Pediatric Checklist Edited

7/29/2019 Pediatric Checklist Edited

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KINGDOM OF SAUDI ARABIAMINISTRY OF HIGHER

EDUCATIONUNIVERSITY OF TABUK

FACULTY OF APPLIED MEDICAL

SCIENCE

Nursing Department

Skills Laboratory Number 1

Part 1Assist with the Assessment of the New born and Preterm Baby and Child

Course: Pediatric nursing Level 6th level Semester Two

Name of the student:

No Skill Stepsvital signs ( Temperature SS)

Required frequency: 5

Required *level of

performance

Performancerating **

Comments

5 4 3 2 1

1 Prepare the equipments & instruments*Thermometer

1. Oral bulb2. Rectal or stubby bulb

3 Electronic ( Interchangeable oral and rectal probes )4. Tympanic probe

5. Gloves

A

2 Explain the procedure to the patient and family y. assemble the

Equipment at the bedside. A

3 Oral determination


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a. Wash handb. Select an instrument ( oral ,stubby or electric )c. If the thermometer has been stored in chemical solution ,

rinse it with water and wipe it dry with a soft tissued. *Shake a glass thermometer until the mercury is belowthe 35.5 c mark .Firmly hold the non-bulb end of the

thermometer and briskly snap the hand at the wrist. If

using an electronic thermometer , remove from charger

and slide cover over probee. *Place the bulb under the right side of the child tongue

.Have the child close mouth around the thermometer (Ifthe child is over the age of 6 years )

f. *Leave the thermometer under the tongue for 3-5minutes. Stay with the child while thermometer is in

placeg. *If an electronic thermometer is used, use the oral probe

with a disposable plastic probe cover. The thermometer

will signal when the peak temperature has been reachedh. Remove the thermometer from the mouth and read the

temperature

i. After use , wipe thermometer with soft tissue , rinse incold water , and store according to policy

A

AD

A

A

A

A

A

A

A

4 Rectal determination

a. Wash handb. Select an instrument ( Rectal /stubby or electric ) and

provide privacy for the child

c. Rinse, wipe and shake the rectal thermometer as in oralA

A


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temperature. If an electronic thermometer is used ,

remove from charger and slide cover over probed. Lubricate the bulb with a water soluble gelInfant

1.place infant prone , spread the buttockswith one hand and insert the thermometer

slowly and gently with other hand

2. *Insert the bulb into the rectum about 1/4 -1/2 .

3. *If resistance is felt , remove thermometerand choose another route

Older child

1. Position child on side , separate buttocks to expose theanal opening

2. *Gently insert the thermometer into the rectum about 1-11/2

3. *Hold thermometer in place for 3-4 minutes or untilelectronic thermometer signal is heard

4. *Never leave child alone with a rectal thermometer inplace

5. Remove the thermometer in a straight line6. Wipe it off with a soft tissue .If an using an electronic

thermometer

7. Insert probe into base and store in charger

A

A

A

A

A

AA

A

A

A

AA


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8. Read the temperature9. Reposition child in a comfortable position and clean

thermometer according to the policy

5 Axillary determination

1. Wash hand2. Select instrumentfollow institution policy

concerning whether to use a rectal or oral thermometer3. *Rinse, wipe and shake the thermometer as suggested

in the procedure for obtaining an oral temperature. If an

electronic thermometer is used , remove from chargerand place cover on probe

4. Place the bulb under the arm, well up into the armpit.Bring the child's arm down close to the body and holdin place

5. *Leave in place 10 minutes or until electronicthermometer signal is heard

A

A

A

A

Final assessment Done Repeat

Level of performance

A. Ability to perform the activity without supervision

B. Ability to perform the activity under supervisionC. Ability to assist with performance of the activity

D. Knowledge of the activity by observation

Rating **5 = Excellent4 = Very Good3 = Good2 = Unsatisfactory1 = Failed


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EDUCATIONUNIVERSITY OF TABUKFACULTY OF APPLIED

MEDICALSCIENCESNursing Department

Course: Pediatric nursing Level .6th

level Semester Two




No Skill Stepsvital signs ( Pulse SS)


Required *level of

performance


Comments

5 4 3 2 1

1 Infant & young child and all cardiac patientsApical rate1.Take the apical rate before any other vital sign measurement is

attempted A

2.*Place the stethoscope between the left nipple and sternum

A3.Count the beats for 1 minute D

2 Older childRadial rate1.* Place the first, second or third finger along the child's radial

artery and press gently against the radius.

A


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2.*Rest the thumb in opposition to the fingers on the back of thechild's wrist

A

3.*Apply only enough pressure so that the child's pulsating artery

can be felt

A

4.Count the arterial pulsations for 30 seconds and multiply by 2

to calculate the rate for one minute .If the pulse rate is

abnormal , palpate the pulse for 1 full minute

D

5.Assess rhythm ( Regularity versus irregularity ) , amplitude (Strength of pulsation ) ,& elasticity of the vessel ( Distension of

vessel ) while counting the rate

D

6.Accurately record the following in the medical recorda. Rateb. Quality of the pulsec. Location feltd. Regularity or irregularity of ratee. Activity of child at time pulse is taken

D

7. Report any changes in pulse characteristics to the physician

immediately

D


:







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level Semester Two




No Skill Stepsvital signs ( Respiration SS)


Required *level of

performance


Comments

5 4 3 2 11 Approach the child in a quiet , nonthreatening manner A

2 In the infant , note the rise and fall of the abdomen with each

inspiration and expiration A

3 In the older child , note the rise and fall of the chest with eachinspiration and expiration

A

4 *Using a watch with a sweep hand , count the respiration for 30 -60

seconds , depending on the age of the child

A

5 Compare to the average rates at rest A6 Record the findings according to policy D




FACULTY OFAPPLIED MEDICAL

SCIENCES

Nursing Department

Rating **

5 = Excellent

4 = Very Good3 = Good

2 = Unsatisfactory1 = Failed


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SCIENCESNursing Department


level Semester Two




No Skill Stepsvital signs ( Blood pressure SS)


Required *level of

performance


Comments

5 4 3 2 1

1 Prepare the equipments & instruments*Stethoscope

* Appropriate size cuff* Sphygmomanometer

* Doppler blood pressure device

* Elastic bandage

A

2 Auscultation : brachial Artery1. Place the infant or child in a sitting or recumbent position. The forearm

is supinated and slightly flexedA

2. Remove all clothing from the upper extremity A3. Demonstrate the equipment and procedure to the child using

appropriate terminology.A


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4. Check equipment for connection and function A5. Place the correct size cuff around the upper arm with the inflatable

portion centered over the blood vessel. The lower edge should be 3 cm

above the antecubital fossa

A

6. Locate the artery by palpation at the antecubital fossa A7. *Close the air valve and rapidly inflate the cuff to 30 mm Hg above the

expected systolic pressure or until the radial pulse disappearsB

8. Place the stethoscope gently over the artery B9. *Slowly release the air valve , permitting the column of mercury to

fall at a rate of 2-3 mm per heartbeatB

10. After readings have been made , the cuff is deflated and removed

from the armB

2 Auscultation : Popliteal Artery11. Place the child in prone position B12. Place the correct size cuff around the thigh , with the lower edge

about 2cm above the popliteal spaceB

*13. The leg is slightly flexed, with the stethoscope over the popliteal

artery. the subsequent procedure is identical to that for the brachial arteryB

3 Palpation14. *The sphygmomanometer cuff is inflated until the radial pulse cannot

be palpated

D

15.* With the palpating digit kept over the artery pressure is releasedslowly until the pulse is felt. The end point is recorded as the systolic

pressure

B

4 Doppler16. Obtain the monitor , dual air hose ,and the correct size cuff

A

17. Place the monitor on a firm , immobile surface A18. plug in the monitor and connect the dual air hose to the back of the B


