BUCHANAN COUNTY TECHNOLOGY



BUCHANAN COUNTY TECHNOLOGY

AND

Higher Education Center

PRACTICAL NURSING Program

Clinical Handbook: Guidelines for Rotations in Specialty Areas

TABLE OF CONTENTS

Guidelines for Rotation in Specialty Areas …2

Confidentiality in the Healthcare Setting 3

Clinical Guidelines 4

Student Worksheet 5-6

General Nursing Task Sheet/Questions 7-8

GENERAL ASSESSMENT GUIDELINE 9

aSSESSMENT AND cARE PLAN 10-27

In-service Form 28

Respiratory Observation 29-31

Evaluation and observation sheets…………………………………………………………………………………………..32-33

Emergency Department 34

Operating Room/PACU/Outpatient Surgery 35

Intensive Care Unit 36

Laboratory Department 37

Physician’s Office 38-42

Geriatric Objectives 43-44

MMSE 45-46

Medication List …………………….…………………………………………………………………………………………..47

Comprehensive chapter list ………………………………………………………………………………………………….48

Medication Card…………………………………………………………………………………………………………..…..49

Other instruction ……………………………………………………………………………………………………………...50

BUCHANAN COUNTY TECHNOLOGY & CAREER CENTER

PRACTICAL NURSING

GUIDELINES FOR ROTATION IN SPECIALTY AREAS

Students' rotation to specialty areas will utilize the following guidelines

Students rotating to specialty areas without assigned clinical faculty should use the attached guidelines. If necessary, you may contact either of the clinical instructors for clarification. Written assignments are required and submitted to the clinical instructor by the specified date.

Specialty areas without clinical faculty are Respiratory Therapy, Physical Therapy, EKG, Laboratory, Pharmacy, Radiology, Oncology, Rehabilitation, Emergency Room, OR, Outpatient Physician's Offices, Nuclear Medicine, Ultrasound, Outpatient Infusion, MRI, Utilization/Case Management/Discharge Planning, and Cumberland Mountain Community Health Services.

You may not leave the assigned clinical area without notifying the staff member that you are observing and/or the clinical instructor.

The clinical preparation assignments are due the day you begin the clinical assignment. The evaluation form is due one week after the clinical assignment is complete. Failure to complete these assignments may result in an unsatisfactory clinical grade.

When in doubt check it out with your instructor. If you do not feel comfortable with the assign task do not perform it. Always follow policy and procedure regardless of the instruction you are given by individual staff members, students or other personal.

Be professional. Be courteous. Be on time. Be accurate. Be ethical. Be honest.

Dress code for the clinical areas is white tennis shoes/rubber sole shoe, clean and wrinkle free, white clinical uniform/jacket; hair worn above the collar (no colors outside of the normal hair color spectrum). No artificial fingernails. If any student arrives to clinical inappropriately dressed will receive an unsatisfactory for the clinical and sent home to make-up the day on his or her own time.

MANAGING CONFIDENTIALITY IN THE

HEALTH CARE SETTING

The U.S. Department of Health and Human Services (“HHS”) issued the Privacy Rule to implement the requirement of the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”).1  The Privacy Rule standards address the use and disclosure of individuals’ health information—called “protected health information” by organizations subject to the Privacy Rule — called “covered entities,” as well as standards for individuals' privacy rights to understand and control how their health information is used. Within HHS, the Office for Civil Rights (“OCR”) has responsibility for implementing and enforcing the Privacy Rule with respect to voluntary compliance activities and civil money penalties. Violations can be one hundred to ten thousand dollars per article violated.

Confidentiality is becoming increasingly important in hospitals these days causing society as a whole to become very concerned. With so much private information being stored in computers, we wonder who has access to all this information. We hear often about someone breaking into these supposedly confidential computer records. It is no wonder that it is hard to keep a secret anymore.

Respecting a patient's right to privacy is now an essential element of guest relations, and it is the responsibility of every employee to promote good guest relations. Patients who feel that their privacy was violated at your institution will go elsewhere if they have a choice. Equally as important, maintaining confidentiality is a matter of respecting human dignity and patient rights. In addition, federally mandated via HIPPA laws, which are subject to criminal and civil penalties by law if violated.

Employees must learn to see themselves as advocates for patients. How should he/she want to be treated? The answer is by treating them in a manner that helps them retain their pride and dignity.

Most patients have a sense of loss of control while hospitalized. This is why anyone who encounters patients should be committed to doing everything possible to alleviate those feelings of helplessness. Respecting the right to privacy is one of the ways we can accomplish this.

Confidentiality affects not only patients but also everyone else connected with that institution. Staff at all levels, as well as patients' families, visitors, and medical personnel rely on confidentiality to protect individual privacy. It is very important for every member of the staff to realize this and practice this earnestly, keeping this thought in one's mind at all times.

The following helpful suggestions will help you become more aware of possible ways to maintain confidentiality

Discourage staff from discussing patients or their diagnosis on elevators, in halls, or at lunch in the cafeteria. You never know who will overhear your conversation, or what kind of damage could result. Often, people misunderstand what they overhear, and that can lead to trouble, too. Remember HIPPA!

Keep written information private. Admitting lists or report papers containing diagnoses, insurance papers, and medical logs should never be accessible to people in the area. These papers should be hidden or destroyed based upon the facility’s policy. As a student, you should never disclose any information and should refer any information and or disclose to the clinical nursing supervisor.

Clinical Guidelines

1. Each clinical day students are assigned patients for whom you will provide care that day as designated by your clinical instructor. You can perform routine AM care, bed linen changes and vital signs (once you have completed skills lab in the first year) without the clinical instructor. The Clinical Instructor must be present before you can perform any invasive procedure (Foley catheter, NG tube, removing heparin lock), etc. You cannot perform any procedure with just the floor nurses observing you; your Instructor must be present.

2. You will be responsible for completing and turning in to your Clinical Instructor the following assignments: Physical assessment (specific body system) and care plan for the day.

3. The major assignment included in this manual is a head-to-toe assessment. This should include definition, signs and symptoms, lab and/or x-ray procedures used to diagnose condition, and usual treatment according to your Medical-Surgical textbook. Also, include signs and symptoms you assessed your patient to have and compare the treatment he/she is receiving to the textbook treatment for that disease process. Compare any abnormal lab results with the normal lab values. For pediatric patients, compare assessment to growth and development charts. This assignment includes up to four plans of care related to the patient’s illnesses (at least 3 medical in nature and 1 psycho-social in nature)

4. While doing your medication administration rotation for two weeks, drugs that the assigned patient are prescribed are to be noted and investigated with findings documented on these medications sheets. (drug cards)Include any IV fluids, IVPB, PRN medications, TPN and lipids, and any nutritional supplements (Resource, Ensure), etc. your patient may be receiving. These drug sheets (cards) are to be turned in two weeks after the finish of your medication administration rotation.

5. A nursing care plan based on your assessment findings. Your nursing plan of care should be appropriate to patient needs and contain no less than four (5) nursing interventions. You will have a Medical Surgical Plan of Care and Psychological Plan of care due upon assignment.

6. Due dates for assignments each report and drug cards will be due on the Monday following the last clinical day of each week unless the clinical instructors assign another date. Nursing care plans will be assigned and scheduled per instructor.

7. Failure to turn in Assignments Failure to turn in required assignments will result in an unsatisfactory (U) clinical grade. If you receive three U’s--Conference with Faculty; five U’s--Conference with Faculty; six U’s Evaluation by Faculty with Possible termination. NO STUDENT WITH MORE THAN six U’s WILL BE ALLOWED TO CONTINUE PROGRAM.

