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Nursing Orientation Checklist - c.ymcdn.com · Nursing Orientation Checklist Red ... Proper hand cleansing technique ... How to test a resuscitation bag to ensure its proper function

Jun 12, 2018

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phungminh

  • Nur

    sing

    Ori

    enta

    tion

    Che

    cklis

    t

    Red

    Com

    plet

    e du

    ring

    off

    ice

    orie

    ntat

    ion

    and/

    or f

    irst

    day

    of

    hom

    e or

    ient

    atio

    n Y

    ello

    w

    Com

    plet

    e w

    ithi

    n 3

    days

    of

    hom

    e or

    ient

    atio

    n pe

    riod

    G

    reen

    Co

    mpl

    ete

    wit

    hin

    30 d

    ays

    of b

    eing

    ass

    igne

    d a

    case

    IM

    PORT

    AN

    T: T

    he c

    heck

    lists

    are

    not

    inte

    nded

    to

    be a

    sub

    stit

    ute

    for

    any

    doct

    ors

    inst

    ruct

    ion

    for

    any

    pati

    ent

    s sp

    ecif

    ic p

    lan

    of c

    are.

    The

    y ar

    e in

    tend

    ed t

    o do

    cum

    ent

    the

    trai

    ning

    pro

    vide

    d by

    the

    Men

    tor

    RN t

    o th

    e N

    urse

    in t

    he h

    ome.

    Pa

    ge 1

    of

    13

    The

    follo

    win

    g ch

    eckl

    ist

    mus

    t be

    com

    plet

    ed a

    nd s

    igne

    d by

    bot

    h M

    ento

    r an

    d Le

    arne

    r. T

    his

    will

    ens

    ure

    that

    the

    Lea

    rner

    has

    all

    the

    skill

    s ne

    cess

    ary

    to s

    afel

    y pr

    ovid

    e on

    e-on

    -one

    car

    e in

    a h

    ome

    sett

    ing.

    Th

    e Le

    arne

    r m

    ust

    give

    ver

    bal e

    xpla

    nati

    on in

    non

    -gre

    y sh

    aded

    are

    as a

    nd m

    ust

    retu

    rn d

    emon

    stra

    te c

    ompe

    tenc

    e w

    ithi

    n th

    e gr

    ey

    shad

    ed a

    reas

    . R

    emin

    der:

    The

    Men

    tor

    and

    Lear

    ner

    mus

    t si

    gn o

    ff o

    n th

    e bo

    ttom

    of

    the

    Nur

    sing

    Ori

    enta

    tion

    Che

    ckli

    st p

    rior

    to

    wor

    king

    ind

    epen

    dent

    ly.

    Teac

    hing

    Che

    cklis

    t Re

    view

    for

    : __

    ____

    ____

    ____

    ____

    ____

    ____

    ____

    ____

    D

    ate

    Star

    ted:

    ___

    ____

    _ D

    ate

    Com

    plet

    ed:

    ____

    ___

    Cl

    ient

    s in

    itia

    ls o

    r #

    ____

    _

    F

    irst

    Nam

    e

    Last

    Nam

    e

    Men

    tor

    Nam

    e/In

    itia

    ls

    Dat

    e of

    or

    ient

    atio

    n D

    ate

    of

    orie

    ntat

    ion

    Dat

    e of

    or

    ient

    atio

    n D

    ate

    of

    orie

    ntat

    ion

    Dat

    e of

    or

    ient

    atio

    n P

    rogr

    ess

    of L

    earn

    ers

    ori

    enta

    tion

    was

    up

    date

    d to

    RN

    Man

    ager

    Ori

    enta

    tion

    Dat

    e __

    __/_

    ____

    /___

    __

    (Wri

    te in

    itia

    ls b

    elow

    )

    Ori

    enta

    tion

    Dat

    e __

    __/_

    ____

    /___

    __

    (Wri

    te in

    itia

    ls b

    elow

    )

    Des

    crib

    es a

    nd/o

    r de

    mon

    stra

    tes

    ____

    /___

    _/__

    __

    (Wri

    te in

    itia

    ls b

    elow

    )

    Hom

    e Sa

    fety

    N

    urse

    kno

    ws:

    M

    ento

    r Le

    arne

    r M

    ento

    r Le

    arne

    r M

    ento

    r Le

    arne

    r

    How

    to

    secu

    re p

    ower

    cor

    ds a

    nd p

    atie

    nt t

    ubin

    g to

    pre

    vent

    tri

    ppin

    g

    Ther

    e ne

    eds

    to b

    e w

    orki

    ng s

    mok

    e de

    tect

    ors,

    fir

    e ex

    ting

    uish

    ers,

    and

    car

    bon

    mon

    oxid

    e de

    tect

    ors

    in t

    he h

    ome

    To k

    eep

    a w

    orki

    ng f

    lash

    light

    at

    all t

    imes

    and

    in t

    he s

    ame

    plac

    e in

    the

    pat

    ient

    s r

    oom

    How

    to

    use

    safe

    ty b

    elts

    , st

    raps

    , re

    stra

    ints

    , ra

    iling

    s, c

    ar s

    eats

    , ga

    tes

    Pote

    ntia

    l haz

    ards

    wit

    h pe

    ts,

    sibl

    ings

    , vi

    sito

    rs

    How

    to

    use

    and

    stor

    e ha

    zard

    ous

    chem

    ical

    s (h

    ouse

    hold

    cle

    anin

    g, C

    ontr

    ol II

    I,

    etc.

    )

    Wha

    t th

    e Em

    erge

    ncy

    Acti

    on P

    lan

    is a

    nd h

    ow t

    o ca

    rry

    it o

    ut

  • Nur

    sing

    Ori

    enta

    tion

    Che

    cklis

    t

    Red

    Com

    plet

    e du

    ring

    off

    ice

    orie

    ntat

    ion

    and/

    or f

    irst

    day

    of

    hom

    e or

    ient

    atio

    n Y

    ello

    w

    Com

    plet

    e w

    ithi

    n 3

    days

    of

    hom

    e or

    ient

    atio

    n pe

    riod

    G

    reen

    Co

    mpl

    ete

    wit

    hin

    30 d

    ays

    of b

    eing

    ass

    igne

    d a

    case

    IM

    PORT

    AN

    T: T

    he c

    heck

    lists

    are

    not

    inte

    nded

    to

    be a

    sub

    stit

    ute

    for

    any

    doct

    ors

    inst

    ruct

    ion

    for

    any

    pati

    ent

    s sp

    ecif

    ic p

    lan

    of c

    are.

    The

    y ar

    e in

    tend

    ed t

    o do

    cum

    ent

    the

    trai

    ning

    pro

    vide

    d by

    the

    Men

    tor

    RN t

    o th

    e N

    urse

    in t

    he h

    ome.

