.
3. Describe safety issues involved with the use of restraints.
4. Discuss the influence JCAHO and OBRA have had on the use of restraints.
5. Describe the restraint free environment and the alternatives to traditional
restraints.
6. List measures to prevent falls; specify measures to use for older adults and the
physiological conditions associated with aging that put these clients at risk.
7. State measures employed to reduce risk of injury in the client with seizures;
with procedure—related accidents; with the use of equipment.
8. Perform the following assessments:
a. Muscle strength of legs and upper arms, comparing right with left.
b. Joint mobility and limitations caused by contractures or discomfort;
assess for history of osteoporosis.
c. Vision, hearing, and altered sensation (numbness or tingling of the feet).
d. Ability to follow verbal instructions and appropriateness of response to
verbal commands.
e. Need for medication before transfer.
f. Position and functioning of IV tubing and poles, need for O2 therapy,
Foley catheter, and surgical drains.
9. Discuss threats to patient/client safety resulting from fatigued nurses (article)
10. Describe fatigue (article)
11. State what nurses can do to improve safety of care (article)
12. Demonstrate understanding and application of National Patient Safety Goals
13. Discuss bioterrorism and the nurses role in treatment

RNSG 1105 3
Unit I: Basic Human Needs
B. Hygienic Care: Bed Bath, Partial Bath, Shower, Back Rub, Perineal
C. Care
FHP: Nutrition-Metabolic, Elimination

Learning Activities
Required Learning Activities
1. Perry & Potter (2005) pp. 1001--1065
2. 2. Video: Bathing (Mosby)
3. Procedure Performance: Bed bath; perineal care; hygiene procedure
for oral care
4. Complete Braden scale on two older adults (due on 3/5th Oct)
Wear pants to class.
Objectives
After completion of this unit, the student will be able to:

Describe hygienic care that nurses provide to clients.


Identify factors influencing personal hygiene.
Identify normal and abnormal assessment findings while providing hygiene care.
Apply the nursing process to common problems related to hygienic care of the
skin.
Identify the purposes of bathing.
Describe various types of baths.
a. Describe and demonstrate the correct procedure for giving a bed bath;
state the rationale for each step.
b. Describe and demonstrate the correct procedure for a partial bath.
c. Describe the correct procedures for giving a shower.
Explain specific ways in which nurses help hospitalized clients with hygiene.
Describe steps for identified hygienic-care procedures – eye care; hearing aids.
9. Describe and demonstrate perineal care for a male and female client; state
rationale for each step.
10. Perform hygiene procedure for oral care
11. Perform the following assessments:
a. Degree of assistance needed for bathing (limitations of activity or
positioning) .
b. Client's tolerance of activity, level of discomfort with movement, and
presence of shortness of breath or chest pain with exertion.
c. Client's preferences for time of bath, products used, and frequency of
bathing.
d. Problems related to condition of the skin:
1. Drainage or excretions from lesions or body cavities
2. External devices (catheters, drains, dressings,
restraints).
3. Rashes or skin damage related to pruritus and scratching.
12. identify common bed positions and uses
RNSG 1105 4
Unit I: Basic Human Needs
D. Bed Making
FHP: Nutrition-Metabolic

Learning Activities
Required Learning Activities:
1. Perry & Potter (2005), pp.1056
2. Video: Bed making (Mosby)
3. Procedure Performance: Occupied bed making; Surgical Bed
Wear pants to class.
Objectives
After completion of this unit, the student will be able to:

1. Identify safety and comfort measures, underlying bed-making procedures.


2. Describe and demonstrate the correct procedure for making an occupied bed;
state the rationale for each step.
3. State procedure and rationales for making an unoccupied bed, surgical bed .
4. Perform the following assessments:
a. Client’s mobility status
b. Client’s self-toileting ability/incontinence
c. Note the presence of any wounds, drainage, tubes etc.