8. Clinical Rotation (Specialty Area) assignment sheets Each clinical rotation (specialty area) assignment is to be turned in to your assigned Clinical Instructor within one week after your clinical experience in that area.

9. Each student must complete an observation sheet and evaluation sheet for each clinical area (page 32-33).

10. When performing an assessment make sure, you always include vital signs and pain assessment. If during your assessment you notice an abnormality document what you did to correct the abnormality.

Buchanan County Technology and Career Center Practical Nursing Student Worksheet (Daily sheets)

|Name |Patient |Date of Care |MR# |

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|Allergies |Age |DOB |DX |

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|Diet |Isolation |DNR Status |VS |

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|Fingersticks/SS |Respiratory |IV/SL |Precautions |

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|Neuro |Gastro |Cardiac/Telemetry |GU |

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|Everything Else |

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|Nursing Diagnosis |Intervention |Rationale |Evaluation |

|Subjective and Objective Data | | | |

|Short and Long Term Goals | | | |

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|Diagnosis | | | |

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|Clinical findings | | | |

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Nurses Notes—Buchanan County Technology and Career Center Practical Nursing

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GENERAL NURSING TASK SHEET

Date tasks as completed

OBJECTIVES ASSISTED COMPLETED

1. Patient history. ____________ _____________

2. Positioning a patient. ____________ _____________

3. Turning a patient. ____________ _____________

4. Transferring a patient. ____________ _____________

5. Feeding a patient. ____________ _____________

6. Bed making. ____________ _____________

7. Vital signs. ____________ _____________

8. Intake and output. ____________ _____________

9. Height and weight. ____________ _____________

10. Isolation. ____________ _____________

11. Teaming with a professional. ____________ _____________

12. Personal Hygiene ____________ _____________

Additional objectives

Student evaluation for rotation improvement

GENERAL NURSING QUESTIONS

1. Contrast the difference between a registered nurse and a licensed practical/vocational nursing, including education and duties.

2. Describe the following positions supine, prone, Sims, and Fowler's.

3. Describe the following fluids 0.9% Normal Saline; 0.45 Half-normal Saline; D5LR Dextrose 5% Lactated Ringers; LR. Describe how each fluid works in the body; Name a type of condition that each fluid is given.

4. What is an SCD? Pulse Oximetry? What can cause inaccuracy in Pulse oximetry readings? What does it mean to spike an IV Bag?

5. Define reverse isolation.

6. What can cause inaccuracy in obtaining a Glucose reading?

7. Describe three methods for taking temperature. Identify the most frequently used, the most accurate, and the least accurate method.

8. Describe how to measure blood pressure. Identify the normal blood pressure range. Name the stages of Hypertension.

9. Fill in the blanks for common measurements used in intake and output

1 cc (mL) = ______drops

1 ounce= ______cc(ml)

1 teaspoon= ______cc(ml)

1 tablespoon= ______cc(ml)

1 cup= ______cc(ml)

1 pint= ______cc(ml)

1 quart= ______cc(ml)

10. Patient A became disoriented and returned to the wrong bed B that was empty at the time. You are asked to turn patient B. You mistakenly turned patient A, not realizing that the patient was in the wrong bed. What should you do to prevent this mistake and what very serious mistakes could have happened?

General Guidelines on Completion of Medical/Surgical Nursing Assessment Care plan

The introduction paper will precede the assessment in the packet to be turned in. The introduction paper will have the following components

• APA formatting

• Use of proper grammar and punctuation (spelling counts)

• Explanations of each diagnosis that the patient has listed in the medical record

• Testing results and the explanation of the impact of the result

• Anything not included in the assessment packet/medication lists/plan of care

Useful resources





http//aspirations.english.cam.ac.uk/converse/essays/essaywriting/index.htm





A very good essay directive http//mnet.edu/apa/index.htm

Other sources of reference are your text, drug book, care plan book, school library.

When planning care, please be careful to include the short-term goal, long-term goal that are measureable and timed. Also, evaluate these in the evaluation columns.

Medication sheets are completed the same as the medication cards that you do while in clinical setting.

Do not leave blank spaces. Answer each section. If a section does not apply to your patient, use N/A or explain why it does not apply.

Do the cover sheet in APA format. The introduction should be the patient’s story in narrative format. Always include vital signs pain assessment; teaching and safety assessment.

Care plans count as a test grade. If you are unsure how to complete the care plan, ask questions!

You may type the care plan but you must use the format provided. If you choose not to type the assessment and hand, write the assessment portion you must be very legible. Points are deducted for care plans that are difficult to read or that do not follow the outline. The narrative and cover sheet must be typed.

BUCHANAN COUNTY TECHNOLOGY & CAREER CENTER

PRACTICAL NURSING PROGRAM

Student _________________________________________________________ Date of Care _____________________

Unit/Floor ______________ Age _______________ Diet _________________________________________________

Primary Diagnosis _________________________________________________________________________________

B/P ____________________ P ________________ R ________________ T ______________ SPO2 ___________

|Intake for 24 hours |Output for 24 hours |

|PO |Urine |

|IV |BM |

|GT/NGT |Emesis |

|Irrigation |GT/NGT |

|Other |Other |

TEACHING / LEARNING

|Non-Prescription Drugs/OTC Medications/Supplements/Herbs/Vitamins |

|Name |Amount |Administered (x per day) |Reason |Route |

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Street drugs □ Yes □ No Smokeless tobacco □ Yes □ No

Cigarettes □ Yes □ No Amount used ________ How long ___________

Alcohol □ Yes □ No Amount ______________________________________

Frequency _________________________ Length of time used _____________________________

Admitting diagnoses per provider

1. ________________________________________________________________________________________________

2. ________________________________________________________________________________________________

3. ________________________________________________________________________________________________

4. ________________________________________________________________________________________________

5. ________________________________________________________________________________________________

Reason for hospitalization per patient __________________________________________________________________

History of current complaint (what brought patient to hospital) _________________________________________________________________________________________________

Patient expectations of this hospitalization

_________________________________________________________________________________________________

Previous illnesses

_________________________________________________________________________________________________

Previous hospitalizations

_________________________________________________________________________________________________

Previous surgeries _________________________________________________________________________________________________

Evidence of failure to improve

_________________________________________________________________________________________________

Last complete physical exam _________________________________________________________________________

HYGIENE

Activities of daily living

Mobility □ Independent □ Assist □ Dependant Feeding □ Independent □ Assist □ Dependant

Bathing □ Independent □ Assist □ Dependant Dressing □ Independent □ Assist □ Dependant

Toileting □ Independent □ Assist □ Dependant Dental □ Independent □ Assist □ Dependant

Preferred time of bath _________________

Equipment / prosthetic devices required Assistance provided by

Other

PAIN / DISCOMFORT

[pic]

Location, intensity (0-10 with 10 most severe) ____________________________________________________

Frequency Quality

Duration Radiation

Precipitating factors Relieved by

Associated factors other

SAFETY

Allergies / sensitivity □ yes □ No Reaction

History of STD (date / type) □ Yes □ No High risk behavior □ Yes □ No

Testing □ Yes □ No

Blood transfusion □ Yes □ No When

Reaction □ Yes □ No Describe

Seat belt/helmet use □ Yes □ No

History of accidental injuries □ Yes □ No

Describe _____________________________________

Fractures/dislocations □ Yes □ No

Site

Cause

Arthritis/Unstable joints □ Yes □ No Back problems □ Yes □ No

Surgical intervention □ Yes □ No

Changes in warts / moles □ Yes □ No Enlarged nodes □ Yes □ No

Delayed healing □ Yes □ No Cognitive limitations □ Yes □ No

Impaired vision □ Yes □ No Hearing □ Yes □ No

Prosthesis □ Yes □ No

Location □ LUE □ RUE □ LLE □ RLE

Objective (Exhibits)