    Pa

    ge 2

    of

    13

    O

    rien

    tati

    on D

    ate

    ____

    /___

    __/_

    ____

    (W

    rite

    init

    ials

    bel

    ow)

    Ori

    enta

    tion

    Dat

    e __

    __/_

    ____

    /___

    __

    (Wri

    te in

    itia

    ls b

    elow

    )

    Des

    crib

    es a

    nd/o

    r de

    mon

    stra

    tes

    ____

    /___

    _/__

    __

    (Wri

    te in

    itia

    ls b

    elow

    )

    Infe

    ctio

    n Pr

    even

    tion

    Pra

    ctic

    es

    Nur

    se k

    now

    s:

    Men

    tor

    Lear

    ner

    Men

    tor

    Lear

    ner

    Men

    tor

    Lear

    ner

    Prop

    er h

    and

    clea

    nsin

    g te

    chni

    que

    Impo

    rtan

    ce o

    f a

    clea

    n/ir

    rita

    nt-f

    ree

    envi

    ronm

    ent

    Wha

    t to

    do

    whe

    n fa

    mily

    , gu

    ests

    , th

    erap

    ists

    are

    sic

    k

    Appr

    opri

    ate

    visi

    tor

    para

    met

    ers

    Com

    mon

    infe

    ctio

    us d

    isea

    ses

    and

    repo

    rtin

    g

    Stan

    dard

    pre

    caut

    ions

    for

    infe

    ctio

    n ex

    posu

    re c

    ontr

    ol

    How

    to

    prop

    erly

    dis

    pose

    of

    cont

    amin

    ated

    mat

    eria

    ls (

    e.g.

    sha

    rps,

    med

    icat

    ions

    )

    How

    to

    clea

    n an

    d di

    sinf

    ect

    reus

    able

    med

    ical

    equ

    ipm

    ent

    and

    supp

    lies

    O

    rien

    tati

    on D

    ate

    ____

    /___

    __/_

    ____

    (W

    rite

    init

    ials

    bel

    ow)

    Ori

    enta

    tion

    Dat

    e __

    __/_

    ____

    /___

    __

    (Wri

    te in

    itia

    ls b

    elow

    )

    Des

    crib

    es a

    nd/o

    r de

    mon

    stra

    tes

    ____

    /___

    _/__

    __

    (Wri

    te in

    itia

    ls b

    elow

    )

    Apn

    ea E

    quip

    men

    t/Pr

    oced

    ures

    N

    urse

    kno

    ws:

    M

    ento

    r Le

    arne

    r M

    ento

    r Le

    arne

    r M

    ento

    r Le

    arne

    r

    Wha

    t an

    apn

    ea m

    onit

    or is

    and

    wha

    t it

    is u

    sed

    for

    How

    to

    turn

    the

    mon

    itor

    on/

    off

    How

    to

    prop

    erly

    pla

    ce t

    he e

    lect

    rode

    s

    How

    to

    resp

    ond

    to a

    n al

    arm

    O

    rien

    tati

    on D

    ate

    ____

    /___

    __/_

    ____

    (W

    rite

    init

    ials

    bel

    ow)

    Ori

    enta

    tion

    Dat

    e __

    __/_

    ____

    /___

    __

    (Wri

    te in

    itia

    ls b

    elow

    )

    Des

    crib

    es a

    nd/o

    r de

    mon

    stra

    tes

    ____

    /___

    _/__

    __

    (Wri

    te in

    itia

    ls b

    elow

    )

    Oxi

    met

    ry E

    quip

    men

    t/Pr

    oced

    ures

    N

    urse

    kno

    ws:

    M

    ento

    r Le

    arne

    r M

    ento

    r Le

    arne

    r M

    ento

    r Le

    arne

    r

    Wha

    t an

    oxi

    met

    er is

    and

    wha

    t it

    is u

    sed

    for

    How

    long

    the

    inte

    rnal

    bat

    tery

    will

    last

    in t

    he o

    xim

    eter

    How

    to

    prop

    erly

    pla

    ce a

    nd s

    ecur

    e th

    e ox

    imet

    er p

    robe

  • Nur

    sing

    Ori

    enta

    tion

    Che

    cklis

    t

    Red

    Com

    plet

    e du

    ring

    off

    ice

    orie

    ntat

    ion

    and/

    or f

    irst

    day

    of

    hom

    e or

    ient

    atio

    n Y

    ello

    w

    Com

    plet

    e w

    ithi

    n 3

    days

    of

    hom

    e or

    ient

    atio

    n pe

    riod

    G

    reen

    Co

    mpl

    ete

    wit

    hin

    30 d

    ays

    of b

    eing

    ass

    igne

    d a

    case

    IM

    PORT

    AN

    T: T

    he c

    heck

    lists

    are

    not

    inte

    nded

    to

    be a

    sub

    stit

    ute

    for

    any

    doct

    ors

    inst

    ruct

    ion

    for

    any

    pati

    ent

    s sp

    ecif

    ic p

    lan

    of c

    are.

    The

    y ar

    e in

    tend

    ed t

    o do

    cum

    ent

    the

    trai

    ning

    pro

    vide

    d by

    the

    Men

    tor

    RN t

    o th

    e N

    urse

    in t

    he h

    ome.

    Pa

    ge 3

    of

    13

    Whe

    n to

    rep

    lace

    the

    oxi

    met

    er p

    robe

    How

    to

    tell

    if t

    he o

    xim

    eter

    rea

    ding

    s ar

    e ac

    cura

    te

    How

    to

    resp

    ond

    to a

    n al

    arm

    Impo

    rtan

    ce o

    f re

    posi

    tion

    ing

    prob

    e si

    te p

    er e

    very

    fou

    r ho

    urs

    How

    to

    turn

    the

    oxi

    met

    er o

    n/of

    f

    Ori

    enta

    tion

    Dat

    e __

    __/_

    ____

    /___

    __

    (Wri

    te in

    itia

    ls b

    elow

    )

    Ori

    enta

    tion

    Dat

    e __

    __/_

    ____

    /___

    __

    (Wri

    te in

    itia

    ls b

    elow

    )

    Des

    crib

    es a

    nd/o

    r de

    mon

    stra

    tes

    ____

    /___

    _/__

    __

    (Wri

    te in

    itia

    ls b

    elow

    )

    Vent

    ilato

    r /

    Trac

    heos

    tom

    y Ca

    re (

    Equi

    pmen

    t)

    Nur

    se k

    now

    s:

    Men

    tor

    Lear

    ner

    Men

    tor

    Lear

    ner

    Men

    tor

    Lear

    ner

    Wha

    t a

    doct

    or o

    rder

    is f

    or a

    nd w

    hy it

    is u

    sed

    in h

    ome

    care

    Use

    of

    a fl

    ow s

    heet

    and

    why

    it is

    use

    d in

    hom

    e ca

    re

    Equi

    pmen

    t al

    arm

    s m

    ust

    be h

    eard

    fro

    m a

    ny p

    lace

    in t

    he h

    ome

    How

    to

    prop

    erly

    use

    the

    equ

    ipm

    ent

    and

    to v

    erif

    y th

    e eq

    uipm

    ent

    sett

    ings

    (e.