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monitor

*19. Screw the pressure cuff's tubing into the other end of the air hose B20. Wrap the correct size cuff around the child's limb B

21. Turn the power switch to the ON position B22. Record the reading B

5 Flush ( should be used in newborns or small infants whose pressure isdifficult or impossible to obtain by other technique)

23. Place the child in a recumbent position

A

*24. Apply the cuff snugly to the distal forearm with the outer edge at

wrist. If lower extremity pressure is to be determined , the cuff is applied

to the distal leg with outer edge at the ankle

B

25. Wrap the extremity distal to the cuff with an elastic bandage B

*26. Inflate the cuff to 150 -200 mm Hg and remove the elastic bandage B*27. Lower the cuff pressure by 5mm Hg and leave at that level for 3-4seconds. Repeat the procedure until flushing is observed in the blanched

limb

B

28. Repeat the procedure at least twice to confirm the reading A29. Upon concluding the blood pressure determination record the

followinga. Reading obtained

b. Extremity used

c. Type of method usedd. Size of cuff used

e. Person notified if reading is of concern

D


Level of performanceA. Ability to perform the activity without supervisionB. Ability to perform the activity under supervisionC. Ability to assist with performance of the activity


Rating **5 = Excellent4 = Very Good3 = Good



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level Semester Two




No

Skill StepsWeighting & measuring the newborn

Anthropometric measurements

SS (A)


Required *level of

performance


Comments

5 4 3 2 1

1 Prepare the equipments & instruments

*Scale

* Cover sheets* Paper tape measure

A

2 Weighting1. Place cover sheet on scale A

*2. Wear gloves if newborn has not been bathed B

*3. Adjust the scale balances to 0 , or push the appropriate pads on thedigital scales , using a protective barrier on your hand

A

4. Record weight on baby's chart. Weight baby at the same time B


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3. Measuring

*1. To measure length , place the newborn in supine position on thecrib mattress , with the hand against the top of crib

A

*2. Place the paper tape measure beside the infant , with the 0 end ofthe tape against the top of the crib A

*3. Wear gloves if the newborn has not been bathed B

*4.Hold the newborn's head straight with one hand , and extended one

leg , with the other hand

B

*5. Watch that the tape measures remains straight B

6. Note the length and record it in the infant's chart D

7. Compare your finding with the normal range , most infants are 48

to 53 cm in length D8. Place the paper tape under the newborn's head to measure head

Circumferences. Compare your finding with the normal range, mostinfants are 32-37 cm.

A

9. Wrap the tape around the newborn's head , measuring just above

the eyebrows so that the largest area of the occiput is included

A

10. Record your finding in the infant's chart D

To measure chest circumference

1.Place the paper tape under the newborn's chest ,at nipple level

D

2. Wrap the tape around the chest , at the nipple line A

3. Note the circumference and record it in the infant's chart. Chest

circumference is measured at the nipple line , average chest

circumference is 30.5 to 33 cm

A

To measure abdominal circumference1.Place the paper tape under the newborn's abdomen, at umbilical level.

A


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*2. Wrap the tape around the newborn's, at umbilical level. A

3. Note abdominal circumference and record it in the infant's chart A


:Level of performanceA. Ability to perform the activity without supervision



Rating **5 = Excellent

4 = Very Good3 = Good2 = Unsatisfactory1 = Failed


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level Semester Two




o Skill Steps

Bathing an infant or small child SS (A)


Required *

level of

performance

Performance

rating **

Comments

5 4 3 2 1


*Basin with warm water ( 40.6 c )* Mild soap

*Cotton balls

* Soft washcloth

*Diaper

* Dry clean clothing* Blanket

* No sterile gloves* Alcohol pad (If care for umbilical cord care is indicated)

A


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* Comb

* Baby lotion* Towel

2 Explain the procedure to the patient and family y. assemble theEquipment at the bedside. A

3 Wash hands A

4 Assess the child D

5 Take & record temperature , pulse and respiration A

6 Wash the child from head to feet. Dry washed areas with a towel , giving addedemphasis to skin folds

A

7 Moisten a cotton ball with water and wipe eyes from inner canthus to outer

canthus. repeat with a clean cotton ball on the other eye

A

8 Wet washcloth & wring. Gently wash one side of the face from forehead to

chin, going around the nose and mouth. Repeat on other side of the face .Do notuse soap on the face

A

9 Dry infant's face with towel A

10 To cleanse the baby's scalp, pick up baby securely by sliding hand under the

baby until the head is well supported in the palm of the hand. Cover ears withthumb and middle finger. Hold baby's head over the basin. Soap and rinse head

and dry with towel

A

11 Continue washing ears and neck, giving particular attention to the skin folds of

the neck, behind the ears, and the external part of the ears. Wipe washed areasrepeatedly to rinse off soap

A

12 Remove infant's shirt. Wash trunk and arms. Wash between fingers. Turninfant one on side to wash back A

13 Cover infant with a blanket. Rinse and wring washcloth, then wipe away soap.

Repeat to ensure removal of soap

A

14 Dry area with towel. Cover trunk after drying A

15 Remove diaper, exposing lower half of body. Keep upper half of body coveredwith blanket

D

16 Lightly soap washcloth, wipe over abdomen & around umbilical cord .Work D


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down each leg to the foot, using long stroking motions. Wash between toes.

clean around umbilical cord with alcohol swab or sterile applicator

17 Rinse washcloth and wipe soap off body , paying particular attention to skin

creases

A

18 Wash genitalia with cotton balls. Spread apart the female's labia and cleanbetween folds, using a front to back motion. use each cotton ball for one strokeonly

A

19 The male genitalia should be washed with cotton balls from penis to anus. Donot retract the foreskin of the penis

B

20 Next wash the anus and between the gluteal fold and buttocks B

21 Dry lower half of body. Rediaper .Redress and position the infant in the

isolette or bassinet

B

22 Document any abnormalities in the skin surface in the medical record

a. Desquamationpeeling of the skin during the first 2-4 weeks oflife

b. Miliatiny, white papillae occurring on the nose and chin thatare caused by obstruction of the sebaceous glands. these

disappear in 1-2 weeks

c. Jaundiceyellow discoloration of the skin that appear betweenthe thirds and seventh day of life

d. Telangiectatic nevi ( Stork bites )flat ,red localized area ofcapillary dilatation forming a variety of angiomas , most notably

on the upper eyelids , these disappear usually by 2 years of agee. Forceps marksmarks left on part of the body here the blades

exerted pressure

D

23 Document the infant's tolerance of the bath process D

24 Replace equipments A

25 Wash hands A



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4 = Very Good

3 = Good2 = Unsatisfactory1 = Failed


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FACULTY OF APPLIED MEDICALSCIENCES

Nursing Department


level Semester Two


Skills Laboratory Number 2No Skill Steps

Oxygen therapy for children

Required frequency: 5 ( CS )

Required *

level of

performance

Performance rating ** Comments

5 4 3 2 1


A

2 Explain the procedure to the child and allow him or her to feel the equipmentand the oxygen flowing through the tube ,mask

A

3* Maintain a clear airway by suctioning , if necessary

4* Measure oxygen concentration every 1-2hours when a child is receiving

oxygen through incubator hood or tenta. Measure when the oxygen environment is closedb. Measure the concentration close to the child's airwayc. Record oxygen concentrations and simultaneous

measurements of pulse & respiration

B

B

D


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5*

6

7

8

9

Observe the child response to oxygen

Organize nursing care so that interruption of therapy is minimal

Periodically check all equipment during each tour of duty

Clean equipment daily and change it at least once each week

Keep combustible materials & potential sources of fire away from oxygen

therapyPt teaching:

a. Avoid using oil or grease around oxygen connectionsb. Do not use alcohol or oils on a child in an oxygen tentc. Do not permit any electrical devices in or near an oxygen tentd. Avoid the use of wool blankets and those made from some

synthetic fiber because of the hazards resulting from static

electricitye. Prohibit smoking in areas where oxygen is being usedf. Have a fire extinguisher available