General appearance ________________________________________________________________

Body odor □ Yes □ No

Condition of hair / scalp ___________________________

Presence of vermin □ Yes □ No

Condition of fingernails toenails __________________________________________________________

Facial grimacing □ Yes □ No Guarding affected area □ Yes □ No

Emotional response □ Flat □ Cheerful □ anxious □ Tearful

□ Depressed □ Distracted □ Labile □Other_____________

Narrowed focus □ Yes □ No

Temperature □ Warm □ Cool □ Hot

General strength Right Arm □ +1 □ +2 □ +3 □ +4

Left Arm □ +1 □ +2 □ +3 □ +4

Right Leg □ +1 □ +2 □ +3 □ +4

Left Leg □ +1 □ +2 □ +3 □ +4

Muscle tone □ Good □ Fair □ Poor

Gait □ Steady □ Unsteady □ N/A

ROM □ Full □ Assist □ Passive

Paresthesia □ Yes □ No

Paralysis □ Yes □ No

FOOD / FLUID

Usual diet (type) _____________________________________________

No. of meals daily ____________________________________________

Loss of appetite □ Yes □ No

N/V □ Yes □ No

Heartburn/Indigestion □ Yes □ No Related to _______________________

Relieved by ___________________________________________________________________________

Allergy / food intolerance (list) ____________________________________________________________

Dentures □ Upper □ Lower With Patient □ Yes □ No

Mastication / swallowing problems □ Yes □ No

Usual weight __________________

Recent weight gain / loss □ Loss □ Gain □ N/A Amount ___________________________

Skin Turgor ________________________________

Pressure sore risk increases as the score decreases 15–16 = mild risk; 12–14 = moderate risk; < 12 = serious risk.

RESPIRATORY

Dyspnea □ Yes □ No Related to _________________

Cough/sputum □ Yes □ No Describe __________________

History of bronchitis □ Yes □ No

Asthma □ Yes □ No TB □ Yes □ No

Emphysema □ Yes □ No

Recurrent Pneumonia □ Yes □ No

Exposure to environmental risks

Use of Oxygen □ Yes □ No Use of respiratory aids □ 02 ____L/minute

CPAP/BIPAP □ Yes □ No

V-Mask □ Yes □ No Ventilator □ Yes □ No

Settings □ SIMV □ AC □ IMV

FIO2 ________% TV _______ Peak F. ________

Spontaneous Resp □ Yes □ No

ETT ______Level (cm) Position □ Rt □ Lt

Cuff Pressure ______mmHg

IPPB □ Yes □ No Other __________________________

Nebs □ Yes □ No Medication(s) ____________________

Rate _______________ Depth __________________ Symmetry _______________________

AP Diameter □ 2:1 □ 1:1

Use of acc. muscles □ Yes □ No Nasal flaring □ Yes □ No

Breath sounds Anterior ___________________ Posterior ________________________

Cyanosis □ Yes □ No

Clubbing □ Yes □ No

Sputum characteristics __________________ Restlessness □ Yes □ No

Tracheostomy □ Yes □ No CPT PD □ Yes □ No

Current weight __________________________ Height ________________________

Body build _____________________________ Mucous mem □ Dry □ Moist

Edema General □ Yes □ No Dependent □ Yes □ No

Pitting □ Yes □ No Periorbital □ Yes □ No

Ascites □ Yes □ No Halitosis □ Yes □ No

Condition of teeth/gums __________________________________

Appearance of tongue ___________________________________

Mucous membranes _____________________________________

Urine S/A or Chemstix ___________________________________

Serum Glucose (Glucometer) _____________________________

IV Fluids □ Yes □ No Type ________________________

Rate ______________________ Force fluids □ Yes □ No

NEUROSENSORY

Fainting/dizziness□ Yes □ No Headaches □ Yes □ No

Symptoms _______________________ Intensity ______________________

Frequency _______________________ Duration ______________________

How relieved ___________________________________________________________________

Tingling/numbness/weakness □ Yes □ No Location ______________________

Stroke/brain injury (residual effects) □ Yes □ No

Seizures □ Yes □ No Type _________________________

Aura □ Yes □ No Frequency _____________________

Postictal state □ Yes □ No

Vision loss □ Yes □ No Last exam ______________________

Glaucoma □ Yes □ No Cataract □ Yes □ No

Hearing loss □ Yes □ No Last exam _____________________

Epistaxis □ Yes □ No Sense of smell □ Normal □ Decreased

Other ______________________________________________________________________________

MENTAL STATUS

Oriented / disoriented Time □ Yes □ No

Place □ Yes □ No

Person □ Yes □ No

Alert □ Yes □ No Drowsy □ Yes □ No

Lethargic □ Yes □ No Comatose □ Yes □ No

Stuporous □ Yes □ No Delusions □ Yes □ No

Combative □ Yes □ No

Memory Recent □ Intact □ Loss

Remote □ Intact □ Loss

Glasses □ Yes □ No Hearing Loss □ Yes □ No

Hearing Aids □ Lt □ Rt □ Bilateral

Pupil shape □ Round □ Oval □ Irregular

Size (Evaluate direct and consensual response to light. Use pupil gauge below to assess size.)

[pic]

Reaction □ Reacts □ Non-reactive

Ptosis □ Yes □ No Facial Droop □ Yes □ No

CIRCULATION

History of

Hypertension □ Yes □ No Heart Problems □ Yes □ No

Rheum. Fever □ Yes □ No Ankle / leg edema □ Yes □ No

Phlebitis □ Yes □ No

Slow-healing □ Yes □ No

Intermittent Claudication □ Yes □ No

Bleeding Tendencies/Episodes □ Yes □ No

Syncope □ Yes □ No

Weakness / Heaviness □ Yes □ No

Pulse (palpation) Radial □ + 1 □ +2 □ +3 □ +4

Popliteal □ + 1 □ +2 □ +3 □ +4

Post-tibial □ + 1 □ +2 □ +3 □ +4

Dorsalis pedis □ + 1 □ +2 □ +3 □ +4

Heart sounds Rate _________ Rhythm □ Regular □ Irregular

Quality ___________________________ Murmur □ Yes □ No

Location ________________________

Neck vein distention □ Yes □ No

Varicosities □ Yes □ No

Extremities Temperature □ Warm □ Cool

Color □ Pale □ Pink □ Red

□ Cyanotic □ Grey □ Tan/Dark

Capillary refill □ Immediate □ < 3 sec□ > 3 sec

Edema Rt □ + 1 □ +2 □ +3 □ +4

Lt □ + 1 □ +2 □ +3 □ +4

Distribution/quality of hair □ Even □ Sparse □ Irregular □ None

□ Dry □ Oily □ Brittle □ Coarse

□ Shiny □ Clean □ Unkempt

Lips □ Moist □ Dry □ Cracked □ Broken Skin □ Pale □ Pink □ Cyanotic

Nail beds □ Pale □ Pink □ Cyanotic

Conjunctiva □ Pale □ Pink □ Cyanotic □ Red

Sclera □ Pale □ Pink □ Cyanotic

Diaphoresis □ Yes □ No

ELIMINATION

Usual bowel pattern Frequency ___________________________________________

Laxative use □ Yes □ No

Character of stools □ Loose □ Formed □ Hard

□ Other _____________

Last Bowl Movement ______________________________

History of bleeding □ Yes □ No

Hemorrhoids □ Yes □ No

Constipation □ Yes □ No

Diarrhea □ Yes □ No

Usual voiding pattern X per day ________, time period____________

Incontinence/when night/day/continuously (circle one)

Urgency □ Yes □ No Frequency □ Yes □ No

Retention □ Yes □ No Nocturia □ Yes □ No

Character of urine

Pain / burning /difficulty voiding □ Yes □ No

Describe _______________________________________________________________________

History of kidney / bladder disease □ Yes □ No

Diuretic use □ Yes □ No

Change in frequency / amount of urine □ Yes □ No

Abdomen

Tender □ Yes □ No Soft / firm

Palpable mass □ Yes □ No

Abd. girth _____ (if diagnosis or acities, abdominal distension, etc.)

|RUQ |LUQ |

| | |

|RLQ |LLQ |

| | |

Bowel sounds

Hemorrhoids internal/external □ Yes □ No

Bladder palpable □ Yes □ No

Stool guaiac □ Yes □ No Result Neg./Pos.