    g.,

    vent

    and

    hu

    mid

    ifie

    r se

    ttin

    gs)

    and

    how

    to

    turn

    it o

    n/of

    f

    How

    to

    test

    a v

    enti

    lato

    r BE

    FORE

    usi

    ng it

    Tubi

    ng c

    ircu

    it s

    houl

    d dr

    ain

    dow

    n an

    d AW

    AY f

    rom

    the

    chi

    ld

    How

    to

    trou

    bles

    hoot

    ven

    tila

    tor/

    hum

    idif

    ier

    alar

    ms

    (e.g

    ., f

    irst

    do

    this

    , th

    en d

    o th

    is)

    Purp

    ose

    of h

    umid

    ity

    wit

    h ve

    ntila

    tor

    or t

    rach

    eost

    omy

    Wha

    t to

    do

    if w

    ater

    has

    dra

    ined

    into

    a p

    atie

    nts

    tra

    cheo

    stom

    y

    How

    to

    use

    an H

    ME

    (art

    ific

    ial n

    ose)

    How

    to

    plug

    in t

    he b

    atte

    ry-o

    pera

    ted

    back

    up e

    quip

    men

    t

    How

    to

    char

    ge t

    he e

    xter

    nal b

    atte

    ries

    for

    ven

    tila

    tors

    , bi

    -lev

    els

    and

    CPAP

    s

    How

    to

    conn

    ect

    an e

    xter

    nal b

    atte

    ry t

    o th

    e ve

    ntila

    tor,

    bi-

    leve

    l or

    CPAP

    How

    long

    the

    app

    roxi

    mat

    e ba

    tter

    y lif

    e (o

    r ca

    n fi

    nd b

    atte

    ry li

    fe in

    form

    atio

    n) f

    or e

    ach

    piec

    e of

    equ

    ipm

    ent

    Prop

    er s

    et u

    p of

    the

    cir

    cuit

  • Nur

    sing

    Ori

    enta

    tion

    Che

    cklis

    t

    Red

    Com

    plet

    e du

    ring

    off

    ice

    orie

    ntat

    ion

    and/

    or f

    irst

    day

    of

    hom

    e or

    ient

    atio

    n Y

    ello

    w

    Com

    plet

    e w

    ithi

    n 3

    days

    of

    hom

    e or

    ient

    atio

    n pe

    riod

    G

    reen

    Co

    mpl

    ete

    wit

    hin

    30 d

    ays

    of b

    eing

    ass

    igne

    d a

    case

    IM

    PORT

    AN

    T: T

    he c

    heck

    lists

    are

    not

    inte

    nded

    to

    be a

    sub

    stit

    ute

    for

    any

    doct

    ors

    inst

    ruct

    ion

    for

    any

    pati

    ent

    s sp

    ecif

    ic p

    lan

    of c

    are.

    The

    y ar

    e in

    tend

    ed t

    o do

    cum

    ent

    the

    trai

    ning

    pro

    vide

    d by

    the

    Men

    tor

    RN t

    o th

    e N

    urse

    in t

    he h

    ome.

    Pa

    ge 4

    of

    13

    O

    rien

    tati

    on D

    ate

    ____

    /___

    __/_

    ____

    (W

    rite

    init

    ials

    bel

    ow)

    Ori

    enta

    tion

    Dat

    e __

    __/_

    ____

    /___

    __

    (Wri

    te in

    itia

    ls b

    elow

    )

    Des

    crib

    es a

    nd/o

    r de

    mon

    stra

    tes

    ____

    /___

    _/__

    __

    (Wri

    te in

    itia

    ls b

    elow

    )

    Vent

    ilato

    r /

    Trac

    heos

    tom

    y Ca

    re (

    Suct

    ioni

    ng)

    Nur

    se k

    now

    s:

    Men

    tor

    Lear

    ner

    Men

    tor

    Lear

    ner

    Men

    tor

    Lear

    ner

    Corr

    ect

    size

    cat

    hete

    r to

    use

    Corr

    ect

    suct

    ion

    pres

    sure

    to

    use

    How

    to

    test

    for

    suc

    tion

    pre

    ssur

    e

    How

    to

    trou

    bles

    hoot

    suc

    tion

    mac

    hine

    and

    how

    to

    turn

    it o

    n/of

    f

    And

    can

    dem

    onst

    rate

    the

    ste

    rile

    suc

    tion

    tec

    hniq

    ue (

    prop

    er d

    epth

    )

    And

    can

    eval

    uate

    suc

    tion

    eff

    ecti

    vene

    ss,

    desc

    ribe

    spu

    tum

    (co

    lor,

    con

    sist

    ency

    , od

    or,

    amou

    nt)

    Whe

    n de

    ep (

    pre-

    mea

    sure

    d) s

    ucti

    onin

    g is

    nec

    essa

    ry

    How

    to

    use

    the

    man

    ual s

    ucti

    on c

    athe

    ter

    in t

    he e

    vent

    of

    a su

    ctio

    n pu

    mp

    failu

    re

    14 F

    r su

    ctio

    n ca

    thet

    ers

    and

    whe

    n it

    sho

    uld

    be u

    sed

    Ori

    enta

    tion

    Dat

    e __

    __/_

    ____

    /___

    __

    (Wri

    te in

    itia

    ls b

    elow

    )

    Ori

    enta

    tion

    Dat

    e __

    __/_

    ____

    /___

    __

    (Wri

    te in

    itia

    ls b

    elow

    )

    Des

    crib

    es a

    nd/o

    r de

    mon

    stra

    tes

    ____

    /___

    _/__

    __

    (Wri

    te in

    itia

    ls b

    elow

    )

    Vent

    ilato

    r /

    Trac

    heos

    tom

    y Ca

    re (

    Emer

    genc

    y Ba

    g an

    d Em

    erge

    ncy

    Beds

    ide

    Stoc

    k)

    Nur

    se k

    now

    s:

    Men

    tor

    Lear

    ner

    Men

    tor

    Lear

    ner

    Men

    tor

    Lear

    ner

    Wha

    t an

    em

    erge

    ncy

    bag

    is f

    or a

    nd w

    here

    it s

    houl

    d be

    kep

    t

    Cont

    ents

    of

    an e

    mer

    genc

    y ba

    g

    Cont

    ents

    of

    emer

    genc

    y ba

    g ne

    eds

    to b

    e ch

    ecke

    d at

    eac

    h sh

    ift

    chan

    ge

    To h

    ave

    a cu

    rren

    t si

    ze t

    rach

    and

    one

    siz

    e sm

    alle

    r tr

    ach

    at t

    he b

    edsi

    de A

    ND

    the

    pat

    ient

    s

    emer

    genc

    y ba

    g

  • Nur

    sing

    Ori

    enta

    tion

    Che

    cklis

    t

    Red

    Com

    plet

    e du

    ring

    off

    ice

    orie

    ntat

    ion

    and/

    or f

    irst

    day

    of

    hom

    e or

    ient

    atio

    n Y

    ello

    w

    Com

    plet

    e w

    ithi

    n 3

    days

    of

    hom

    e or

    ient

    atio

    n pe

    riod

    G

    reen

    Co

    mpl

    ete

    wit

    hin

    30 d

    ays

    of b

    eing

    ass

    igne

    d a

    case

    IM

    PORT

    AN

    T: T

    he c

    heck

    lists

    are

    not

    inte

    nded

    to

    be a

    sub

    stit

    ute

    for

    any

    doct

    ors

    inst

    ruct

    ion

    for

    any

    pati

    ent

    s sp

    ecif

    ic p

    lan

    of c

    are.