RNSG 1105 5
Unit II: Promoting Physiologic Health
Activity and Exercise
FHP: Activity-Exercise

Learning Activities
Required Learning Activities:
1. Perry & Potter (2005), Chapter 36 pp 930-958
2. Video: Body Mechanics, Exercise and Activity (Mosby)
3. Article: Tabone S. (2005). Safe patient handling. Texas Nursing March 2005 at
Library reference desk.
Performance Procedure: Assistive Devices
Objectives
After completion of this unit, the student will be able to:

1. Describe the assessment the nurse must perform in preparation for ambulating
a client.
2. Describe and demonstrate the correct procedure for assisting a client to walk.
3. Describe and demonstrate the correct procedure for assisting a client who
begins to fall when walking.
4. Describe assistive devices utilized for ambulation and the safety factors for
proper use indicated for each one.
5. State and demonstrate the steps utilized in crutch walking, walking up and
down stairs and sitting and arising from a chair.
6. Perform the following assessments:
a. Client's most recent activity experience, including distance ambulated
and tolerance of activity.
b. Best time to ambulate, considering other activities such as bathing and
physical therapy.
c. Environment for obstacles and safety hazards. If client has IV, a rolling
IV pole is needed.
d. Client's motivation and ability to cooperate.
e. Medications that may alter stability.
f. Client’s need for a place to sit and rest during ambulation.
7. Consider alternative methods of patient handling and legislation
pertaining to this topic (article)

RNSG 1105 6
Unit II: Promoting Physiologic Health
Mobility and Immobility
Positioning
Transfers

FHP: Activity-Exercise

Learning Activities
Required Learning Activities:
1. Perry & Potter (2005) Chapter 46 pp. 1421-1480
2. Video: ROM Exercise (MED COM), Positioning (HSC)
3. Procedure Performance: transfers, positioning
Bring 2 bed pillows to class.
Wear pants to class
Objectives
After completion of this unit, the student will be able to:

1. Demonstrate correct body alignment and body mechanics during all


procedures.
2. List the principles of body mechanics.
3. State the assessment needed prior to lifting an object and the technique to
follow when lifting
4. Differentiate between active ROM (AROM)and passive ROM (PROM)
5. Identify nursing precautions used when performing PROM.
6. Perform AROM exercises correctly; demonstrate the correct technique for
performing PROM.
7. State the main purpose for PROM.
8. Describe and demonstrate correct body alignment for the immobile client
lying in bed.
9. Perform the following assessments:
a. Client's weight, age, level of consciousness, and ability to cooperate.
b. Strength of muscles and mobility of joints. Compare strength in arm and
legs.
c. Need for analgesic medication 30 - 60 minutes before position
changes
10. Describe the following positions and indicate the correct steps for
positioning clients and appropriate support measures for each; state the
rationale for each step:
a. prone/supine
b. dorsal recumbent
c. Sims and side lying
d. orthopneic
e. supported Fowler’s position
11. Describe and demonstrate the correct procedure for:
a. turning a client from his back to side.

RNSG 1105 7
b. moving a client up in bed.
c. Log rolling a client from back to side.
12. Describe devices utilized in proper positioning.
13. Describe and demonstrate the steps for transferring a client from bed to chair
and bed to stretcher utilizing proper body mechanics; state the rationale of
each step.
14. Describe the use of a transfer device to assist in the transfer of a client from
bed to stretcher.
15. State the safety considerations necessary in transfer of the client.
16 Perform the following assessments:
a. Physician's orders, client's history and progress.
b. Client's readiness to learn.
c. Client's level of comfort (scale 0 to 10) before exercising.
d. Level of activity/mobility.

RNSG 1105 8
Unit III: Assessing Health
B. Vital Signs
FHP: Nutrition-Metabolic

Learning Activities

Required Learning Activities:


1. Perry & Potter (2005), pp. 617—670
2. Video: Vital Signs (Mosby)
2. Procedure Performance: Temperature, Pulse, Respirations, Blood Pressure
3. Wear a short sleeve shirt to class

Objectives
After completion of this unit, the student will be able to:

1. Describe factors that affect the vital signs and accurate measurement of
them.
2. Identify the normal ranges for each vital sign.
3. Identify the variations in normal body temperature, pulse, respirations, and
blood pressure that occur from infancy to old age.
4. Describe factors influencing the body’s heat production and loss.
5. Compare oral, tympanic, rectal, and axillary methods of measuring body
temperature.
6. Describe appropriate nursing care for alterations in body temperature.
7. Identify nine sites used to assess the pulse and state the reasons for their use.
8. List the characteristics that should be included when assessing pulses.
9. Explain how to measure the apical pulse and the apical-radial pulse.
10. Describe the mechanics of breathing and the mechanisms that control
respirations.
11. Assess respirations
12. Differentiate systolic from diastolic blood pressure.
13. Describe five phases of Korotkoff’s sounds.
14. Describe various methods and sites used to measure blood pressure.
15. Discuss measurement of blood oxygenation using pulse-oximetry.
16. Identify when it is appropriate to delegate measurement of vital signs to
unlicensed assistive personnel.