Urinary drainage

Foley □ Yes □ No

Characteristics of urine

Color □ Amber □ Clear □ Tea-colored □ Pink/Bloody/Red

Sediment present □ Yes □ No Color _______________

3-way Foley □ Yes □ No Solution Irrigation__________________

Type _________________________________________________________________________________

SEXUALITY (COMPONENT OF SOCIAL INTERACTION ( May defer upon patient request)

Sexually active □ Yes □ No

Use of Condoms Birth control method _____________________________________________

Sexual concerns / difficulties _________________________________________________________

Recent change in frequency / interest □ Yes □ No

Patient is Male □ Yes □ No (if yes, skip questions concerning females)

Age at menarche ___________ Length of cycle ___________________Duration___________

Tampon use □ Yes □ No

Pads □ Yes □ No

Number tampons/pads used /day _________

LMP _______________________________

Bleeding between periods□ Yes □ No

Menopause □ Yes □ No

Vaginal lubrication_____________________________________

Vaginal discharge_____________________________________

Surgeries_____________________________________________

Hormonal therapy □ Yes □ No Type ____________________________

Calcium use □ Yes □ No

BREAST EXAM

Practices breast self-exam □ Yes □ No

Last mammogram__________________________

Last breast exam___________________________

Last PAP smear ___________________________

Other_________________________________

MALE

Vasectomy □ Yes □ No Comments _____________________

Genital warts/lesions □ Yes □ No Comments _____________________

Breasts □ Yes □ No Comments _____________________

Penis (circumcision) □ Yes □ No Comments _____________________

Penile discharge □ Yes □ No Comments _____________________

Self-testicular exam □ Yes □ No Comments _____________________

Self-breast exam □ Yes □ No Comments _____________________

Prostate disorder □ Yes □ No Comments _____________________

Last proctoscopy/prostate exam __________________________________________________

TEACHING/LEARNING

Dominant language (specify) _____________________________________________________

Read □ Yes □ No Write □ Yes □ No

Education level ________________________________________________________________

Learning disabilities (specify) ____________________________________________________

Cognitive limitation ___________________________________________________________

Health beliefs/practices _________________________________________________________

Special healthcare concerns (e.g., impact of religious/cultural practices)

Health Goals

Familial risk factors

Diabetes □Mother □Father □Sibling □Child □Grandparent

Thyroid □Mother □Father □Sibling □Child □Grandparent

Heart disease □Mother □Father □Sibling □Child □Grandparent

Strokes □Mother □Father □Sibling □Child □Grandparent

Hypertension □Mother □Father □Sibling □Child □Grandparent

Epilepsy □Mother □Father □Sibling □Child □Grandparent

Kidney disease □Mother □Father □Sibling □Child □Grandparent

Cancer □Mother □Father □Sibling □Child □Grandparent

Mental illness □Mother □Father □Sibling □Child □Grandparent

Other □Mother □Father □Sibling □Child □Grandparent

Prescribed Medications (taken at home) (For each list drug, dose, times, indicate regular use, purpose, side effects/problems)

|Medication |Use |Last Taken |Adverse Effects |Comment |

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Resources available Persons Financial

Community support

Groups

Socialization

Areas that may require alteration/assistance (ADDRESSESS EACH AREA AS IT PERTAINS TO YOUR PATIENT)

Food preparation

Ambulation

Shopping

Transportation

Medication/IV therapy

Treatments

Wound care

Supplies

Self-care (be specific)

Homemaker

Maintenance

Plan of Care (at minimum you will have four different diagnosis)

Client Initials _______ Gender ______ Age ________

Room Number _______ Student Name __________________________________

|Nursing Diagnosis |Intervention |Rationale |Evaluation |

|Subjective and Objective Data | | | |

|Short and Long Term Goals | | | |

| |Evaluate the students baseline knowledge |Must have APA formatted reference |These objectives must be an evaluation |

|Diagnosis: |of APA format |Example: |of the intervention and must be reliable|

|Knowledge deficit r/t the first APA | | |and measurable. |

|paper completed. | |APA style is a difficult citation |Meaning they can be duplicated by other |

| | |format for first-time learners (Jones, |staff. |

|Subjective | |1998, p. 199). | |

|“ I am so nervous about completing a | | |The bicep area of the upper arm measured|

|plan of care” |Given examples of proper APA format | |at 2 cm from the acromion process is 30 |

| | | |cm in diameter. |

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|Objective | | |Repeated task evaluation. |

|Sweating, pacing blood pressure 140/100,| | | |

|Heart rate 110 | | | |

| |3. | | |

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|STG | | | |

|By the end of the lecture the student | | | |

|will be able to locate APA resources on | | | |

|the Owl Purdue website | | | |

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|LTG | | | |

|By the end of the week the student will | | |Do not forget to reevaluate the STG and |

|demonstrate an in text reference | | |LTGs as well as the five interventions |

|properly. | | | |

| |5. | | |

| | | |Failed STG of …. Will reevaluate after |

| | | |further teaching |

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| | | |LTG: Met as evidenced by>>>> |

Plan of Care

Client Initials _______ Gender ______ Age ________

Room Number _______ Student Name __________________________________

|Nursing Diagnosis |Intervention |Rationale |Evaluation |

|Subjective and Objective Data | | | |

|Short and Long Term Goals | | | |

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|Diagnosis/Clinical Findings | | | |

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|LTG | | | |

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|Drug Name |Drug Name |

|Generic Name |Generic Name |

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|Trade Name |Trade Name |

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|Usual Routes |Usual Routes |

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|Classification |Classification |

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|Child and Adult Dosing |Child and Adult Dosing |

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|Contraindications |Contraindications |

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|Interactions |Interactions |

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|Antidote |Antidote |

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|Uses |Uses |

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|Nursing Considerations |Nursing Considerations |

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|Teaching |Teaching |

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|Drug Name |Drug Name |

|Generic Name |Generic Name |

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|Trade Name |Trade Name |

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|Usual Routes |Usual Routes |

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|Classification |Classification |

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|Child and Adult Dosing |Child and Adult Dosing |

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|Contraindications |Contraindications |

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|Interactions |Interactions |

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|Antidote |Antidote |

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|Uses |Uses |

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|Nursing Considerations |Nursing Considerations |

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|Teaching |Teaching |

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Buchanan County Technology and Career Center

Practical Nursing Program

In-service Record

Name of Student _____________________________________________________________________

|In-service Title |Location |Time In |Time Out |Signature of Speaker/Sponsor |Contact Information |

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RESPIRATORY THERAPY

Buchanan General Hospital

First Floor

Mike RRT

Dept. Supervisor

Full uniform

OBJECTIVES Following completion of the experience, the student will

1. Observe and evaluate the respiratory status of the patient receiving inhalation therapy.

2. Become familiar with some of the equipment, treatments, and diagnostics tests available through respiratory therapy.

3. Differentiate between the role of respiratory technician and the role of respiratory therapist.

4. Distinguish adventitious breath sounds from normal breath sounds.

PREPARATION Read BEFORE our first clinical experience in Respiratory Therapy. C. Rosdahl and M. Kowalski Textbook of Basic Nursing; Ch. 86

ASSIGNMENTS Briefly describe in no more than ONE page how you met the above objectives. Comment on the value of your experience including recommendations for any change in this learning opportunity if objectives were not attainable. Submit this assignment to your nursing instructor within one week after your clinical experience I Respiratory Therapy.