A

A

A

A

D


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10

11

Terminate oxygen therapy gradually

a. Slow reduce liter flowb. Open air events in incubators

Continually monitor the child's response during weaning .

a. Observe for restlessnessb. Increase pulse ratec. Observe respiratory distress , cyanosis

B

B

D

Oxygen by mask

1. Choose an appropriate size mask that cover themouth and nose but no the eye

2. Use a mask that is capable of delivering thedesired oxygen concentration

3. Place the mask over the child ,s mouth and noseso that it fits securely .Secure the mask with anelastic head grip

4. Remove the oxygen mask at hourly intervals ,wash the face & dry

5. Do not use masks for comatose infant orchildren

B

B

B

B

D

Face tent1. Face tent are available in the adult size only2. A flow of 8-10 L should be to flush the system

and provide a stable oxygen concentration

B

B


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T-bars and tracheostomy mask1.These devices are used to deliver oxygen to

intubated patients2. The flow rate must be set to meet the minute volume

requirements of the child and to provide a 100% source of gas.

CB

Oxygen tent1. Select the smallest tent & canopy that will achieve the desired

concentration of oxygen and maintain patient comfort

2. Pad the metal frame that support the canopy3. Analyze & record the tent atmosphere every 1-2 hours.

Concentrations of 30% - 50% can be achieved in well maintained tents

4. Maintain a tightfitting canopy. Whenever possible , providenursing care through the sleeves or pockets of the tent

5. Make certain that the crib sides are up6. Select toys that retard absorption , are washable & will not

produce static electricity

B

B

B

B

B

Croupette

1.This is an oxygen tent equipped with highHumidification system.

2Change the child's clothing and bed linen when damp cover the

child with a cotton blanket

3. Check the child frequently4. Remove the child from the mist periodically5. Promote postural drainage and suction the child as

necessary

6. Observe the small infant for signs of over hydration

B

B

C

B

A

B


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Incubator oxygen therapy

1. The incubator is used to provide a controlled environment forthe neonate

2. Adjust the oxygen flow to achieve the desired oxygenconcentration

a. An oxygen limiter prevent the oxygenconcentration inside the incubator from

exceeding 40%

b. Higher concentrations ( up to 85% ) may beobtained by placing the red reminder flag in

the vertical position3. Secure a nebulizer to the inside wall of incubator if mist therapy

is desired4. Keep sleeves of incubator closed to prevent loss of oxygen5.

Periodically analyze the incubator atmosphere

B

D

B

C

CC

C

3 Oxygen hood1. *Warmed , humidified oxygen is supplied through a plastic

container that fits over the child's head2. *Continuously monitor the oxygen concentration ,temperature

& humidity inside the hood

3. Open the hood or remove the baby from its infrequently aspossible

4. Several different designs are available for use. The manufacture's

direction should be carefully followed

B

B

B

D



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SCIENCES

Nursing Department


level Semester Two



No Skill Steps

Obtaining throat culture (CS)


Required *

level of

performance


5 4 3 2 11 Prepare the equipments

* Throat swab

* Tongue depressor

* Media culture

A

2 Explain the procedure to the woman & describing the sensation to expect B

3 Gather equipment D

4 Wash hand ,wears gloves B

5 Have child stick out tongue and say ah

C

6 Depress anterior half of tongue with tongue depressor if necessary

C

7* Swab area with exudates or redness , one time only per swab ( Avoid


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teeth , tongue , cheeks , lips & palate C

8 Be sure parents or nurse comfort child A

9 Label , obtain requisition

A10 Transport to laboratory

A

11 Document procedure , including description of pharyngeal area if you can see

it

D


:





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MEDICALSCIENCES

Nursing Department


level Semester Two



No Skill Steps

Promoting postural drainage in pediatric patient (IS)Required frequency: 1

Required *

leveloperformance

Performance rating

**

Comments

5 4 3 2 1

1 Preparatory phase

*1. Assess the child's respiratory statusa. Obtain a baseline respiratory rateb. Observe for respiratory distress retraction, nasal flaring, and so

forth

D

2. Identify the involved portions of the lung by auscultation , percussion or review

of the x ray report

B

3. Explain the procedure to the child or the parent D

4. Make the child comfortablea. Remove constricting clothesb. Flex the child's knee and hipsc. Have tissue and an emesis basin availabled. Have several pillows available

C

*5.Provide bronchodilator or nebulization therapy prior to the procedure if

indicated

C


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2 Performance phase

*1. Place the child in asides of appropriate position

a. Thereat to be drained should be elevatedb. The spine should be as straight as possible to permit

optimal expansion of the rib cage

C

2. Unless contraindicated , cup the chest wall for 1-2 minutes C

*3. Have the child inhale deeply , then ,as he exhales ,vibrate the chest wall during

three to five exhalation B

4. Encourage the child to cough D

*5. Allow the child to rest for a minute , then repeat cupping vibration and

coughing until no more mucus is produced or the child ,s condition indicates thatthe procedure should be stopped

B


Level of performanceA. Ability to perform the activity without

supervisionB. Ability to perform the activity under supervision

C. Ability to assist with performance of the activity


Rating **

5 = Excellent

4 = Very Good

3 = Good

2 = Unsatisfactory

=


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SCIENCES

Nursing Department


level Semester Two



No Skill Steps

Suctioning the tracheostomy (CS)Required frequency: 2

Required *

level ofperformance

Performance rating

**

Comments

5 4 3 2 1

1 Prepare the equipments

Sterile tracheostomy tube Twill tape Scissors Sterile cottontipped applicators Sterile water Hydrogen peroxide Sterile dressing Sterile suctioning catheters Sterile gloves Sterile saline

A

1 Explain procedureD

2 Gather equipment A


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3 Wash hands , put on sterile gloves A

4 Instill 0.5 to 2ml of normal saline into the trachea before suctioning to loosensecretions per institution policy

C

5 Lubricate the tube with sterile saline and insert the catheter without applying

suction

C

6 Withdraw the catheter in a continuous rotating motion while applying suction ( 5

seconds only ) C

7 Allow the child to rest. some children may need a few breaths via a resuscitationbag D

8 Clear the catheter with sterile saline between insertions, child may need to besuctioned more than once

* Saline should also be discarded to prevent growth of pseudomonas in standing

solution

C

9 Document procedure

a. Time & frequency of suctioningb. The character of the secretionsc. The relief afforded the patientd. The patient's behaviore. The appearance of the stomaf. Other pertinent data

D



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KINGDOM OF SAUDI ARABIA

MINISTRY OF HIGHER



SCIENCENursing Department


level Semester Two



No Skill StepsGastrostomy tube feeding CS ( C )


Required * level

ofperform

ance


5 4 3 2 1


*Tray* Warm feeding fluid

* Pacifier* Reservoir syringe or funnel

* Syringe for aspiration , to flush tube as ordered ( may be up to 15 to 30 Ml)

Note : Equipment should be sterile for premature and new born infants

A

2 Explain procedure A3 Gather equipments A

4 Wash hands A

5 Position child comfortably , with head lightly elevated if not contraindicated

* Provide pacifier to relax a baby* An infant can be held and cuddled during the feeding

* An older child can sit in a highchair

B


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6 Check residual stomach contents by attaching syringe to gastrostomy tube and aspirating.