    The

    y ar

    e in

    tend

    ed t

    o do

    cum

    ent

    the

    trai

    ning

    pro

    vide

    d by

    the

    Men

    tor

    RN t

    o th

    e N

    urse

    in t

    he h

    ome.

    Pa

    ge 5

    of

    13

    Ori

    enta

    tion

    Dat

    e __

    __/_

    ____

    /___

    __

    (Wri

    te in

    itia

    ls b

    elow

    )

    Ori

    enta

    tion

    Dat

    e __

    __/_

    ____

    /___

    __

    (Wri

    te in

    itia

    ls b

    elow

    )

    Des

    crib

    es a

    nd/o

    r de

    mon

    stra

    tes

    ____

    /___

    _/__

    __

    (Wri

    te in

    itia

    ls b

    elow

    )

    Vent

    ilato

    r /

    Trac

    heos

    tom

    y Ca

    re (

    Resu

    scit

    atio

    n Ba

    g)

    Nur

    se k

    now

    s:

    Men

    tor

    Lear

    ner

    Men

    tor

    Lear

    ner

    Men

    tor

    Lear

    ner

    How

    and

    whe

    n to

    use

    the

    res

    usci

    tati

    on b

    ag

    That

    a r

    esus

    cita

    tion

    bag

    nee

    ds t

    o be

    kep

    t at

    the

    bed

    side

    AN

    D in

    the

    em

    erge

    ncy

    bag

    How

    to

    test

    a r

    esus

    cita

    tion

    bag

    to

    ensu

    re it

    s pr

    oper

    fun

    ctio

    n

    How

    to

    conn

    ect

    the

    oxyg

    en t

    o th

    e re

    susc

    itat

    or b

    ag a

    nd c

    heck

    it t

    o en

    sure

    it is

    wor

    king

    as

    it

    shou

    ld

    Oxy

    gen

    liter

    flo

    w s

    etti

    ng t

    o us

    e w

    ith

    the

    resu

    scit

    ator

    How

    to

    asse

    ss p

    atie

    nt f

    or t

    he c

    orre

    ct s

    ize

    resu

    scit

    ator

    bag

    , an

    d if

    app

    licab

    le,

    mas

    k

    Ori

    enta

    tion

    Dat

    e __

    __/_

    ____

    /___

    __

    (Wri

    te in

    itia

    ls b

    elow

    )

    Ori

    enta

    tion

    Dat

    e __

    __/_

    ____

    /___

    __

    (Wri

    te in

    itia

    ls b

    elow

    )

    Des

    crib

    es a

    nd/o

    r de

    mon

    stra

    tes

    ____

    /___

    _/__

    __

    (Wri

    te in

    itia

    ls b

    elow

    )

    Vent

    ilato

    r /

    Trac

    heos

    tom

    y Ca

    re (

    Trac

    heos

    tom

    y Ca

    re)

    Nur

    se k

    now

    s:

    Men

    tor

    Lear

    ner

    Men

    tor

    Lear

    ner

    Men

    tor

    Lear

    ner

    Trac

    h tu

    be t

    ype,

    siz

    e, a

    nd d

    owns

    ize

    back

    up

    Freq

    uenc

    y an

    d ho

    w t

    o pe

    rfor

    m t

    rach

    sit

    e (s

    tom

    a) c

    ares

    Freq

    uenc

    y an

    d ho

    w t

    o pe

    rfor

    m t

    rach

    tie

    cha

    nges

    Min

    imal

    leak

    tec

    hniq

    ue (

    MLT

    ) fo

    r cu

    ffed

    tra

    ch t

    ubes

    Purp

    ose

    and

    how

    to

    use

    a Pa

    ssy-

    Mui

    r sp

    eaki

    ng v

    alve

    (sa

    fety

    pre

    caut

    ions

    )

    Sign

    s of

    air

    way

    blo

    ckag

    e

    How

    to

    perf

    orm

    a t

    rach

    cha

    nge

    rout

    ine

    freq

    uenc

    y ve

    rsus

    unp

    lann

    ed/e

    mer

    genc

    y (l

    ive

    or

    wit

    h m

    anne

    quin

    )

    How

    to

    dete

    rmin

    e w

    hen

    911

    shou

    ld b

    e ca

    lled

    How

    to

    insp

    ect

    the

    neck

    and

    sto

    ma

    area

    for

    sig

    ns o

    f in

    fect

    ion

    How

    to

    prop

    erly

    pos

    itio

    n or

    rep

    osit

    ion

    wit

    h in

    crea

    se m

    ovem

    ent

    of c

    lient

  • Nur

    sing

    Ori

    enta

    tion

    Che

    cklis

    t

    Red

    Com

    plet

    e du

    ring

    off

    ice

    orie

    ntat

    ion

    and/

    or f

    irst

    day

    of

    hom

    e or

    ient

    atio

    n Y

    ello

    w

    Com

    plet

    e w

    ithi

    n 3

    days

    of

    hom

    e or

    ient

    atio

    n pe

    riod

    G

    reen

    Co

    mpl

    ete

    wit

    hin

    30 d

    ays

    of b

    eing

    ass

    igne

    d a

    case

    IM

    PORT

    AN

    T: T

    he c

    heck

    lists

    are

    not

    inte

    nded

    to

    be a

    sub

    stit

    ute

    for

    any

    doct

    ors

    inst

    ruct

    ion

    for

    any

    pati

    ent

    s sp

    ecif

    ic p

    lan

    of c

    are.

    The

    y ar

    e in

    tend

    ed t

    o do

    cum

    ent

    the

    trai

    ning

    pro

    vide

    d by

    the

    Men

    tor

    RN t

    o th

    e N

    urse

    in t

    he h

    ome.