Respiratory Objectives and Competencies

Objectives Observed Assisted Performed

|Review policies and procedures | | | |

|Pulmonary function test | | | |

|Arterial blood gases | | | |

|Oxygen therapy | | | |

| Nebulized Breathing treatment | | | |

|IPPB treatment | | | |

|CPAP | | | |

|Ventilator | | | |

|Suction | | | |

|Oxygen safety precautions | | | |

|Chest physiotherapy (PT) | | | |

|Mist tent | | | |

|Bronchoscopy | | | |

|Incentive spirometry | | | |

Additional objectives

Student evaluation for rotation improvement

RESPIRATORY QUESTIONS

Describe the duties of a respiratory therapist.

Explain the difference between a registered respiratory therapist (RRT) and a respiratory therapy technician

(RTT).

3. Discuss a typical use of the pulmonary function test.

Explain three ways oxygen can be given to the patient and the amount of oxygen received per minute.

5. Explain the intermittent positive pressure breathing treatment.

What safety precautions should be observed with the administration of oxygen

7. What are the classifications and action of drugs used to treat respiratory conditions?

What are the normal values for arterial blood gas?

Explain why the chest x-ray is the most common of all radiographic procedures.

You are the respiratory technician. Describe how you would instruct the patient for collection of a sputum s specimen.

BUCHANAN COUNTY TECHNICOLOGY & CAREER CENTER

PRACTICAL NURSING PROGRAM

NURSING STUDENT EVALUATION

Student Name ________________________________________________________________________________

Date of Visit/Clinical Rotation ____________________________________________________________________

Observation Area ______________________________________________________________________________

Activity Observed ______________________________________________________________________________

This section to be completed by the nurse, technician, teacher, etc. who supervises the student for this observation

Student Arrival Time _______Student Departure Time _______

Student attitude toward observations of the day Yes No

Appeared interested □ □

Assisted staff (as appropriate) □ □

Asked questions □ □

Interacted as appropriate □ □

Seemed bored □ □

Professional/courteous/accepting attitude toward patient/pt. family □ □

Accepting attitude toward assignment □ □

Safety with equipment and materials □ □

Remained in area of assignment (did not leave area without notification or permission from instructor) □ □

Work accurate and complete □ □

Comments (if any) _____________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

Name and Title of Staff Member completing form _____________________________________________________

Thank you.

COMPLETE FOR EACH ASSIGNED AREA

CLINICAL ROTATION ASSIGNMENT _______________________________

NAME _________________________________

DATE ________________________________

SUPERVISOR OR PERSON YOU REPORTED TO _____________________________________

What type of personality do you think would be required to be a successful employee on this rotation?

Name one positive and one negative experience you had in your rotation.

What type of education does an employee from this rotation require?

Which hands-on skills were you able to perform?

What other hands-on skills do you think a student could perform?

Suggestions that would benefit this rotation?

What did you learn from this rotation that you will use in the future?

Describe the best thing that happened in this rotation.

Describe the worst thing that happened in this rotation.

Describe one procedure or treatment and tell the patient's response.

Interview one staff member and give his or her name, title, training, job description and level of job satisfaction.

EMERGENCY ROOM

Buchanan General Hospital

First Floor

Tina Owens, RN, CCRN, BS Department Manager

Full uniform

OBJECTIVES: Following completion of clinical experience, the student will be able to

1. Perform initial assessment of patient admitted to the E.R. and document pertinent information.

2. Obtain admission vital signs of E.R. patients.

3. Perform basic triage techniques under the direct supervision of licensed personnel.

4. Perform duties with decreased anxiety and less stress by becoming familiar with emergencies and routines.

5. Review ACLS, BLS, PCLS guidelines.

6. Perform EKG

PREPARATION: Read BEFORE your first clinical experience in ER C. Rosdahl & M. Kowalski; Textbook of Basic Nursing Ch. 39 &

Ch. 43

ASSIGNMENTS: Briefly describe in no more than ONE page how you met the above objectives. Comment on the

value of your experience including recommendations for any change in this learning experience if objectives were not attainable.

Submit this assignment to your nursing instructor within one week after your clinical experience in E.R.

OPERATING ROOM

Buchanan General Hospital

Second Floor

Vicki Sperry, RN

OR Nurse Manager

Hospital Scrub Suit

*Full uniform must be worn to hospital. Please arrive at 0645 for this rotation.

OBJECTIVES: Following completion of clinical experience the student will be

1. Familiar with procedure for transporting patients from nursing unit to O.R.

2. Be familiar with pre-op checklist, time out and consent for treatment.

3. Be able to demonstrate proper scrubbing procedures and sterile techniques used in O.R.

4. Become familiar with roles of nursing personnel in the Recovery Room.

5. Be familiar with the role of L.P.N. in the O.R.

6. Recognize common surgical instruments.

7. Observe, prepare and wrap instrument trays and “peel packs”

8. Become familiar with procedure for processing for cleaning surgical equipment.

9. Review anatomy and Physiology of the GI tract

PREPARATION Read BEFORE your first clinical experience in surgery C. Rosdahl & M. Kowalski Textbook of Basic Nursing Ch. 41, 42, 56, & 57. Make sure you review anatomy of the GI system well and cover chapter 88.

ASSIGNMENT Briefly describe in no more than ONE page how you met the above objectives. Comment on the value of your experiences including recommendations for any change in this learning experience if objectives were not attainable. Submit this assignment to your nursing instructor within one week after your clinical experience in O.R.

INTENSIVE CARE UNIT

Buchanan General Hospital

Fourth floor

Missy Taylor, RN, MSN

Nurse Manager

Full uniform

OBJECTIVES Following completion of clinical experience, the student shall be able to

1. Decrease his/her anxiety and stress by becoming familiar with the critical care patient.

2. Assess the cardiac status of a patient.

3. Participate in prevention and treatment of cardiac failure.

4. Recognize normal cardiac rhythms.

5. Recognize some of the most common arrhythmias and their significance.

6. Identify protocol for effective CPR.

7. Assess emotional responses of patient and family in an acute care setting.

8. Observe Ventilator use and common high and low ventilator alarms.

PREPARATION Read BEFORE first clinical experience in ICU

C. Rosdahl & M. Kowalski Textbook of Basic Nursing Ch. 81,86, & Ch. 59

ASSIGNMENTS: Briefly describe in no more than ONE page how you met the above objectives.

Comment on the value of your experience including recommendations for any changes in this learning

experience if objectives were not attainable. Submit this assignment to your nursing instructor within one week

after your clinical experience in Intensive

LABORATORY

Buchanan General Hospital

First Floor

Beverly Anderson M.P. or personnel assigned to Lab

Full Uniform

OBJECTIVES: Following completion of clinical experiences the student will

1. Be able to clock specimens into the lab according to hospital policy.

2. Be familiar with basic procedures performed in the lab.

3. Recognize procedures for disposing of specimens.

4. Have an awareness of rationale behind various laboratory tests.

5. Observe bacteria and virus under a microscope

6. Recognize lab tests that require N.P.O. status and other Nursing interventions.

7. Recognize different Nuclear Scans & preparation for each.

PREPARATION: Read BEFORE your first clinical experience in Laboratory. C. Rosdahl & M. Kowalski Textbook of Basic Nursing Ch. 52.