* Residual is always checked because overloading the stomach can cause reflux &

increase the danger of aspiration* If the residual amount or increases , this needs to be reported to the physician C

7 Attach syringe barrel to gastrostomy tube. Fill with formula.Remove clamp .( This prevents air from entering the stomach and causing

distension )

C

8 Elevate receptacle. Allow formula to flow slowly by gravityForce should never be

used C

9 Continue to add formula to the syringe before it empties completely

* The feeding should take 20 to 25 minutes to complete in order to prevent regurgitation ,vomiting ,or aspiration

C

10 Observe the signs of respiratory distress .Stop feeding if any of these occur and notify the

charge nurse

D

11 Clamp the tube as the final formula or water is passing through the lower part of thesyringe

C

12 Position or hold patient

* Hold the patient quietly*Reposition in Fowler's position or in right side to promote gastric emptying

C

13 Document procedure*Record the type ( gastrostomy feeding )

*The amount given*The amount and characteristics of the residual

* How the patient tolerated he procedure

* Record on intake & output section

D


15 Wash hands A



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SCIENCES

Nursing Department


level Semester Two



No Skill Steps

Breast feeding the ill or hospitalized infant (SS )Required frequency: 2

Required *

level ofperformance

Performance rating

**

Comments

5 4 3 2 1

1 1. Preparatory phaseEncourage the mother to continue breast feeding if the infant condition does not

contraindicate it

D

2 Explain to the mother that

a. Supplemental artificial formula can be given to the infant if she isnot available

b. She can pump her breasts bring in her milk to be given to theinfant via bottle when she is not available

c.

Breast milk can be frozen for up to 6 months ( check the facilityspecific policyd. Thaw frozen breast milk for use in tepid water .Do not microwave

for it may destroy vitamins and nutritional properties

D

3 Provide the mother & infant with a relatively quiet area that is as private aspossible and free from interruption

D


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4 Provide the mother with comfort armchair or pillow so that she can assume a

comfortable position during the feeding

* A footstool should also be available so that she can support her feet and theinfant

A

5 The infant should be awake and dry before the feeding is started D6 Dress the infant appropriately so that he or she is not too warm or too cool during

the feeding. The infant should also be hungryA

7 Help position the at breast

* Put in semisitting position with face close to the breast and supported by

one arm and hand.* A pillow may be used under the baby for support

* The breast may need to be supported by mother other hand

B

8 2. Performance phase

* Start feeding and let the breast touch the infant's cheek.

* Do not hold cheek and try to help infant find the nipple

D

9 The infant's lips should be out over the areola not just around the nipple before

beginning to suck. A

10 Note the presence or absence of the " Let down " reflex during the nursing periodD

11 The length of feeding time may vary from 5 to 30 minutes let the infant nurseuntil satisfied.

D

12 Instruct the mother*to burp the baby during and at the end of the feeding

*One or both breast may be used at each feeding* Once the infant has stopped sucking ,instruct mother to put her finger to the

corner of the baby's mouth and gently pull

D

13 3. Followup phaseWhen the infant has finished feeding

* Change diaper if it is wet or soiled* Position the infant on right side in bed C


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*Note if the baby appear satisfied or still seem to be hungry

14 Record descriptively & accurately

a. How baby feed ( Weight before & after may be helpful )b. How baby went to breastc. Satiety or hunger after feedingd. Breast or breast used ( Which breast was emptied and which breast

was nursed from thereafter

D

5 Provide the new mother with anticipatory guidance for possible problems ( i.e. ,breast engorgement )

* promote maternal confidence in handling and nursing her infant*Increase mother's knowledge about the mechanics of breast feeding. Some

facilities may have a lactation specialist to visit with the mother

A

16 Wash hands A


:

NB:-If this step not performed correctly, the procedure should be cancelled






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SCIENCES

Nursing Department


level Semester Two



No Skill Steps

Artificial or nipple feeding (SS )


Required *

level ofperformance

Performance rating

**

Comments

5 4 3 2 1

1 Equipment*Sterile nipple and bottle

*Sterile formula or feeding fluid

A

1. Preparatory phase

*Baby should be awake & hungry.*Change wet or soiled diaper

*Check formula for correct type and amount* Sit in a comfortable chair. Cradle baby with one hand and arm ,while

supporting baby against your body or lap

D


a. Let the baby root for the nipple by touching the corner of mouth with thenipple. When the infant open the mouth insert the nipple

b. Hold the bottle at an angle to completely fill the nipple with fluid

D

A


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c. Never prop the bottle or leave the baby unattended during feeding

d. The bottle should be handled so as to contaminate the nipple or fluid

e. Baby feeding time will vary from 10 to 25 minutesg. Position baby so eye contact can be established during feeding

h. Burp the baby at least once during the feeding and at the end of feeding* Place the baby in sitting position in nurse lap , tilt slightlyforward & gently rub or pat back or abdomen

*Place the baby in prone position on nurse's shoulder and

gently pat or rub back*Place the baby in prone position on nurse's lap and

gently pat or rub back

A

A

AA

3 3. Followup phaseWhen the infant has finished feeding

* Change diaper if it is wet or soiled

* Position the infant on right side in bed*Note if the baby appear satisfied or still seem to be hungry

* Check baby in a few minutes. If restless, pick baby up and burp .If restless , pick baby

D

4 Accurate & descriptive recordinga. What was feed and amountb. How feeding was toleratec. Any regurgitation or emesisAmount and materiald. Length of time of feedinge. How baby sucked and took the feeding , behavior before ,during

& following feeding

D

16 Wash hands A


:






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FACULTY OFAPPLIED MEDICL

SCIENCES

Nursing Department


level Semester Two



No Skill StepsGavages feeding (CS )


Required *level of

performance

Performancerating ** Comments

5 4 3 2 1


*Sterile rubber or plastic catheter

*Roundtip ,size 5 -14* Clear , calibrated reservoir for feeding fluid

*Syringe

*Stethoscope

*Water for lubrication

* Tapehypoallergenic

* Feeding fluid , room temperature

* Pacifier

A


1. Place the infant on side or back with a diaper roll placed under shoulders .A

mummy restraint may be necessary to help maintain this position

D


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2. Measure feeding catheter and mark with tape , measure distance from tip of nose to

ear to xiphisternum

3. Have suction apparatus readily available

B


*1. with Lubricate catheter sterile water or saline B

*2. Stabilize the patient head with one hand , use the other hand to insert catheter

a*Insertion through nares : Slip the catheter into nostril and direct toward the

occiput in a horizontal plane along floor of nasal cavity

b* Insertion through the mouth : Pass the catheter through the mouth toward the

back of the throat

* Depress anterior portion of tongue with forefinger ,

insert catheter along forefinger & tilt head slightly

forward

C

C

C

3. If the patient swallows , passage of the catheter may be synchronized with the

swallowing

* Do not push against resistance. Gently rotating the tube if

resistance is met

* If there is no swallowing , insert the catheter smoothly and

Quickly

C

C

C

4. Observe the infant for vagal stimulation ( i.e. bradycardia { Slow heart rate } &

apnea

D

5. Once the catheter has been inserted to the premeasured length ,tape the catheter to

the patient face

B

6. Test for correct position of the catheter in the stomach

* Inject 0.5 -5 ml air into the catheter and stomach

* Listen to the typical growling stomach sound with a stethoscope placed over the

epigastric region

* Aspirate injected air from the stomach

C

CB

B


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*Aspirate small amount of stomach content and test acidity by

pH tape

* Observe and gently palpate for tip of catheter ,avoid inserting catheter into the

infant's trachea

B

B

7.The feeding position should be right side lying , with head and chest slightlyelevated* Attach reservoir to catheter and fill with feeding fluid