    Pa

    ge 6

    of

    13

    Ori

    enta

    tion

    Dat

    e __

    __/_

    ____

    /___

    __

    (Wri

    te in

    itia

    ls b

    elow

    )

    Ori

    enta

    tion

    Dat

    e __

    __/_

    ____

    /___

    __

    (Wri

    te in

    itia

    ls b

    elow

    )

    Des

    crib

    es a

    nd/o

    r de

    mon

    stra

    tes

    ____

    /___

    _/__

    __

    (Wri

    te in

    itia

    ls b

    elow

    )

    Vent

    ilato

    r /

    Trac

    heos

    tom

    y Ca

    re (

    Oxy

    gen)

    N

    urse

    kno

    ws:

    M

    ento

    r Le

    arne

    r M

    ento

    r Le

    arne

    r M

    ento

    r Le

    arne

    r

    Prop

    er w

    ay t

    o ch

    ange

    an

    oxyg

    en t

    ank

    Whe

    re t

    he f

    low

    cha

    rts

    are

    loca

    ted

    How

    to

    dete

    rmin

    e ho

    w m

    uch

    oxyg

    en is

    in t

    he o

    xyge

    n ta

    nk

    Whe

    re t

    he O

    xyge

    n Sa

    fety

    sig

    n ne

    eds

    to b

    e po

    sted

    Safe

    ty is

    sues

    rel

    ated

    to

    oxyg

    en

    Whe

    re a

    nd h

    ow o

    xyge

    n sh

    ould

    be

    stor

    ed

    How

    to

    dete

    rmin

    e ho

    w m

    uch

    oxyg

    en s

    houl

    d be

    use

    d an

    d w

    hen

    Ori

    enta

    tion

    Dat

    e __

    __/_

    ____

    /___

    __

    (Wri

    te in

    itia

    ls b

    elow

    )

    Ori

    enta

    tion

    Dat

    e __

    __/_

    ____

    /___

    __

    (Wri

    te in

    itia

    ls b

    elow

    )

    Des

    crib

    es a

    nd/o

    r de

    mon

    stra

    tes

    ____

    /___

    _/__

    __

    (Wri

    te in

    itia

    ls b

    elow

    )

    Neb

    uliz

    er/I

    nhal

    er

    Nur

    se k

    now

    s:

    Men

    tor

    Lear

    ner

    Men

    tor

    Lear

    ner

    Men

    tor

    Lear

    ner

    Whe

    n ne

    buliz

    er/i

    nhal

    er t

    hera

    py is

    indi

    cate

    d (o

    rder

    ed a

    nd p

    rn)

    How

    to

    asse

    mbl

    e ne

    b ki

    t, c

    onne

    ct in

    -lin

    e

    How

    and

    whe

    n to

    add

    /rem

    ove

    a fi

    lter

    to

    exha

    lati

    on t

    ubin

    g

    Whi

    ch m

    edic

    atio

    ns c

    an b

    e m

    ixed

    ver

    sus

    othe

    rs t

    hat

    requ

    ire

    desi

    gnat

    ed n

    eb k

    its

    O

    rien

    tati

    on D

    ate

    ____

    /___

    __/_

    ____

    (W

    rite

    init

    ials

    bel

    ow)

    Ori

    enta

    tion

    Dat

    e __

    __/_

    ____

    /___

    __

    (Wri

    te in

    itia

    ls b

    elow

    )

    Des

    crib

    es a

    nd/o

    r de

    mon

    stra

    tes

    ____

    /___

    _/__

    __

    (Wri

    te in

    itia

    ls b

    elow

    )

    Resp

    irat

    ory

    Syst

    em M

    anag

    emen

    t N

    urse

    kno

    ws:

    M

    ento

    r Le

    arne

    r M

    ento

    r Le

    arne

    r M

    ento

    r Le

    arne

    r

    Com

    pone

    nts

    of t

    he r

    espi

    rato

    ry t

    ract

    Thei

    r cl

    ient

    s d

    iagn

    oses

    and

    the

    impa

    ct o

    n th

    e ai

    rway

    (tr

    ache

    osto

    my)

    and

    bre

    athi

    ng

    (ven

    tila

    tor,

    hum

    idif

    icat

    ion

    syst

    ems)

    Sign

    s of

    res

    pira

    tory

    dis

    tres

    s (i

    ncre

    ased

    WO

    B: n

    asal

    fla

    ring

    , re

    trac

    tion

    s, a

    bd.

    brea

    thin

    g,

    incr

    ease

    /dec

    reas

    e in

    RR

    and/

    or H

    R, d

    ecre

    ase

    in S

    pO2,

    ski

    n co

    lor,

    sec

    reti

    on c

    hang

    es)

  • Nur

    sing

    Ori

    enta

    tion

    Che

    cklis

    t

    Red

    Com

    plet

    e du

    ring

    off

    ice

    orie

    ntat

    ion

    and/

    or f

    irst

    day

    of

    hom

    e or

    ient

    atio

    n Y

    ello

    w

    Com

    plet

    e w

    ithi

    n 3

    days

    of

    hom

    e or

    ient

    atio

    n pe

    riod

    G

    reen

    Co

    mpl

    ete

    wit

    hin

    30 d

    ays

    of b

    eing

    ass

    igne

    d a

    case

    IM

    PORT

    AN

    T: T

    he c

    heck

    lists

    are

    not

    inte

    nded

    to

    be a

    sub

    stit

    ute

    for

    any

    doct

    ors

    inst

    ruct

    ion

    for

    any

    pati

    ent

    s sp

    ecif

    ic p

    lan

    of c

    are.

    The

    y ar

    e in

    tend

    ed t

    o do

    cum

    ent

    the

    trai

    ning

    pro

    vide

    d by

    the

    Men

    tor

    RN t

    o th

    e N

    urse

    in t

    he h

    ome.

    Pa

    ge 7

    of

    13

    Appr

    opri

    ate

    airw

    ay m

    anag

    emen

    t, in

    terv

    enti

    ons

    for

    resp

    irat

    ory

    dist

    ress

    (e.

    g.,

    suct

    ioni

    ng,

    nebu

    lizer

    the

    rapy

    , hu

    mid

    ity,

    tra

    ch c

    hang

    e, v

    enti

    ng G

    T)

    How

    to

    ausc

    ulta

    te f

    or b

    reat

    h so

    unds

    , ho

    w t

    o de

    scri

    be

    How

    to

    perf

    orm

    bro

    nchi

    al d

    rain

    age

    (BD

    ), in

    clud

    ing

    man

    ual B

    Ds

    Ori

    enta

    tion

    Dat

    e __

    __/_

    ____

    /___

    __

    (Wri

    te in

    itia

    ls b

    elow

    )

    Ori

    enta

    tion

    Dat

    e __

    __/_

    ____

    /___

    __

    (Wri

    te in

    itia

    ls b

    elow

    )

    Des

    crib

    es a

    nd/o

    r de

    mon

    stra

    tes

    ____

    /___

    _/__

    __

    (Wri

    te in

    itia

    ls b

    elow

    )

    Gas

    troi

    ntes

    tina

    l/G

    enit

    ouri

    nary

    Sys

    tem

    Man

    agem

    ent

    Nur

    se k

    now

    s:

    Men

    tor

    Lear

    ner

    Men

    tor

    Lear

    ner

    Men

    tor

    Lear

    ner

    Com

    pone

    nts

    of a

    GI t

    rack

    Type

    s an

    d pl

    acem

    ent

    of G

    I tub

    e (a

    ppro

    pria

    te t

    o th

    eir

    clie

    nt)

    GI t

    ube

    site

    car

    es

    GER

    /asp

    irat

    ion/

    emes

    is p

    reca

    utio

    ns (

    body

    pos

    itio

    ning

    , el

    evat

    ing

    HO

    B, D

    anny

    Slin

    g)