RNSG 1105 9
Department of Nursing
RNSG 1105 - PREPARATION FOR BASIC NURSING CARE
BASIC CLINICAL SKILLS

These forms must be turned in to the Professor at the final skill check-off.

Independently Practiced Skills


The following skills must be independently practiced by the students. The expectation is that the
students will be able to perform these skills in the clinical area.

1. Body mechanics 4. Ambulating a client 7. Grooming, dressing a client


2. Range of motion 5. Oral care, care of eyes, ears
3. Positioning 6. Nail and foot care

Supervised Practice Skills


The following skills must be practiced independently and then an instructor will observe the
student performing the skill during an assigned supervised lab period. If the student has not
practiced sufficiently the instructor will not sign the clinical skill form. The practice will be
rescheduled at the discretion of the instructor. If the student misses an appointment without the
prior approval of the instructor, it will count as one of the three opportunities to have the practice
supervised. The student may not schedule another skill check-off/practice until the skill is
performed to the satisfaction of the instructor. If the supervised skill is not completed the student
may not be able to go into clinical.
Presentations
National Pt.
__________________________________________________________________
Safety
__________________________________________________________________
Goals
Supervised Skills Date Instructor Signature

Personal Protective ____________________________________________________________


Equipment ________________________________________________________________
_________________________________________________________________

Bed Bath _________________________________________________________________

_________________________________________________________________

_________________________________________________________________

Transfer
RNSG 1105 10
_________________________________________________________________

__________________________________________________________________

Occupied Bed
_________________________________________________________________

__________________________________________________________________

Skills Check-offs
The student will be given three (3) opportunities to pass each skill check-off.
Remediation: Will be required for those not passing a skill on the first and second attempts. If
the student is unsuccessful on any attempt, the student must have remediated and rescheduled the
skill for the second and/or third time within 48 hours of the last attempt. If the student chooses
not to show up for an appointment for a skill check-off without prior approval from the
instructor, or if the student states he/she is not ready for the check-off, the student will
receive a “Fail” and the missed appointment will count as one of three opportunities to
perform the skill. The student will not be able to perform the next scheduled skill check-off or
supervised practice until the previous skill has been successfully passed. The third attempt of a
skill may be videotaped.

Failure to successfully complete check-off on any one of the skills by the third attempt is
grounds for course failure. All RNSG 1105 skills check-offs and supervised practices must be
completed satisfactorily (Pass) before the evaluation check-off.

Skills Grade S/U Date Instructor Signature

Hand washing 1.
____________________________________________________________
Remediator
Date__________________
2.
____________________________________________________________
Remediator
Date__________________
3.
____________________________________________________________

Temperature 1.
___________________________________________________________
_
Remediator
Date___________________
RNSG 1105 11
2.
_____________________________________________________________
Remediator
Date___________________
3.
_____________________________________________________________

Pulse 1.
___________________________________________________________
__
Remediator
Date___________________
2.
_____________________________________________________________
Remediator
Date___________________
3.
_____________________________________________________________

Respirations 1.
_____________________________________________________________
Remediator
Date___________________
2.
_____________________________________________________________
Remediator
Date___________________
3.
_____________________________________________________________

Blood Pressure 1.
___________________________________________________________
__
Remediator
Date___________________
2.
_____________________________________________________________
Remediator
Date___________________
3.
_____________________________________________________________

RNSG 1105 12
Falls Assessment

Client A Client B
Yes No Yes No
Client has fallen 2 or
more times in the
last two months
Observe client
transferring or
ambulating 20-40
feet. If stopping to
rest, holding
walls/furniture,
stumbling or
swaying present,
mark yes
Client’s physical
impairment, related
to balance and
weight bearing, is
less than 2 months
old
Client has history of
syncope’s or
seizures within the
past 6 months
Client is disoriented
Client has poor
judgment
Client has CNS side
effects of medication
that is new or dosage
has recently been
modified. Or, client
suffers from
drowsiness,
dizziness, or tremors
Total