* Encourage infant to suck on pacifier during feeding .Hold infant when possible

CC

C

8. Aspirate tube before feeding begins

* If over half the previous feeding is obtained , withhold the feeding

* If small residual of formula is obtained , return it to stomach and subtract the

amount from the total amount of formula to be given

CC

C

9. The flow of the feeding should be slow. Do not apply pressure

* Elevate reservoir 15-20 cm above the patient's head

C

10 .Food taken too rapidly will interfere with peristalsis causing abdominal distension

and regurgitation

* Feeding time should last approximately as long as when a corresponding amount is

given by nipple ,5ml / 5-10 min or 15-20 minutes total time

C

C

11. When the feeding is completed , the catheter may be irrigated with clear water

* Before the fluid reaches the end of the catheter , clamp it off withdraw it quickly

or keep in place for next feeding

C

12. Discard feeding tube and any leftover solution C

3 Followup phase

1. Burp the patient2. Place the patient on right side for at least 1 hour3. Observe condition after feeding , bradycardia and apnea may still occur

D


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4. Note any vomiting or abdominal distension5. Note infant's activity

4 Accurate & descriptive recording

1. Time of feeding2. Type of gavages feeding3. Type and amount of feeding fluid given4. amount retained or vomited5. How the patient tolerated feeding6. Activity before , during and following feeding

D

16 Wash hands A


NB:-Ifthis step not performed correctly, the procedure should be cancelled

Level of performanceA. Ability to perform the activity without supervisionB. Ability to perform the activity under supervision

C. Ability to assist with performance of the activity


Rating **5 = Excellent4 = Very Good

3 = Good2 = Unsatisfactory1 = Failed


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SCIENCES

Nursing Department


level Semester Two



No Skill Steps

Nasojejunal & nasoduodenal feeding (CS )Required frequency: 2

Required *

level ofperformance

Performance

rating **

Comments

5 4 3 2 1

1 Prepare the equipments & instruments*Sterile radiopaque silicone or polyvinyl nasojejunal or nasoduodenal tube , 1 meter

appropriate size for child*Tape

* Ph paper

*Reservoir for feeding*possibly an infusion pump

*3- way stopcock

* Syringe0.5 ml normal saline or sterile water* Equipment for nasogastric tube insertion , introducer catheter

A


1. Attach cardiac monitor to infant

D

2. Tube is generally inserted by health care providerC


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*3. Place the infant on right side with hips slightly elevated gentle restraint or soft mittens

may have to be applied C

*4. Tube is inserted by threading the nasojejunal or nasoduodenal vinyl catheter into a No.

10 French feeding catheter and introducing both through the nostril into the stomach.

*5. Check intestinal aspirate for PH every 1-2 hours .Infant may be positioned on right side ,

back, or abdomen* Once the tube is past the pylorus , abdominal posteroanterior & lateral

xrays are taken to confirm that tip of catheter is at the ligament.

*6. A small N.G feeding tube may pass through the other nostril at time & left indwelling.*This is used to check stomach for residual fluid and regurgitation

through the pylorus

C

C

C

7 7. N-D /N-J feeding can generally be started following this progression

1.

D5 W initially2. *-strength formula with low osmolality for 6-12 hours .Higher osmolarityformula for old children.

3. *Full strength low osmolality formula for infants & high osmolarity formulafor old children.

4. *The volume of feeding is increased at a slow rate until daily caloric andfluid requirements are being administered

5. Medications may be given via the N-D/N-J tube if prescribe

D

C

CC

C


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1. N-J feeding can be given as followsa. Intermittentlyb. In a continuous slow drip

2.

*If intermittent feeding is the method used , the feeding techniques are thesame as for ( Gavage feeding )3. *If slow continuous drip method is used , the set up used is similar to the

pediatric IV infusion using an infusion pump and small ( 100-250 mL ) closed

chamber for reservoira. Reservoir chamber and tubing should be changed 8- 24 h.

Record input every hour. Fill reservoir as needed, with no more than 3 hours worth offeeding fluid.

D

C

C

C

3 Followup phase

1. Be constantly alert for mechanical problemsa. Check for abdominal distension resulting from the infant's

inability to handle amount of fluid :

Palpate abdomen Observe for ripple of intestines Measure abdominal girth 3-8 h Check residual formula in jejunum as

prescribed

b. Check stool for occult blood and ph & urine for glucose everyvoiding or 4-8 hours to determine tolerance of feeding tube

c.

Check emesis for blood and report to physician immediately may be a sign of necrotizing enterocolitis

2. Position child /infant in recumbent position3. Observe child /infant closely to avoid potential dangers as tube passes the

pylorus

a. Close attention to amount , type , concentration and osmolityof feeding fluid is stressed

D

A

D

A

CD


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b. Check heart rate & blood pressure

4 Accurately & describe & record condition of infant and procedure including:

1. Type & amount of feeding given2. A mount of residual & characteristics3. Any signs of impending infant distress or problems.

D

16 Wash hands A


NB:-If this step not performed correctly, the procedure should be cancelled

Level of performanceA. Ability to perform the activity without supervision






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SCIENCES

Nursing Department


level Semester Two



Obtaining a stool specimen (SS)


Required *level of

performance


5 4 3 2 1

1 Prepare the equipments & instruments*Clean container

*Tongue blade

A

2 Explain the procedure to the child or parent A

3 Wash hands well & wear gloves to obtain specimen B

4* Obtain stool specimen directly from the diaper ( If it has not been

contaminated by urine ) With the tongue blade ,or use the tongueblade to receive the specimen from the collection device

A

5* The specimen is labeled properly and the laboratory slip is attached B

6* Some specimens must be sent to the laboratory while they are warm B7 Document procedurea. Charts the time ,color ,amount and consistency of the stoolb. The purpose for which it was collected ( e.g. . blood ,ova,

parasites , bacteria ) & any related information

B



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College instructor

NameSign:



MEDICALSCIENCES FNursing Department


level Semester Two



No Skill Steps

Administering an enema ( IS)Required frequency: 2

Required *

level ofperformance

Performance rating

**

Comments

5 4 3 2 1


Disposable irrigation bag with connecting tube and clamp Funnel or aseptic syringe and pitcher for smaller amount No 10 to 12 French catheter Saline solution ( 1 teaspoon of table salt to 1 pint of water ) Lubricant Toilet paper Absorbent pad Bedpan Extra diapers ( depending on age )

A

2 Explain procedure


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D

3 Wash hands, wear gloves B

4 Assemble the equipment and take it to the bedside A

5 * Place the absorbent pad beneath the child. keep bedpan readily available

B6 *Position the child on his or her left side, with knees drawn toward the chest. You

need assistance to hold the child

B

7 *Allow the solution to run through the tubing to warm it and to expel air B

8 *Lubricate and insert the tube 1-4 inches into the rectum , depending on the age of

the child B

9 *Administer the prescribed amount of fluid :

120 to 240 ml of infants

240 to 360 ml for 2to 4 years 360 to 480 ml for 4 to 10 years 480 to 720 ml for 11 yearsold

B

10 Remain with the patient while enema is being expelled. Small children may usethe potty chair or bedpan B

11 Remove the bedpan. clean the buttocksA

12 Remove the rubber sheet and incontinence padA

13 Apply a clean diaper if age appropriate. Check to see if a stool specimen is desiredA

14 Empty and clean the bedpan. Discard disposable enema set- up and tubing

A


Chart time of procedure Name , amount and temperature of solution used D


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Amount and character of result Untoward reaction



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SCIENCES FNursing Department


level Semester Two



Intramuscular injection (CS)Required frequency: 5

Required *

level ofperformance


5 4 3 2 1

1 Prepare the equipments A

2 Explain to the child where you are going to give the injection ( site ) and why you

are giving it

D

3 * Allow the child to express fears D

4 Carry out procedure quickly and gently. Have needle and syringe completely

prepared and ready before contact with child

B

5 Infants

Selection the acceptable site includes rectus femoris ( mid anterior thigh ) , vastuslateralis ( middle third ) or ventrogluteal