ASSIGNMENTS Briefly describe in no more than ONE page how you met the above objectives. Comment on the value of your experience including recommendations for any changes in this learning experience if objectives were not attainable. Submit this assignment to your nursing instructor within one week after your clinical experience in the Lab.

OUTPATIENT PHYSICIAN'S OFFICECLINICAL GUIDELINES

PURPOSE

The purpose of clinical rotation through outpatient physician's office is to assist the practical nursing student with an opportunity to develop a broad base of knowledge of the basic issues involved in working in any medical facility. Some of these issues will include, but may not be limited to managing patient registration and communication; scheduling and referral management; manage correspondence; patient and medical records management; filing system; office, equipment, and financial management; specific aspects of medication handling; coding, billing, and claims processing; insurance responsibilities; managed care plans; credit, billing and collection; computer operations; banking, accounting, and bookkeeping.

CLINICALS

Clinical are planned in collaboration with local medical offices and health care facilities that serve as an extension of the Practical Nursing program to provide the student with basic knowledge of entry-level skills. These skills will enable the graduate student to perform in outpatient care, private practice, ancillary care, general and specific clinic settings, surgery center, an agency, health maintenance organization (HMO), and hospital based care.

SUPERVISION

The on-site supervisor and physician assume responsibility for continued evaluation of the student performance, as directed by the clinical instructor, and this evaluation becomes part of the student's record. NO procedure should be performed by the student unless the student has been taught and has been authorized to do it.

BENEFITS

School The school has a line of communication to the community and is better able to assess the needs and expectations of the public for which it is training prospective employees. It ensures greater understanding and cooperation as well as the assurance that work habits and procedures meet the standards promoted in the classroom.

Agency

The agency benefits from the new ideas and methods that the student may introduce. If the facility is looking for additional help, this is an ideal way to evaluate the performance of the student without involvement in the hiring process.

The student benefits most of all by the exposure to practical experience in a variety of settings. This experience in the real world removes a great deal of the anxiety that might otherwise be present in a first employment situation.

EVALUATION

Ongoing evaluation will be by the nursing instructor in cooperation with the assigned health care facility supervisor and/or physician. The areas of evaluation will include both personal qualities and clinical performance.

Personal

Personal evaluation will include

Grooming in appropriate attire, neat, clean and well groomed

Punctuality observes all the office protocols and being on time

Relations with co-workers and patients

Reaction to criticism and direction

Respect for ethical standards

Consideration of others

Clinical

Clinical evaluation will include

Willingness to learn

Responsibly carry through with assigned tasks

Maintaining patient privacy and confidentiality

Ability to work in cooperation and coordination with others.

Practice within scope of education, training, and personal capabilities and act as patient advocate.

Expectations of Students in Outpatient Clinical Observation

Report to the clinical area on time at the beginning of the shift. Nursing Instructor and physician's office must be notified 30 minutes prior to the shift's beginning in the event of absence or tardiness. Unauthorized absence will be considered as a clinical unsatisfactory.

Full student uniform is to be worn in all clinical areas. When arriving at the physician's office for clinical assignment, the student is to notify his/her respective office manager/supervisor. Clinical schedules are completed by the program director and may not be changed without faculty instructor approval.

Consideration of the office staff's time and space is requested when students use office materials, care plans, and patient charts.

Supervisors are responsible for safe and therapeutic patient care. Students are accountable for informing the supervisor/MD of his/her competencies in caring for assigned patients.

Students are to follow agency protocols, specific rules, regulations, standards and procedures that have been established by the agency.

Clinical evaluation MUST be completed by the student and Supervisor, signed by Supervisor and submitted to the clinical instructor.

Emphasis during this rotation will be on developing skills of the expected roles of the licensed practical nurse while gaining a broad base of knowledge of the basic issues involved in working in any outpatient medical facility.

During this observation/experience, students will be less accessible to the instructor, but the instructor may be reached by telephone. Clinical conferences may be designated as deemed necessary by the instructor to review student progress and to discuss topics of concern.

Breaks and lunch schedule will be at the discretion of the office manager/supervisor.

OUTPATIENT PHYSICIAN’S OFFICE

1. Discuss career and interpersonal skills required to thrive in a rapidly changing world of work.

2. Define

a. Patient care technician

b. Patient focused care

c. Scope of practice

3. Explain why teamwork is an essential part of work in the outpatient physician's office.

4. Discuss routine telephone skills and describe appropriate action to take with each. What information should be included when taking telephone messages?

5. Describe typical shift routine responsibilities and expectations.

6. Explain the LPN's role in handling the patient's chart.

7. Explain the procedures for

a. Clarification of orders

b. Scheduling appointments

c. Scheduling lab / x-ray / other procedures

d. Handling / distributing sample medications

8. Discuss the procedures involved in "working up" a patient prior to seeing the physician.

9. The office worker is responsible for managing the verbal and written communications processes in the medical office. How are the medical staff expected to treat patient information?

10. Describe the skills performed in the medical office.

11. Identify required education and credentials for each career in the outpatient physician's office.

12. Assisting with examinations will be part of the LPN's responsibilities. Name main areas examined in each of the following

a. EENT

b. GYN

c. General Physical

13. Identify the following techniques used during physical examinations

a. Physician uses hands /fingers to "feel" various parts of body.

b. Physician uses fingers to "tap" various body parts and listens to sounds emitted

c. Physician uses stethoscope to "listen" to sounds produced by body organs

d. Physician "looks" at patient closely

14. List the use of each of the following pieces of equipment

a. ophthalmoscope

b. otoscope

c. tonometer

d. laryngeal mirror

e. percussion hammer

f. rectal/vaginal speculum

g. Snellen eye chart

15. Why is it important to explain all procedures to a patient while preparing the patient for physical examination?

16. List three (3) specific standard precautions that must be followed at all times while assisting with a physical examination.

OUTPATIENT PHYSICIAN'S OFFICE

Assigned physician's office

Office manager Supervisor in charge

Full Uniform

OBJECTIVES:Rotation through outpatient physician's office will provide an opportunity to develop a broad base of knowledge

of the basic issues involved in working in any medical facility.

Objectives for this rotation will include:

1.Managing patient registration and communication

2.Scheduling and referral management

3.Managing correspondence

4.Patient and medical records management

5.Filing system

6.Office equipment

7.Financial management

8.Specific aspects of medication handling

9.Billing and claims processing

puter operations

PREPARATION

Read Before your first clinical experience in Physician's office. Textbook of Basic Nursing, Tenth Edition. C. Rosdahl & M. Kowalski, Ch. 44, 45, 99, 101-103.

ASSIGNMENTS

Complete the assigned questions. Comment on the value of your experience including recommendations for any changes in this learning experience if objectives were not attainable. Submit this assignment to your clinical instructor within one week after your clinical rotation.

GERIATRIC OBJECTIVES

Objective Observed Assisted Performed

| Observe Psychology and physiology of aging. | | | |

|Observation of wound care | | | |

|Administer medications | | | |

|Observe aging process | | | |

|Exercise ( Physical therapy ) observation | | | |

|Diet. (feeding ) | | | |

|Bath. | | | |

|Nail care. | | | |

|Back rub. | | | |

|Oral hygiene. | | | |

|Hair care. | | | |

|Activities in dayroom | | | |

Additional objectives performed by the student during the rotation to HHNH (Heritage Hall Nursing Home).

Student evaluation for rotation improvement

GERIATRIC QUESTIONS

1. Define and differentiate between geriatrics and gerontology.

2. Discuss the degenerative changes that can occur in the senior citizen.

3. Discuss the personal needs with which you can help the geriatric resident.

4. List the steps used to give medications through a Peg tube.

5. Explain how to obtain residual in a peg tube. What is considered a high residual level?

6. Name the steps to Foley insertion. Name 3 problem solving techniques for a leaking Foley. How do you perform perineal someone with a Foley?