0—3: low risk


4—6: moderate risk
7—12: high risk

Adapted from Metroplex Home Health


RNSG 1105 13
Client Pulse Respirations Temp (oral) Blood Pressure

1.rate 1. .rate
1. 2. rhythm,
3. strength
2. depth
3. rhythm
4. equality
1.rate 1. .rate
2. 2. rhythm,
3. strength
2. depth
3. rhythm
4. equality
1.rate 1. .rate
3. 2. rhythm,
3. strength
2. depth
3. rhythm
4. equality
1.rate 1. .rate
4. 2. rhythm,
3. strength
2. depth
3. rhythm
4. equality
1.rate 1. .rate
5. 2. rhythm,
3. strength
2. depth
3. rhythm
4. equality
1.rate 1. .rate
6. 2. rhythm,
3. strength
2. depth
3. rhythm
4. equality
1.rate 1. .rate
7. 2. rhythm,
3. strength
2. depth
3. rhythm
4. equality
1.rate 1. .rate
8. 2. rhythm,
3. strength
2. depth
3. rhythm
4. equality
1.rate 1. .rate
9. 2. rhythm,
3. strength
2. depth
3. rhythm
4. equality
1.rate 1. .rate
10. 2. rhythm,
3. strength
2. depth
3. rhythm
4. equality
Vital Signs

Turn this page in to your professor at the vital sign check-off

RNSG 1105 Basic Nursing Skills


RNSG 1105 14
Patient Quality and Safety Indicators, Sources, and Organizations

Writing and Presentation Assignment

You will be assigned a topic and a partner for a written and oral presentation due on a specified date. Your
presentation will be done with your partner but the written assignment must be your own original work. This is a
pass/fail score. All components of the requirement must be satisfied to pass.

Written assignment – 2-3 typed pages, single spaced


Oral presentation -- 5-10 minute summary of written assignment.

Required components of written work:


1) History of Organization/Work
2) Mission of Organization/Work
3) Is it a public or private organization/ Is it profit or not-for-profit
4) What questions can the quality or safety indicators answer?
5) Examples of some of the organizations indicators
6) How is the information published or used?

Topics for assignment:


1) AHRQ—Agency for Healthcare Research Quality
2) IHI- Institute of Healthcare Improvement/Save 100K Lives Campaign
3) NDNQI—National Database of Nursing Quality Indicators
4) NQF/NAHQ—National Quality Forum/National Association of Healthcare Quality
5) Healthgrades Report
6) Leapfrog Group
7) CMS- Centers for Medicare and Medicaid Services/Hospitals Quality Initiative
8) JCAHO- Joint Commission on Accreditation of Healthcare Organizations Core Measures/Performance
Measurement Initiatives
9) Six Sigma—Motorola project to decrease errors

RNSG 1105 15
MONDAY
TUESDAY WEDNESDAY THURSDAY

Aug 28 29 30 31
Classes Start Syllabus Classes Start Syllabus
1. Introduction Course Guidelines 1. Introduction Course Guidelines
Hx of asepsis Skill: Hx of asepsis Skill:
2. Textbook, Ch. 33- Hand Washing-practice 2. Textbook, Ch. 33-Infection Hand Washing-practice
Infection Control PPE supervised check off Control PPE supervised check off

Sept 4 5 6 7
Holiday: Labor Day Skill: Hand Washing- check Skill: Hand Washing- check off
off Open lab
Library time
Library time National Patient Safety Goal
National Patient Safety Goal Presentation (5min)
Presentation (5min)

11 12 13 14
Textbook, Skill: Textbook, Skill:
Ch. 37, Safety Ch. 37, Safety
Restraint supervised practice Restraint supervised practice
Falls assessment Case Study Falls assessment Case Study
18 19 20 21
Exam I Skill: Exam I Skill:
(Ch 33 & 37) (Ch 33 & 37)
Bathing, Bed making, oral care Bathing, Bed making, oral care-
Textbook, Textbook,
supervised practice supervised practice
Ch. 38 Ch. 38, Hygiene
Hygiene
25 Exam 1 Review 26 27 Exam 1 Review 28
Text, Ch. 36 Skill: Skill:
Text, Ch. 36 Turning/positioning Assistive devices
Activity and Exercise Turning/positioning Assistive
devices Activity and Exercise

Oct 2 3 4 5
Skill: Skill:
Text, Ch. 46 Pt. Transfer, PROM Text, Ch. 46
Pt. Transfer, PROM
Mobility and Guest speaker Mobility and Immobility
Guest speaker
Immobility Braden scale Case Study Braden scale Case Study

9 10 11 12
Exam II (Ch 36, 38, Skill: Exam II (Ch 36, 38, 46) Skill:
46) Text, Ch. 31 Vital Signs-practice
Vital Signs-practice
Text, Ch. 31 Vital Signs
Vital Signs
16 Exam 2 Review 17 18 Exam 2 Review 19
Vital sign check-off Final Exam Vital Signs check-off Final Exam comprehensive
VS sheet due Comprehensive VS sheet due

RNSG 1105 16