Toddlers and school age children

Site selection includesa. Posterogluteal ( Upper outer quadrant )b. Ventroglutealc. Deltoidd. Lateral and anterior aspect of the thigh

C

B


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6 Administration

a. Rectus femoris1. Place the child in a secure position to prevent movement of

the extremity

2. *Do not use a needle more than 2.5 cm3. Use upper quadrant of the thigh4. *Insert needle at a 45 angle in a downward direction ,

toward the knee

B

DBB

b. Vastus lateralis1. Place the child in a prone or supine position2. Area is a narrow strip of muscle extending along a line

from the greater trochanter to lateral femoral condylebelow

3. Insert needle perpendicular to skin 2-4 cm deepneedleparallel to floor

A

B

B

c. Ventrogluteal1. Place the child on back2. Place the index finger on the anterosuperior spine3. *With the middle finger moving dorsally, locate the iliac

crest, drop finger below the crest. The triangle formed bythe iliac crest , index finger & middle finger is the injection

site

4. *Inject needle perpendicular to the surface on which thechild is lying

A

BB

B


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d. Posterogluteal1. Do not use a needle longer than 2.5 cm2. Position the child in a prone position*3.Place thumb on the trochanter

* 4. Place middle finger on the iliac crest5. Let index finger drop at a point midway between the

thumb and middle finger to the upper outer quadrant of

the buttock

* 6. Insert needle perpendicular to the surface on whichthe child is lying ,not to the skin

D

BA

BB

B

E. Deltoid1. Determine injection site as with an adult2. *Inject needle perpendicular to the skin 2-3 cm deep DB

F. Lateral & anterior aspect of the thigh1. Do not use a needle longer than 2.5 cm2. *Use the upper outer quadrant of the thigh3. *Insert needle at a 45 angle in a downward direction ,

toward the knee

DB

B



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level Semester Two



No Skill StepsIntravenous fluid therapy (CS)


Required *level of

performance

Performance rating**

Comments

5 4 3 2 1


a. Needle method* IV solution ( For small children , 250 ml bottles should be used for

purpose of safety* IV pole , pump device

* IV administration set , pump tubing

* Microspore filter*Syringe , 5 to 10 mlapproximately 1/2 -1/3 filled with normal saline

* Butterfly needle or catheter of appropriate gauge( The size of the needle depends on the age and size of the child and the

type of fluid to be administered

*Alcohol sponge , dry sponges*Betadine or other antibacterial cleansing solution

* Normal saline*Small tourniquet or rubber band

* Hypoallergenic tape , 1/2 cm , 2.5 cm , 5 cm

* Padded arm board

A


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* Gauze bandage for securing the extremity to the arm board

* Restraining devicesbath blanket , extremity restraint ,

cover sandbags ( The type of restraint depend on the child'sage , his level of cooperation & the kind of IV to be started

* Safety razor ( If scalp vein is to be used )b. Cut down method

* IV solution , IV pole , IV administration set

* Alcohol sponges

* Hypoallergenic tape , 1.2 cm , 2.5 cm*Padded arm board

* Dry sponge* Gauze bandage

* Sterile cut down tray* Assorted sizes of sterile polyethylene tubing & luer adapter

* Normal saline

* Tourniquet* Sterile gloves

* Restraining devices

2 Preparatory phase1. Obtain the IV solution A

2. Check the IV fluid for cracks D

*3. Attach a micropore filter to the end of the infusion tubing that attaches to the

needle. Use aseptic technique

B

*4. Remove the metal seal from IV container without touching the rubber top B

*5. Following product insert , insert the end of the administration set into the

container's opening, Fill the tubing with solution

B


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7.Promote the cooperation of the child

* Infant : provide with a Pacifier

* Old child: explain the procedure and its purpose child for comfort.

B

8.Position the child for comfort B

9. Restrain the child as necessary

* Infant or young child: restraints may include mummy

wrappings , jacket or elbow restraints or small sand bag* Old child : The extremity to be used should be comfortably

restrained on the arm board

C

3 Performance phase

*1.The persons starting the IV & holding the infant should wear gloves B

2. Assist as necessary A

*3. When applying the tourniquet , a second rubber band is placed crosswise

under it

* To remove the tourniquet grasp` the unstretched rubber band , pull up & cutthe tourniquet

B

4. Check the restraints at intervals and adjust them as necessary B

5. Comfort and reassure the child B

*6.Regulate the IV rate pump B

7. Recording on the container or reservoir rate flowa. Time that infusion beganb. Name of the physician or nurse who started the IV

site of administrationc. Reaction of the child to the procedured. Return the child to room

D


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4. Follow up phase

1. Check the child at least hourlya. Note the location of IVb. Note the color of the skin at the needle pointc. Check for swelling of skin at the needle pointd. Feel the area around the site fluid or sponginess or

leak age

e. Check for blood return into the tube when the flowof fluid is stopped

f. Make certain that the child is adequately restrainedg. Check function of the pumprate set versus

amount infused

B

2. Observe closely for complicationa. Local reaction

* Compromised circulation

*Pressure sores

* Thromophlebitisb. Fluid & electrolyte disturbance

1* Maintain an accurate record of intake and out puta. Total the intake and put

b.Describe care fully the amount &

consistency of all stool & vomitusc.Collect all urine and weight diapers if more accurate

measurement of the child's is necessary

2. Weight the child at regular intervals , using the same

scales each time

B

B

B


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3. Monitor laboratory electrolytes4. Report

* Decrease skin turgor* Marked increase or decrease in urination

* Fever* sunken or bulging fontanelles in an infant* Sudden change in weight or vital signs

* Diarrhea

* Weakness , apathy or lethargy

D

3. Record essential information

* Reading on the container

* Amount of fluid absorbed in the hours

* Total amount of fluid absorbed

* Rate of flow* Apparent condition of the child

D

4. Irrigate the IV as necessary* Gather equipment

*Clamp off the IV solution* Disconnect the IV tubing at the needle insertion site

keep it sterile* Remove the needle from the syringe

* Connect the syringe to the tubing at the needleinsertion site or stopcock

* Slowly inject the normal saline solution* Disconnect the syringe and reconnect the IV tubing to the

needle insertion site

* Unclamp the IV and regulate the flow of the solution

* Check Frequently to make certain that the IV is functioning properly

5. Change the IV container and tubing 24 h or as per hospital policy


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7. If a catheter is used , check the dressing 4 h and change according to

policy

8. Disconnect the IV when prescribed or if it has obviously infiltrated

a. Gather equipment

* Scissors* 4X4 gauze square* Bandaid

b. Explain the procedure to the child , depending on age

c. Clamp off the flow of the IV fluidd. Determine the location of the needle

e. Loosen the tape around the needle , holding the needle firmly inposition ` so that it does not slip out

f. Hold the 4x4 lightly over the insertion site and removed the needle

quickly and carefully

g. Apply pressure to the site immediately and hold until bleeding stopsh. apply Bandaid

i. Remove the tape and arm board from the extremityj. Comfort the child as required

k. Note the fluid level on the container or reservoir and completerecording

l. Record that the IV was discontinued

D



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level Semester Two


Skills Laboratory Number 15o Skill Steps

Obtaining a specimen for urine analysis ( 1S )


Required *level of

performance


Comments

5 4 3 2 1

1 Prepare the equipments* Sterile container

* Urine collection bag

* Label specimen clearly

* Deliver specimen immediately to the lab ( Bacteria may grow at roomtemperature)