7. Why do you think it is important for geriatric residents to wear their own clothes?

8. What type of person would work with geriatric residents?

9. The term applied to a number of pathological conditions where there is a thickening, hardening, and loss of elasticity in the walls of arteries is called

10. Discuss your feelings regarding the possible placement of your grandparents in a nursing home.

Medication List/Further Instructions

Each section of the chapter work has a corresponding Pharmacology section. These sections must be hand written and turned in with the chapter/workbook /or turned in at the end of the subject. The instructor will set due dates throughout the course. You can access the dates on the BCTCC website or use the calendar on the blackboard.

Medication cards requirements:

Prototype/Classification

List of all corresponding mediations listed under the classification at least (5).

Expected pharmacological action

Purpose

Therapeutic uses at least list (3)

Complications/adverse effects list at least (5)

Contraindications/Precautions list at least (5)

Interactions list (5)

Nursing Administration at least (5)

Labs

Antidotes/supportive care

Diet considerations

Pregnancy classification

Drug schedule classification

Other instructor will add other instruction as needed.

|Practical Nursing | |

| | |

| |Comprehensive Chapter List |

|# |Med/SUR 1 |Geriatrics |PEDS |OB |Med/Sur 2 |Med/Sur 2 |

|1 |Chapter 33 |chapter 92 |chapter 9 |Chapter 65 |Chapter 75 |Chapter 101 |

|2 |Chapter34 |chapter 93 |chapter 10 |Chapter 66 |Chapter 76 |Chapter 102 |

|3 |Chapter 35 |chapter 59 |Chapter 11 |Chapter 67 |Chapter 77 |Chapter 103 |

|4 |Chapter 36 |Chapter 12 |Chapter 71 |Chapter 68 |Chapter 78 |Portfolio |

|5 |Chapter 37 |Chapter 13 |Chapter 72 * |Chapter 69 |Chapter 79 |Resume |

|6 |Chapter 37 |Chapter 14 |Chapter 73 |Chapter 70 |Chapter 80 |Interview |

|7 |Chapter 39 |Care plan #1 |Chapter 74 |ATI-F-18-21 |Chapter 81 |Nclex Review |

|8 |Chapter 40 |Chapter 96 |Ati- C-1-39 |ATI-M-Ch:1-17 |Chapter 82 |ATI-L CH:1-5 |

|9 |Chapter 43 |Chapter 97 |Pharm 26 & 36 |  |Chapter 83 ** |Pharm 12-25 |

|10 |Chapter 44 |Chapter 98 |  |  |Chapter 84 |Pharm 12-25 |

|11 |Chapter 45 |Chapter 99 |  |  |Chapter 85** |Pharm 27-29 |

|12 |Assessment |Chapter 100 |  |  |Chapter 86 |Pharm 34,35 |

|13 |Review skills |ATI-Fundamentals ch:33-36 |  |  |Chapter 87 |  |

|14 |Test taking |ATI-Fundamentals ch:23-25 |  |  |Chapter 88 |  |

|15 |Ati -Fundamentals Ch:1-17 |pharm-30-33 |  |  |Chapter 89 |  |

|16 |ATI-Fundamentals Ch:26-32 |  |  |  |Chapter 90 |  |

|17 |ATI-Fundamentals Ch:37-57 |  |  |  |Chapter 91 |  |

|18 |Pharm-1-5 (Psy 5-11) ch. 37-42 |  |  |  |CAREPLAN#2 |  |

|19 |*= MULTIPLE TEST ON CH |ATI-C is care of the child |ATI-F is fundamentals |Ati -L is |  |All other |

| | | | |leadership | |chapters are |

| | | | | | |textbook |

|20 |**=OPEN BOOK |ATI-M is Maternal newborn |Ati-P=Pharm |ATI-MS = |med/sur |  |

Medication Card

Medication Classification ___________________________________________________________________

Prototype Medication: ______________________________________________________________________

Other Medications in this class: _______________________________________________________________

Purpose: Expected pharmacological action_____________________________________________________

Therapeutic uses: (3) _________________________________________________________________________________________

__________________________________________________________________________________________

Complication: Adverse effects: (5) __________________________________________________________________________________________

Contraindications/Precautions/Interactions: (5)_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Nursing Considerations (5)_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Labs:_____________________________________________________________________________________

Antidotes: ________________________________________________________________________________

Dietconsiderations:___________________________________________________________________________________________________________________________________________________________________

Other:___________________________________________________________________________________

*include all the information in the text provided about the classification unless otherwise indicated above

Further instructions:

To access this handbook, Power Points and other links



Once you go to the above website choose the school staff>instructor

ATI proctor test are exam content and are an excellent assessment tool that the instructor uses to gage the students total grasp of the subject matter. After many years of observation, this school of nursing with collaboration of the ATI team have found students, performing at or below level one in any proctored test do not have adequate understanding of the subject matter. For this reason, any student that scores less than a level one on any proctor exam will need to repeat the subject matter the following year. Failure of a proctored exam is considered incomplete and as a failure of the subject matter regardless of the grade in the subject matter. With the approval of the instructor and/or director students with a satisfactory academic score have an opportunity to re-test a proctored exam.

Clinical Time

Any student missing more than two clinical days will need to arrange with Family Care Center (Frannie) to reschedule the clinical time missed. Any clinical day missed in excess of two days will be considered unsatisfactory and can result in a clinical U grade. If you will receive a U grade in clinical if you are late, dressed inappropriately, disrespectful or otherwise fail to uphold the standards of the program outline in the handbook.

Assignments:

A late assignment will receive a five-point deduction in grade for every day it is late with exceptions. If exceptions apply, the instructor will inform the class when instructions are given concerning the assignments.

Terms, acronyms and workbook homework is due on the day of the test for that chapter. Medication cards are due as assigned and usually are at the end of a body system covered.

Prerequisite: Before the first day of 2nd year, each student is required:

1. Have completed 5 observation in-services

2. Physical/immunizations up-to –date

3. Complete all of 1st year’s work successfully

4. Tuition for 1st year paid in full.

Contact Information:

Rhonda Keen

Home: (276) 935-4606

Cell: (276) 244-2830

BGH: 935 1282

-----------------------

Revised June 2007

|Braden Skin Assessment Scale |

| |

|Value |

|SENSORY PERCEPTION |1. Completely Limited |2. Very Limited |2 of body. |3. Slightly Limited Responds to verbal |4. No |

|ability to respond meaning-|Unresponsive (does not |Responds only to painful | |commands, but cannot always communicate |Impairment |

|fully to pressure-related |moan, flinch, or grasp) to |stimuli. Cannot | |discomfort or the need to be turned, has |Responds to |

|discomfort |painful stimuli, due to |communicate discomfort | |some sensory impairment which limits |verbal |

| |diminished level of |except by moaning or | |ability to feel pain or discomfort in 1 |commands. |

| |consciousness or sedation |restlessness or has a | |or 2 extremities. |Has no |

| |or |sensory impairment which | | |sensory |

| |limited ability to feel |limits the ability to feel | | |deficit |

| |pain over most of body |pain or discomfort over 2ð | | |which would |

| | |of body. | | |limit |

| | | | | |ability to |

| | | | | |feel or |

| | | | | |voice pain |

| | | | | |or |

| | | | | |discomfort. |

|MOISTURE |1. Constantly Moist |2. Very Moist |3. Occasionally Moist: |4. Rarely Moist | |

|degree to which skin is |Skin is kept moist almost |Skin is often, but not |Skin is occasionally moist,|Skin is usually dry, linen only requires | |