    How

    to

    chec

    k re

    sidu

    als,

    whe

    n to

    hol

    d fe

    edin

    gs

    Die

    t/hy

    drat

    ion

    need

    s

    appr

    opri

    ate

    feed

    ing

    sche

    dule

    , Pe

    dial

    yte

    use

    , im

    pact

    of

    oral

    inta

    ke,

    impa

    ct o

    f hy

    drat

    ion

    in r

    elat

    ion

    to c

    ardi

    ac/r

    espi

    rato

    ry s

    yste

    ms

    Proc

    edur

    e to

    cor

    rect

    ly m

    ix a

    nd s

    tore

    for

    mul

    as

    How

    to

    calc

    ulat

    e fo

    rmul

    a am

    ount

    s

    Proc

    edur

    e to

    unc

    log

    a ga

    stri

    c tu

    be

    How

    to

    vent

    the

    GI t

    ube,

    wha

    t th

    e Fa

    rrel

    l bag

    is u

    sed

    for,

    if a

    pplic

    able

    Aver

    age

    hang

    tim

    e fo

    r fo

    rmul

    as

    How

    to

    ausc

    ulta

    te f

    or b

    owel

    sou

    nds

    How

    to

    mea

    sure

    abd

    omin

    al g

    irth

    Nor

    mal

    I/O

    s

    fee

    ding

    sch

    edul

    e, u

    rine

    out

    put

    (dia

    per

    coun

    ts/w

    eigh

    ts,

    cath

    eter

    izat

    ion

    sche

    dule

    /mea

    sure

    men

    ts,

    BM n

    orm

    s [f

    requ

    ency

    /con

    sist

    ency

    /mea

    sure

    men

    ts])

  • Nur

    sing

    Ori

    enta

    tion

    Che

    cklis

    t

    Red

    Com

    plet

    e du

    ring

    off

    ice

    orie

    ntat

    ion

    and/

    or f

    irst

    day

    of

    hom

    e or

    ient

    atio

    n Y

    ello

    w

    Com

    plet

    e w

    ithi

    n 3

    days

    of

    hom

    e or

    ient

    atio

    n pe

    riod

    G

    reen

    Co

    mpl

    ete

    wit

    hin

    30 d

    ays

    of b

    eing

    ass

    igne

    d a

    case

    IM

    PORT

    AN

    T: T

    he c

    heck

    lists

    are

    not

    inte

    nded

    to

    be a

    sub

    stit

    ute

    for

    any

    doct

    ors

    inst

    ruct

    ion

    for

    any

    pati

    ent

    s sp

    ecif

    ic p

    lan

    of c

    are.

    The

    y ar

    e in

    tend

    ed t

    o do

    cum

    ent

    the

    trai

    ning

    pro

    vide

    d by

    the

    Men

    tor

    RN t

    o th

    e N

    urse

    in t

    he h

    ome.

    Pa

    ge 8

    of

    13

    Ori

    enta

    tion

    Dat

    e __

    __/_

    ____

    /___

    __

    (Wri

    te in

    itia

    ls b

    elow

    )

    Ori

    enta

    tion

    Dat

    e __

    __/_

    ____

    /___

    __

    (Wri

    te in

    itia

    ls b

    elow

    )

    Des

    crib

    es a

    nd/o

    r de

    mon

    stra

    tes

    ____

    /___

    _/__

    __

    (Wri

    te in

    itia

    ls b

    elow

    )

    Card

    iac

    Syst

    em M

    anag

    emen

    t N

    urse

    kno

    ws:

    M

    ento

    r Le

    arne

    r M

    ento

    r Le

    arne

    r M

    ento

    r Le

    arne

    r

    Thei

    r cl

    ient

    s c

    ardi

    ac d

    isea

    se a

    nd im

    pact

    on

    othe

    r sy

    stem

    s

    Nor

    mal

    HR,

    sig

    nifi

    canc

    e of

    incr

    ease

    d/de

    crea

    sed

    HR

    in t

    heir

    clie

    nt

    Nor

    mal

    ski

    n co

    lor

    How

    to

    obta

    in m

    anua

    l pul

    ses

    ap

    ical

    and

    per

    iphe

    ral

    Rela

    tion

    of

    acti

    vity

    leve

    l for

    the

    ir c

    lient

    How

    to

    iden

    tify

    ede

    ma/

    inte

    rven

    tion

    How

    to

    iden

    tify

    dia

    phor

    esis

    /int

    erve

    ntio

    n

    How

    to

    chec

    k ca

    pilla

    ry r

    efill

    n

    orm

    al,

    sign

    ific

    ance

    of

    incr

    ease

    d ti

    me

    Med

    icat

    ions

    (i.

    e. d

    iure

    tics

    ) an

    d th

    e im

    pact

    on

    card

    iova

    scul

    ar a

    nd G

    I sys

    tem

    s

    How

    to

    chec

    k BP

    - n

    orm

    al B

    P, v

    ersu

    s hy

    pert

    ensi

    on/h

    ypot

    ensi

    on c

    ause

    s in

    the

    ir c

    lient

    Ori

    enta

    tion

    Dat

    e __

    __/_

    ____

    /___

    __

    (Wri

    te in

    itia

    ls b

    elow

    )

    Ori

    enta

    tion

    Dat

    e __

    __/_

    ____

    /___

    __

    (Wri

    te in

    itia

    ls b

    elow

    )

    Des

    crib

    es a

    nd/o

    r de

    mon

    stra

    tes

    ____

    /___

    _/__

    __

    (Wri

    te in

    itia

    ls b

    elow

    )

    Neu

    rolo

    gic

    Syst

    em M

    anag

    emen

    t N

    urse

    kno

    ws:

    M

    ento

    r Le

    arne

    r M

    ento

    r Le

    arne

    r M

    ento

    r Le

    arne

    r

    Neu

    rolo

    gic

    dise

    ase

    and

    impa

    ct o

    n ot

    her

    syst

    ems

    (i.e

    . ce

    ntra

    l apn

    ea,

    auto

    nom

    ic d

    ysre

    flex

    ia)

    Nor

    mal

    men

    tal s

    tatu

    s/le

    vel o

    f co

    nsci

    ousn

    ess,

    sig

    nifi

    canc

    e of

    incr

    ease

    d/de

    crea

    sed

    leve

    l of

    cons

    ciou

    snes

    s

    Nor

    mal

    neu

    rom

    uscu

    lar

    mov

    emen

    t/m

    obili

    ty

    How

    to

    iden

    tify

    sei

    zure

    s/in

    terv

    enti

    ons

    Shun

    t ty

    pe,

    sign

    s of

    mal

    func

    tion

    How

    to

    iden

    tify

    ede

    ma/

    inte

    rven

    tion

    rel

    ated

    to

    shun

    t m

    alfu

    ncti

    on

  • Nur

    sing

    Ori

    enta

    tion

    Che

    cklis

    t

    Red

    Com

    plet

    e du

    ring

    off

    ice

    orie

    ntat

    ion

    and/

    or f

    irst

    day

    of

    hom

    e or

    ient

    atio

    n Y

    ello

    w

    Com

    plet

    e w

    ithi

    n 3

    days

    of

    hom

    e or

    ient

    atio

    n pe

    riod

    G

    reen

    Co

    mpl

    ete

    wit

    hin

    30 d

    ays

    of b

    eing

    ass

    igne

    d a

    case

    IM

    PORT

    AN

    T: T

    he c

    heck

    lists

    are

    not

    inte

    nded

    to

    be a

    sub

    stit

    ute

    for

    any

    doct

    ors

    inst

    ruct

    ion

    for

    any

    pati

    ent

    s sp

    ecif

    ic p

    lan

    of c

    are.