A

2 Explain the procedure

* a. Apply newborn and pediatric urine collection

* The skin must be clean and perfectly dry* Avoid oils , baby powder & lotion soap

* Application must begin on the tiny area of skinbetween the anus and genitals

* The narrow bridge on the adhesive patch keep feces

from contaminating the specimen and help positionthe collector correctly

* b. Put the child on his back , spread the legs and wash each skin fold ingenital area

A

B


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c. Do not use a scrub soap solution

d. Wash the anus last ,allow a few moments for air drying

e. Remove protective paper from the bottom half of the adhesive patch*g. For girl , stretch the perineum to separate the skin folds and expose the

vaginah. For boys, begin between the anus and the base of scrotumi. Press adhesive firmly against the skin and avoid wrinkles , remove

paper from the upper portion of adhesive patch

B

A

B

3 Use a sterile container or apply a urine collection device B

4 If a bag is used , Secure the diaper over the bag D

5 Check bag every 20 to 30 minutes D

6Label all specimens clearly and attach the proper laboratory slip ,Collected specimens should be transported in plastic bag ( check

institution policy) B

7 Document procedure D



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KINGDOM OF SAUDI ARABIA

MINISTRY OF HIGHER





level Semester Two



No Skill Steps

Cardiopulmonary resuscitation & air way obstruction (CS)


Required *

level of

performance

Performance rating

**

Comments

5 4 3 2 11 No equipment is needed to provide CPR

D

1 Identify children at risk and place them near the nurse stationD

2 Monitor vital signs, including temperature and level consciousness at least every 4

hours if not more frequently

A

3 If arrest is suspected , gently and call by name D

4 Call out for help D

5 Position child on his back A

6 *Open airway with head tilt / chin life or jawthrust maneuver

a. Head tilt /chin leftStanding next to the child, tilt the child head Back by placing one hand on the

forehead and pushing down. At the same time, lift the chin with the fingers of the

C


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other hand. Do not overextend

b. Jawthrust maneuver

From behind the head , place , place 2-3 finger of each hand under both angles ofthe lower jaw and left upward

7 While maintaining the open airway , look , listen and feel for breathing C

8 Place cheek and ear close to child, s mouth and nose. Listen and feel for air flow

C

9 Look at chest and abdomen. observe for movement D

10. *If there is no breathing, provide two initial breaths.a. For the infant ( 1year old or younger ) cover both the nose and mouth with

rescuer's mouthb. For the child between 1-8 years of age , the rescuer covers the child's

mouth , creating a mouth to mouth seal , while pinching the child's nostrils

shut

C

11 Evaluate breaths by watching for the chest to rise and fall D

12 *Reposition head and airway if air does not enter freely. Treat for airway

obstruction if continued rescue breaths are thwarted

B

13 Locate & palpate the brachial pulse in the infant B

14 Locate and palpate the carotid pulse of the child B

15 If there is a pulse, proceed with rescue breaths only provide one breath every

3 seconds for the infant. Provide one breath very 4 seconds for the child

D

16 *If there is no pulse , locate finger and hand position for chest compressions

a. For the infant , place two fingers breath below the nipple lineb. For the child , place the heel of one hand one finger's breadth above the

xyphoid notch

B

BB


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17 *Compress the child is to a depth of 1/2 -1 inch at a rate of 100 compressions

per minute. Provide a rescue breath after every fifth compression

C

18 *Compress the child's chest to a depth of 11 1/2 inches at a rate of 80 -100compressions per minute. Provide a rescue breath after every fifth

compression

C

19 Reassess for spontaneous respirations and pulse after one minute ( 10 cycle of

five compressions to one breath )

D

20 If no help is immediately available , stop CPR & telephone for help

D

21 Reestablish CPR once help has been called. Continue until trained in

advanced life support respond

D

22 *If airway obstruction is suspected in the infant, hold the infant on his or her

abdomen with legs straddling the rescuer's arm. With the infant's head helddownward , apply four back blows between the shoulder blades

C

23 *Turn the infant to his or her back and with the infant's head downward ,apply four chest thrusts in the same location for CPR compressions C

24 *Open the airway and remove only visible particles

B

25 Reposition airway and provide two strong rescue breaths D

26 Continue alternating back blows , chest thrusts and rescue breaths

C

27 Call for help D

28 Begin CPR if no pulse is palpable. Child ( over 1 year of age ) D

29 If airway obstruction is suspected in the child , place the child on his or herback on the floor D


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30 Place the heel of one hand on the child's abdomen at midline , above the navel

and below the rib cage ( The rescuer may straddle or sit astride the child ) B

31` Provide several upward thrusts ( Toward the rib cage )D

32 Open the child's airway. turn head to the side and sweep out visible objects B

33 Reposition airway and provide two strong rescue breathsB

34 Call for help D

35 Continue by alternating abdominal thrusts with rescue breaths untilobstruction is relieved C

36 Begin CPR if pulse is not palpable

D


:


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level Semester Two

Name of the student:Skills Laboratory Number 17

No Skill Steps

Administering medication


Required *

level of

performance


5 4 3 2 1

1 Dropper.

*Wash hands.*Hold the infant in the cradle position and stabilize the head against your

body. Hold infant's arm with your free arm. Press on the infant's chin to open

mouth. Squirt the medication to the back and side of the mouth in smallamount

AA

2* Syringe.

Hold the infant or toddler in the cradle position, supporting the head and

holding the arms. place the syringe to the back and side of the mouth and givethe medication slowly , allowing the child to swallow

B

3* Nipple.*Hold the infant in the cradle position, squirting the medication from the

syringe into the nipple pour the medication from a cup into the nipple.* Allow the infant to suck the medication from the nipple

* Follow the medication with 2-3 ml of water

BB

B


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4* Medicine cup.

*A cup can be used for the older infant , toddler , preschooler , school

age child & adolescent* For the younger patient , a patient , apparent or child may hold the cup

* Stay with the child until the entire dose is swallowed

* A spoon is an effective alternative to the medicine cup.* Disguise a disagreeable taste in a small amount of food like applesauce

* Syrup is also good for mixing medications that do not dissolve in water

* Dilute alcoholbased elixirs with water before administering

B

BB

B

B

5 Chewable tabletsTablets may be chewed by the child or cursed and given in a fruit syrup or

applesauce.* Check with the pharmacist to see if crushing the tablet will affect drug

absorption or action* Do not give a child a tablet if he or she resists , as the child could easily

aspirate

C

6 Capsules

Older children may enjoy swallowing a capsule

* Place the capsule on the back of the tongue and have them swallow a lot offluid.

* Stay with child until all the medicine is swallowed* Some capsules may also be opened & the contents sprinkled on a spoonful

of food.

* Check with the pharmacist to see which capsules can be opened

C

7 Nose drops

*Hold the infant in the cradle position, stabilizing the head with your arm, and tilting it back slightly

* Squeeze the drops into each nostril as you try to comfort & hold theinfant in this position for at least 1 minute

* Place a toddler's head over a pillow

* Squeeze the drops into each nostril* The school age child and adolescent may give themselves their own

C


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medication since they can sniff the medication into the nasal passage

8 Ear drops* Position infants & toddlers on their sides.

*The pinna of the ear is to be pulled down and back.* Instill warm drops into the external canal and gently massage the area

anterior to the ear* For children over 3 years , pull the pinna upwards and back* After instillation, the child should maintain the position for 5-10

minutes.