|exposed to moisture |constantly by perspiration,|always moist. Linen must be|requiring an extra linen |changing at routine intervals. | |

| |urine, etc. Dampness is |changed at least once a |change approximately once a| | |

| |detected every time patient|shift. |day. | | |

| |is moved or turned. | | | | |

|ACTIVITY |1. Bedfast |2. Chairfast |3. Walks Occasionally |4. Walks Frequently | |

|degree of physical activity|Confined to bed. |Ability to walk severely |Walks occasionally during |Walks outside room at least twice a day | |

| | |limited or non-existent. |day, but for very short |and inside room at least once every two | |

| | |Cannot bear own weight |distances, with or without |hours during waking hours | |

| | |and/or must be assisted |assistance. Spends | | |

| | |into chair or wheelchair. |majority of each shift in | | |

| | | |bed or chair | | |

|MOBILITY |1. Completely Immobile Does|2. Very Limited |3. Slightly Limited |4. No Limitation | |

|ability to change and |not make even slight |Makes occasional slight |Makes frequent though |Makes major and frequent changes in | |

|control body position |changes in body or |changes in body or |slight changes in body or |position without assistance. | |

| |extremity position without |extremity position but |extremity position | | |

| |assistance |unable to make frequent or |independently. | | |

| | |significant changes | | | |

| | |independently. | | | |

|NUTRITION |1. Very Poor |2. Probably Inadequate |3. Adequate |4. Excellent | |

|usual food intake pattern |Never eats a complete meal.|Rarely eats a complete meal|Eats over half of most |Eats most of every meal. Never refuses a | |

| |Rarely eats more than α of |and generally eats only |meals. Eats a total of 4 |meal. Usually eats a total of 4 or more | |

| |any food offered. Eats 2 |about 2 of any food |servings of protein (meat, |servings of meat and dairy products. | |

| |servings or less of protein|offered. Protein intake |dairy products per day. |Occasionally eats between meals. Does | |

| |(meat or dairy products) |includes only 3 servings of|Occasionally will refuse a |not require supplementation. | |

| |per day. Takes fluids |meat or dairy products per |meal, but will usually take| | |

| |poorly. Does not take a |day. Occasionally will take|a supplement when offered | | |

| |liquid dietary supplement |a dietary supplement or |or is on a tube feeding or | | |

| |or is NPO and/or maintained|receives less than optimum |TPN regimen which probably | | |

| |on clear liquids or IV’s |amount of liquid diet or |meets most of nutritional | | |

| |for more than 5 days. |tube feeding |needs | | |

|FRICTION & SHEAR |1. Problem |2. Potential Problem |3. No Apparent Problem | | |

| |Requires moderate to |Moves feebly or requires |Moves in bed and in chair | | |

| |maximum assistance in |minimum assistance. During|independently and has | | |

| |moving. Complete lifting |a move skin probably slides|sufficient muscle strength | | |

| |without sliding against |to some extent against |to lift up completely | | |

| |sheets is impossible. |sheets, chair, restraints |during move. Maintains | | |

| |Frequently slides down in |or other devices. |good position in bed or | | |

| |bed or chair, requiring |Maintains relatively good |chair. | | |

| |frequent repositioning with|position in chair or bed | | | |

| |maximum assistance. |most of the time but | | | |

| |Spasticity, contractures or|occasionally slides down. | | | |

| |agitation leads to almost | | | |Total |

| |constant friction | | | | |

| | | | | | |

Issue Number 3, January 1999 Series Editor: Meredith Wallace, PhD, RN, MSN, CS

The Mini Mental State Examination (MMSE)

By: Lenore Kurlowicz, PhD, RN, CS and Meredith Wallace, PhD, RN, MSN

WHY: Cognitive impairment is no longer considered a normal and inevitable change of aging. Although

older adults are at higher risk than the rest of the population, changes in cognitive function often call for prompt and aggressive action. In older patients, cognitive functioning is especially likely to decline during illness or injury. The nurses’ assessment of an older adult’s cognitive status is instrumental in identifying early changes in physiological status, ability to learn, and evaluating responses to treatment.

BEST TOOL: The Mini Mental State Examination (MMSE) is a tool that can be used to systematically and

thoroughly assess mental status. It is an 11-question measure that tests five areas of cognitive function:

orientation, registration, attention and calculation, recall, and language. The maximum score is 30. A score

of 23 or lower is indicative of cognitive impairment. The MMSE takes only 5-10 minutes to administer and

is therefore practical to use repeatedly and routinely.

TARGET POPULATION: The MMSE is effective as a screening tool for cognitive impairment with older,

community dwelling, hospitalized and institutionalized adults. Assessment of an older adult’s cognitive function is best achieved when it is done routinely, systematically and thoroughly.

VALIDITY/RELIABILITY: Since its creation in 1975, the MMSE has been validated and extensively used in

both clinical practice and research.

STRENGTHS AND LIMITATIONS: The MMSE is effective as a screening instrument to separate patients

with cognitive impairment from those without it. In addition, when used repeatedly the instrument is able to measure changes in cognitive status that may benefit from intervention. However, the tool is not able to diagnose the case for changes in cognitive function and should not replace a complete clinical assessment of mental status. In addition, the instrument relies heavily on verbal response and reading and writing. Therefore, patients that are hearing and visually impaired, intubated, have low English literacy, or those with other communication disorders may perform poorly even when cognitively intact.

MORE ON THE TOPIC:

Folstein, M., Folstein, S.E., McHugh, P.R. (1975). “Mini-Mental State” a Practical Method for Grading the

Cognitive State of Patients for the Clinician. Journal of Psychiatric Research, 12(3); 189-198.

Foreman, M.D., Grabowski, R. (1992). Diagnostic Dilemma: Cognitive Impairment in the Elderly. Journal of

Gerontological Nursing, 18; 5-12.

Foreman, M.D., Fletcher, K., Mion, L.C., & Simon, L. (1996). Assessing Cognitive Function. Geriatric Nursing,

17; 228-233.

Permission is hereby granted to reproduce this material for not-for-profit educational purposes only, provided

The Hartford Institute for Geriatric Nursing, Division of Nursing, New York University is cited as the source. Available on the internet at . E-mail notification of usage to: hartford.ign@nyu.edu.

The Mini-Mental State Exam

Patient Examiner Date

Maximum Score

Orientation

5 ( ) What is the (year) (season) (date) (day) (month)?

5 ( ) Where are we (state) (country) (town) (hospital) (floor)?

Registration

3 ( ) Name 3 objects: 1 second to say each. Then ask the patient

all 3 after you have said them. Give 1 point for each correct answer. Then repeat them until he/she learns all 3. Count trials and record. Trials

Attention and Calculation

5 ( ) Serial 7’s. 1 point for each correct answer. Stop after 5 answers. Alternatively spell “world” backward.

Recall

3 ( ) Ask for the 3 objects repeated above. Give 1 point for each correct answer.

Language

2 ( ) Name a pencil and watch.

1 ( ) Repeat the following “No ifs, ands, or buts”

3 ( ) Follow a 3-stage command:

“Take a paper in your hand, fold it in half, and put it on the floor.”

1 ( ) Read and obey the following: CLOSE YOUR EYES

1 ( ) Write a sentence.

1 ( ) Copy the design shown.

Total Score

ASSESS level of consciousness along a continuum

Alert Drowsy Stupor Coma

"MINI-MENTAL STATE." A PRACTICAL METHOD FOR GRADING THE COGNITIVE STATE OF PATIENTS FOR THE CLINICIAN.

Journal of Psychiatric Research, 12(3): 189-198, 1975. Used by permission.

A series provided by

The Hartford Institute for Geriatric Nursing

(hartford.ign@nyu.edu)



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