    The

    y ar

    e in

    tend

    ed t

    o do

    cum

    ent

    the

    trai

    ning

    pro

    vide

    d by

    the

    Men

    tor

    RN t

    o th

    e N

    urse

    in t

    he h

    ome.

    Pa

    ge 9

    of

    13

    Ori

    enta

    tion

    Dat

    e __

    __/_

    ____

    /___

    __

    (Wri

    te in

    itia

    ls b

    elow

    )

    Ori

    enta

    tion

    Dat

    e __

    __/_

    ____

    /___

    __

    (Wri

    te in

    itia

    ls b

    elow

    )

    Des

    crib

    es a

    nd/o

    r de

    mon

    stra

    tes

    ____

    /___

    _/__

    __

    (Wri

    te in

    itia

    ls b

    elow

    )

    Vasc

    ular

    Sys

    tem

    (In

    fusi

    on)

    Man

    agem

    ent

    Nur

    se k

    now

    s:

    Men

    tor

    Lear

    ner

    Men

    tor

    Lear

    ner

    Men

    tor

    Lear

    ner

    Type

    of

    IV t

    hera

    py b

    eing

    use

    d an

    d w

    hy

    How

    to

    prep

    are

    a sa

    fe w

    ork

    area

    for

    the

    IV li

    ne m

    anag

    emen

    t/m

    eds

    How

    to

    scru

    b th

    e hu

    b of

    the

    IV c

    athe

    ter

    Wha

    t to

    do

    if a

    n un

    capp

    ed t

    ip,

    IV t

    ubin

    g, o

    r hu

    b is

    tou

    ched

    How

    to

    insp

    ect

    the

    IV c

    athe

    ter

    site

    and

    cat

    hete

    r

    wha

    t to

    look

    for

    How

    to

    secu

    re t

    he IV

    cat

    hete

    r

    Sign

    s of

    a b

    lood

    stre

    am in

    fect

    ion

    Who

    /whe

    n to

    rep

    ort

    sign

    s of

    a b

    lood

    stre

    am in

    fect

    ion

    Prop

    er p

    roto

    col f

    or f

    lush

    ing

    the

    IV li

    ne

    And

    can

    dem

    onst

    rate

    the

    pro

    per

    infe

    ctio

    n pr

    even

    tion

    met

    hod

    of c

    hang

    ing

    the

    dres

    sing

    and

    m

    anag

    ing

    the

    site

    O

    rien

    tati

    on D

    ate

    ____

    /___

    __/_

    ____

    (W

    rite

    init

    ials

    bel

    ow)

    Ori

    enta

    tion

    Dat

    e __

    __/_

    ____

    /___

    __

    (Wri

    te in

    itia

    ls b

    elow

    )

    Des

    crib

    es a

    nd/o

    r de

    mon

    stra

    tes

    ____

    /___

    _/__

    __

    (Wri

    te in

    itia

    ls b

    elow

    )

    Com

    mun

    icat

    ion

    / Re

    sour

    ces

    M

    ento

    r Le

    arne

    r M

    ento

    r Le

    arne

    r M

    ento

    r Le

    arne

    r

    Com

    mun

    icat

    ing

    wit

    h of

    fice

    sta

    ff,

    doct

    ors,

    the

    rapi

    sts,

    nur

    ses

    Com

    mun

    icat

    ion

    book

    Com

    pone

    nts

    of r

    epor

    ts a

    nd w

    hy t

    hey

    are

    impo

    rtan

    t

    Giv

    e re

    port

    to

    prec

    epto

    r fo

    r pr

    acti

    ce

    Giv

    e re

    port

    to

    next

    nur

    se

    Init

    iate

    cal

    l to

    PDN

    to

    com

    mun

    icat

    e vi

    a af

    ter

    hour

    s on

    -cal

    l sys

    tem

    s

    Repo

    rt c

    once

    rns

    to n

    urse

    , nu

    rse

    supe

    rvis

    or,

    or c

    ase

    man

    ager

    DM

    E, e

    quip

    men

    t m

    anua

    ls

    Nur

    se s

    uper

    viso

    r/le

    ad n

    urse

    /pre

    cept

    or

    Clin

    ical

    man

    ager

    or

    on-c

    all c

    linic

    al n

    urse

    and

    sta

    ffer

  • Nur

    sing

    Ori

    enta

    tion

    Che

    cklis

    t

    Red

    Com

    plet

    e du

    ring

    off

    ice

    orie

    ntat

    ion

    and/

    or f

    irst

    day

    of

    hom

    e or

    ient

    atio

    n Y

    ello

    w

    Com

    plet

    e w

    ithi

    n 3

    days

    of

    hom

    e or

    ient

    atio

    n pe

    riod

    G

    reen

    Co

    mpl

    ete

    wit

    hin

    30 d

    ays

    of b

    eing

    ass

    igne

    d a

    case

    IM

    PORT

    AN

    T: T

    he c

    heck

    lists

    are

    not

    inte

    nded

    to

    be a

    sub

    stit

    ute

    for

    any

    doct

    ors

    inst

    ruct

    ion

    for

    any

    pati

    ent

    s sp

    ecif

    ic p

    lan

    of c

    are.

    The

    y ar

    e in

    tend

    ed t

    o do

    cum

    ent

    the

    trai

    ning

    pro

    vide

    d by

    the

    Men

    tor

    RN t

    o th

    e N

    urse

    in t

    he h

    ome.

    Pa

    ge 1

    0 of

    13

    Prim

    ary

    diag

    nosi

    s

    Prim

    ary

    doct

    or

    Phar

    mac

    y

    Hom

    e m

    edic

    al e

    quip

    men

    t co

    mpa

    ny

    Resp

    irat

    ory

    ther

    apis

    t

    Hom

    e in

    fusi

    on c

    ompa

    ny/s

    peci

    alty

    pha

    rmac

    y

    Infu

    sion

    nur

    se

    Tran

    spor

    tati

    on (

    e.g.