* A cotton pledged placed into the ear canal can prevent the medicationfrom leaking out , however , it must be loose enough to allow discharge to

drain from the ear canal

A

AA

AA

A

9 Eye drops or ointment

* Place the child in a supine position*Restraining him or her as necessary to safely instill the medication

* Pull the lower eyelid down and out to form cup.* Drop the solution into cup

* The medicine will enter the conjunctiva

* Close the eye gently and attempt to keep it closed for a few moments* Ointments are applied along the inner canthus in outward direction

* Avoid touching the tip of the dropper or ointment tube to the body part

AA

A

A

AA

A

10 Rectal medications

* Place the child in asidelying or prone position.* Lubricate the suppository with a water soluble gel

* Using a finger cot , gently insert the suppository into the rectum* Do not insert your finger more than 1/2 inch.* The buttocks should be held tightly together for 5-10 minutes

AA

AAA


Prepared by :

Lecturer /Basem masadehMSN, Ph.D in Nursing education ,


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SCIENCES

Nursing Department


level Semester Two



Restraint (CS)Required frequency: 2

Required *level of

performance


Comments

5 4 3 2 1

1 Equipement

Jacket ( For jacket restraint ) Large dressing , gauze bandage , adhesive tape and stoknette if

available ( For mitt restraint )

Acommercially prepared mitt (For mitt restraint ) Safety pins ( For elbow restraint ) Elbow restraint

A

2 Jacket Restraint1. Check physician's order and agency polcy regarding use of restraints. D2. Gather equipment. A

3. Wash hands A

4. Explain purpose of restraints to child and parents. Reassure child that restraint is

not a punishment

A


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*5. Place the jacket on the patient gown and tie it from back B

*6. Ensure that patient's gown and jacket are not wrinkled A

*7.Secure each tie to unmovable portion of the bed , using half bowknt which iseasily removed

A

8.Secure shoulder straps to head of the bed A

9.Secure abdomen straps on either sides A

3. Mitt or hand restraint*1.Place a large folded dressing in patient's palm

a.Separate the fingers with a pieces of largedressingb.Put a padded dressing around the wrist

c.Place two large dressings over the hand , one isfirst placed from the back of the hand over the

fingers to the palm and the other is then wrapped

from side to side around the handd.Cover these dressing by placing stocknette

dressings over the hand or elastic bandage , usingthe recurrent pattern

e.Secure the strokinette or elastic bandage withadhesive tape

B

*2. Apply commercially made restraints

a. If mitts are worn for several days remove them at least every twelve hours ,wash , exercise the hand and reapply again B

4 Elbow restraint

*1. Check the restraints to make sure that the tongue depressors are intact and in

place

B

*2. Apply elbow restraint over gown sleeves B


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3. Make sure the end of the tongue depressors are covered by padded material A

4. Place elbow in the center of restraint A

5. Warp the restraint smoothly around the arm A

*6. Secure the restraint , using safety pins , ties or strings A

*7. Ensure that it is not too tight so not to occlude blood B

5 Clove hitch restraint1. prepare the equipement

Bandage 5-8 cm wide and 90120 cm long Cotton Commercially made restraint

A

*2. Apply 2-3 layers of cotton around ankle or wrist B

3. Make 2 loop forming finger of 8

B

4. Pick up the two loops

B

*5. Make sure that the loops are small to fit patient hands B

6. Using halfbow knot attach the end of restraint to the end of the bedspring

B

7. Check every two hours and readjust accordingly D

6 Mummy restraint1. Prepare the equipement

Blanket or sheet Safety pins or adhesive tape A


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*2. Lay the blanket or sheet on flat dry surface B

*3. Fold down one corner of the blanket and place the baby on it the supineposition , make sure that the infant shoulder touches the upper border of the

blanket

B

*4. Fold the right side of the blanket over the infant,s body and tuck it under

his back leaving the left arm free

B

7. Crip net restraint

1. prepare the equipement* Astretch net with long strap

A

2. Place the net over sides and ends of the crip B

3. Secure the tie to bed frame

A

4. Tie the strap in halfbow knot

B







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SCIENCES

Nursing Department


level Semester Two



Sponge bath to reduce fever IS (A)


Required *level of

performance


Comments

5 4 3 2 1

1 Prepare the equipments & instruments*Basin of tepid water ( 29 to 32c )* Three washcloths towel

*Two bath blankets

* Waterproof sheet

A

2 Explain the procedure to the patient and family y. assemble the

equipment at the bedside. A

3 Wash hands A

4 Screen the child A5 Take & record temperature , pulse and respiration D

6 Cover the patient with a bath blanket or sheet .Fanfold bed clothes to the foot of

the bed .Place a water proof sheet and bath blanket beneath the patient

D

7 Remove the patient's gown A

8 Wash the patient's face and neck with tepid water A


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9 Lift the corner of the bath blanket and bathe the child's body, part by part. Use

long strokes. Expose one area of the body at a

time

A

10 Place moist , folded cloths over blood vessels that lie close to the skin (Underarms and groin )

A

11 Turn the patient and repeat the procedure , beginning with neck , then going tothe shoulders , the back, and so forth

A

12 Check color & pulse.*to be sure that the child is tolerating the procedure without adverse effects

* If the child begins to shiver, the water temperature should be raised. If

shivering continues , stop the bath

B

13 Remove the waterproof sheet and blanket. Replace the hospital gown. ANinfant may be placed on a large towel , covered by receiving blanket

A

14 Arrange pillow and bedding for the patient's comfort A

15 Record temperature, pulse and respiration

*Take the patient's temperature within 30 minutes of the time procedures endedand record.

D


Chart : Time procedure began , length of the time administered , untoward

reaction , patient's temperature before and after procedure

D


18 Wash hands A



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http://nursingcrib.com/nursing-notes-reviewer/fundamentals-of-nursing/respiratory-patterns/

http://quizlet.com/496647/maternal-newborn-nursing-newborn-measurements-and-vital-signs-flash-cards/

http://www.mayoclinic.com/health/healthy-baby/PR00041 videoshttp://en.wikipedia.org/wiki/Otitis_media

http://kidshealth.org/parent/general/sick/labtest11.html

http://www.emedicinehealth.com/script/main/art.asp?articlekey=138419&ref=137489

http://www.tracheostomy.com/care/suction.htm

http://kidshealth.org/parent/system/surgery/g_tube.html
http://nursingcrib.com/nursing-notes-reviewer/fundamentals-of-nursing/respiratory-patterns/http://nursingcrib.com/nursing-notes-reviewer/fundamentals-of-nursing/respiratory-patterns/http://quizlet.com/496647/maternal-newborn-nursing-newborn-measurements-and-vital-signs-flash-cards/http://quizlet.com/496647/maternal-newborn-nursing-newborn-measurements-and-vital-signs-flash-cards/http://www.mayoclinic.com/health/healthy-baby/PR00041http://www.mayoclinic.com/health/healthy-baby/PR00041http://en.wikipedia.org/wiki/Otitis_mediahttp://en.wikipedia.org/wiki/Otitis_mediahttp://kidshealth.org/parent/general/sick/labtest11.htmlhttp://kidshealth.org/parent/general/sick/labtest11.htmlhttp://www.emedicinehealth.com/script/main/art.asp?articlekey=138419&ref=137489http://www.emedicinehealth.com/script/main/art.asp?articlekey=138419&ref=137489http://www.tracheostomy.com/care/suction.htmhttp://www.tracheostomy.com/care/suction.htmhttp://www.tracheostomy.com/care/suction.htmhttp://www.emedicinehealth.com/script/main/art.asp?articlekey=138419&ref=137489http://kidshealth.org/parent/general/sick/labtest11.htmlhttp://en.wikipedia.org/wiki/Otitis_mediahttp://www.mayoclinic.com/health/healthy-baby/PR00041http://quizlet.com/496647/maternal-newborn-nursing-newborn-measurements-and-vital-signs-flash-cards/http://nursingcrib.com/nursing-notes-reviewer/fundamentals-of-nursing/respiratory-patterns/

Pediatric Checklist Edited

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