    , Li

    fe L

    ink,

    Med

    ivan

    )

    Pois

    on c

    ontr

    ol c

    ente

    r

    Boun

    dari

    es in

    the

    hom

    e/co

    mm

    unic

    atio

    n/co

    nfid

    enti

    alit

    y

    How

    to

    invo

    lve

    the

    fam

    ily in

    the

    Pla

    n of

    Car

    e

    Clie

    nt c

    hart

    How

    to

    com

    mun

    icat

    e in

    an

    age-

    appr

    opri

    ate

    man

    ner

    wit

    h th

    e cl

    ient

    O

    rien

    tati

    on D

    ate

    ____

    /___

    __/_

    ____

    (W

    rite

    init

    ials

    bel

    ow)

    Ori

    enta

    tion

    Dat

    e __

    __/_

    ____

    /___

    __

    (Wri

    te in

    itia

    ls b

    elow

    )

    Des

    crib

    es a

    nd/o

    r de

    mon

    stra

    tes

    ____

    /___

    _/__

    __

    (Wri

    te in

    itia

    ls b

    elow

    ) In

    tegu

    men

    tary

    Men

    tor

    Lear

    ner

    Men

    tor

    Lear

    ner

    Men

    tor

    Lear

    ner

    Inci

    sion

    /sca

    r ca

    res

    Oth

    er o

    stom

    y ca

    res

    Brea

    kdow

    n

    Gra

    nulo

    mas

    S/S

    infe

    ctio

    n/ir

    rita

    tion

    s/al

    lerg

    ies

    Tem

    pera

    ture

    Chan

    ge d

    iape

    r

  • Nur

    sing

    Ori

    enta

    tion

    Che

    cklis

    t

    Red

    Com

    plet

    e du

    ring

    off

    ice

    orie

    ntat

    ion

    and/

    or f

    irst

    day

    of

    hom

    e or

    ient

    atio

    n Y

    ello

    w

    Com

    plet

    e w

    ithi

    n 3

    days

    of

    hom

    e or

    ient

    atio

    n pe

    riod

    G

    reen

    Co

    mpl

    ete

    wit

    hin

    30 d

    ays

    of b

    eing

    ass

    igne

    d a

    case

    IM

    PORT

    AN

    T: T

    he c

    heck

    lists

    are

    not

    inte

    nded

    to

    be a

    sub

    stit

    ute

    for

    any

    doct

    ors

    inst

    ruct

    ion

    for

    any

    pati

    ent

    s sp

    ecif

    ic p

    lan

    of c

    are.

    The

    y ar

    e in

    tend

    ed t

    o do

    cum

    ent

    the

    trai

    ning

    pro

    vide

    d by

    the

    Men

    tor

    RN t

    o th

    e N

    urse

    in t

    he h

    ome.

    Pa

    ge 1

    1 of

    13

    Nor

    mal

    ski

    n ap

    pear

    ance

    Soap

    s/oi

    ntm

    ents

    /lot

    ions

    Peri

    car

    e

    Dre

    ss

    Envi

    ronm

    enta

    l tem

    pera

    ture

    par

    amet

    ers

    (in

    and

    outs

    ide)

    Bath

    e

    O

    rien

    tati

    on D

    ate

    ____

    /___

    __/_

    ____

    (W

    rite

    init

    ials

    bel

    ow)

    Ori

    enta

    tion

    Dat

    e __

    __/_

    ____

    /___

    __

    (Wri

    te in

    itia

    ls b

    elow

    )

    Des

    crib

    es a

    nd/o

    r de

    mon

    stra

    tes

    ____

    /___

    _/__

    __

    (Wri

    te in

    itia

    ls b

    elow

    ) M

    edic

    atio

    ns

    Men

    tor

    Lear

    ner

    Men

    tor

    Lear

    ner

    Men

    tor

    Lear

    ner

    Revi

    ew d

    rug

    info

    rmat

    ion

    (i.e

    ., n

    ames

    , do

    ses,

    tim

    es,

    side

    eff

    ects

    , st

    orag

    e, a

    nd d

    esir

    ed

    effe

    cts)

    . S

    ee M

    edic

    atio

    n Pr

    ofile

    s.

    Rout

    e (P

    O,

    GT,

    top

    ical

    , SQ

    , IM

    , IV

    , PR

    , in

    hale

    rs,

    puff

    s)

    Chec

    k ph

    arm

    acy

    labe

    ls/e

    xpir

    atio

    n da

    tes

    Prep

    are

    and

    adm

    inis

    ter

    all m

    edic

    atio

    ns

    Revi

    ew s

    ched

    uled

    vs

    PRN

    med

    icat

    ions

    O

    rien

    tati

    on D

    ate

    ____

    /___

    __/_

    ____

    (W

    rite

    init

    ials

    bel

    ow)

    Ori

    enta

    tion

    Dat

    e __

    __/_

    ____

    /___

    __

    (Wri

    te in

    itia

    ls b

    elow

    )

    Des

    crib

    es a

    nd/o

    r de

    mon

    stra

    tes

    ____

    /___

    _/__

    __

    (Wri

    te in

    itia

    ls b

    elow

    ) Ve

    ntila

    tor

    / Tr

    ache

    osto

    my

    Care

    Men

    tor

    Lear

    ner

    Men

    tor

    Lear

    ner

    Men

    tor

    Lear

    ner

    Equi

    pmen

    t: K

    now

    s ho

    w t

    o m

    aint

    ain

    the

    equi

    pmen

    t (e

    .g.,

    filt

    er a

    nd t

    ubin

    g ch

    ange

    s,

    reus

    able

    sup

    plie

    s)

    Suct

    ioni

    ng:

    Know

    s th

    e cl

    eani

    ng o

    f co

    llect

    ion

    bott

    le/t

    ubin

    g, f

    ilter

    cha

    nges

    Trac

    heos

    tom

    y ca

    re:

    Know

    s ho

    w t

    o cl

    ean,

    dis

    infe

    ct,

    proc

    ess

    trac

    h tu

    bes

    and

    inne

    r ca

    nnul

    as,

    per

    Plan

    of

    Care

    Oxy

    gen:

    Kno

    ws

    how

    to

    ensu

    re t

    here

    is a

    thr

    ee-d

    ay s

    uppl

    y fo

    r cl

    ient

    s th

    at li

    ve w

    ithi

    n a

    40-

    mile

    rad

    ius

    of t

    he e

    quip

    men

    t su

    pply

    com

    pany

    and

    a o

    ne-w

    eek

    supp

    ly if

    are

    a is

    far

    ther

    tha

    n 40

    mile

    s

  • Nur

    sing

    Ori

    enta

    tion

    Che

    cklis

    t

    Red

    Com

    plet

    e du

    ring

    off

    ice

    orie

    ntat

    ion

    and/

    or f

    irst

    day

    of

    hom

    e or

    ient

    atio

    n Y

    ello

    w

    Com

    plet

    e w

    ithi

    n 3

    days

    of

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    M

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    Initi

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    ___

    ____

    ____

    ____

    ____

    ____

    ____

    ____

    ____

    _ R

    espo

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    mer

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    igna

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    tials

    ___

    ____

    ____

    ____

    ____

    ____

    ____

    ____

    ____

    __

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