Nursing Performance Skills

Kingdom of Saudi Arabia
Ministry of Higher Education

University of Hail
Clinical Training Administration
Performance Skill # 1
APPLY PROPER BODY MECHANICS
Directions: Place a "p" for PASSED in the column to the right of each step when it is performed according to the
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Get a firm footing by keeping feet 10 to 12 inch (25 to 30 cm) apart.

Put one foot slightly ahead of the other
Lower self by flexing knees and place more weight on the front foot than on the back foot. Keep the upper body straight by not bending
at the waist.
Hold the object close to body at the waist height (near the body's center of gravity)
Stand up by straightening the knees, using the leg, and hip muscles. Always keep back to maintain a fixed center of gravity.
Tighten abdominal muscles to lift.
Stand close to the object and place one foot slightly ahead of the other, as in a walking position. Tighten the leg muscles and set the pelvis
by simultaneously contracting the abdominal and gluteal muscles.
To push, place hands on the object and flex elbows. Lean into the object and by shifting weight from the back leg, and apply smooth,
continuous pressure.
To pull, grasp the object and flex elbows. Lean away from the object by shifting weight from the front leg to the back leg. Pull smoothly,
avoiding sudden, jerky movements.
After starting to move the object, keep it in motion.
Turn by moving feet, not trunk, while lifting.
If the object is heavy, get help or use a mechanical lift.
Perform Hand Washing
STANDARD: HANDS ARE WASHED WITHOUT CONTAMINATION
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Stood so that clothes did not touch sink.

Turned on water and adjusted temperature to warm; left water running.
Wet wrists and hands; kept hands lower than level of elbow throughout
procedure.
Applied soap or cleaning agent to hands using available products
Washed hands and wrists using friction for 15-20 seconds.
Rinsed hands and wrists well under running water with fingertips pointed down.
Dried hands thoroughly with paper towel(s) from fingertips to wrists.
Disposed of paper towel(s).
Used dry paper towel between hand and faucet to turn off water.
Disposed of used paper towels.

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Apply and Remove Personal Protective Equipment
STANDARD: APPLIED AND REMOVED PERSONAL PROTECTIVE EQUIPMENT WITHOUT
CONTAMINATION.
May be tested in the classroom or in the clinical setting.
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Performed beginning tasks

Identified type of isolation required
Applied appropriate personal protecti ve equipment outside the isolation
room.
Mask: Placed mask over nose and mouth, secured appropriately
Gown: Applied gown and secured it at neck and waist.
Gloves: Applied gloves appropriately.
Removed Personal Protective Equipment inside the isolation room.
Gloves: Removed gloves appropriately.
Washed hands.
Gown: Removed gown appropriately. Washed hands.
Mask: Removed mask appropriately. Washed hands.
Discarded Personal Protective Equipment appropriately.
Performed completion tasks
DONNING AND REMOVING STERILE GLOVES
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Wash hands.
Open the package of sterile gloves.
a. Place the package of sterile gloves on dry surface area.
b. Open the outer package.
c. Remove the inner package.
Put the first glove on the dominant hand.
a. Grasp the folded cuff of sterile glove with thumb and forefinger of the non dominant hand.
b. Insert the dominant hand into the glove.
Pull glove on.
c. Leave the cuff turned down
Put the second glove on the non dominant hand.
a. Slide fingers of gloved hand under the cuff, and lift glove upward.
Adjust each glove on both hands.
Remove and dispose of used gloves.
a. Grasp other glove near the cuff end and remove it by inverting it.
b. Slide fingers of ungloved hand inside the remaining glove. Remove by turning inside out.
c. Discard gloves properly.
d. Wash hands.

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Performance Skill # 5, 6, & 7
Measure and Record Temperature, Pulse, and Respirations
STANDARD: ORAL TEMPERATURE IS MEASURED TO WITHIN + OR - 0.2 DEGREES OF
EVALUATOR'S READING UNLESS A DIGITAL THERMOMETER IS USED. RADIAL
PULSE IS MEASURED TO WITHIN + OR - TWO BEATS OF EVALUATOR'S RECORDING
OF RATE. RESPIRATION IS MEASURED TO WITHIN + OR - TWO RESPIRATIONS OF
EVALUATOR'S RECORDING OF RATE.
The evaluator must simultaneously count the rate for the length of time specified by the student
and determine the correct rate.
Pulse and Respiration cannot be a combined procedure; they must be measured separately.
Directions: Place a "p" for PASSED in the column to the right of each step when it is performed according to
the standard.
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MEASURE ORAL TEMPERATURE:

Positioned resident, sitting or lying down.
Activated the thermometer.
Covered thermometer as appropriate.
Placed the thermometer probe appropriately.
Instructed the resident to close mouth around the thermometer.
Stayed with the resident during the entire procedure.
Removed the thermometer when appropriate.
Read the thermometer.
Recorded and reported the results within + or - 0.2 degrees of the evaluator's recorded temperature
reading.
MEASURE RADIAL PULSE:
Positioned resident, sitting or lying down.
Located radial pulse at wrist.
Placed fingers over radial artery. Student does this first, then evaluator locates pulse on opposite wrist.
Determined whether to count for 30 seconds or 60 seconds.
Counted pulsations for 30 seconds and multiplied the count by 2; or for one minute if irregular beat.
Student must tell when to start and end count.
Recorded the pulse rate within + or - two beats per minute of pulse rate recorded by evaluator.
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MEASURE RESPIRATIONS:
Positioned hand on wrist as if taking the pulse as appropriate.
Determined whether to count for 30 seconds or 60 seconds.
Counted respirations for 30 seconds and multiplied the count by 2; or for one minute if irregular. Student
must tell when to start and end count.
Recorded the respiratory rate within + or two respirations per minute of respiratory rate recorded by
evaluator.

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Measure and Record Blood Pressure
STANDARD: MEASURE AND RECORD BLOOD PRESSURE TO WITHIN + OR 4MM OF
THE EVALUATOR'S READING USING DUAL STETHOSCOPE.
May be tested in the classroom or the clinical setting
A teaching/training (dual head design) stethoscope must be used simultaneously by the student and the
evaluator. On the exam itself, a safety issue is listed, "cuff deflated in a timely manner." This means
that the cuff should not be left inflated over the resident's arm long enough to cause discomfort,
discoloration or injury. In the event that a student is hearing impaired, that student will be allowed to
use an amplified stethoscope.
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Cleaned earpieces of stethoscope.
Positioned resident sitting or lying
Made sure the room was quiet; turned down loud TV or radio.
Selected the appropriate size cuff and applied it directly over the skin,
above the elbow
Positioned the stethoscope over the brachial artery.
Inflated the cuff per the instructor's direction.
Identified the systolic and diastolic measurements while deflating the cuff.
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Deflated the cuff in a timely manner.

Re-measured, if necessary, to determine the accuracy (waited one minute
if using the same arm or use the other arm, if appropriate).
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Recorded blood pressure measurement to be compared with the blood

pressure recorded by the evaluator.
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Performance Skill #9
Measure and Record Weight

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STANDARD: MEASURE AND RECORD WEIGHT WITHIN + OR Kilogram
May be tested in the classroom or the clinical setting.
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Balanced scale at zero
Weighed individual.
A. Individual who is able to stand to be weighed:
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a. Placed paper towel on scale platform.

b. Assisted individual to stand on scale platform without footwear.
c. Read weight measurement
d. Recorded weight measurement to be compared to the weight
measurement
recordedoff
byof
thescale
evaluator.
e. Assisted individual
with
appropriate assistance as necessary
OR
B. Individual who is weighed by wheelchair or bed scale:
a. Sanitized wheelchair/bed scale according to
facility
policy.
b. Assisted
individual on wheelchair scale or
bedRead
scaleweight
as appropriate.
c.
measurement.
d. Recorded weight measurement to be
compared
the weight
measurement recorded
e.
Assistedtoresident
off wheelchair/bed
scale as by the evaluator.
appropriate.
Returned scale balanced to zero.
Measure and Record Height
STANDARD: HEIGHT IS MEASURED TO WITHIN + OR 1 CENTIMETER IN EITHER A

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STANDING OR A NON-STANDING INDIVIDUAL.
May be tested in the classroom or the clinical setting
Directions: Place a "p" for PASSED in the column to the right of each step when it is performed according to the standard.
Measured height.
A. Individuals who are ABLE TO STAND:
a. Used appropriate measuring device
b. Placed paper towel on platform as appropriate.
c. Instructed individual to stand erect without shoes.
d. Read height measurement.
e. Recorded height measurement and converted appropriately to be compared to
the height measurement recorded by the evaluator.
OR
B. Individuals who are UNABLE TO STAND:
a. Position individual on side or back without shoes.
b. Used appropriate measuring device.
c. Read height measurement.
d. Recorded height measurement and converted appropriately to be compared
with the height measurement recorded by the evaluator.
e. Repositioned individual, as necessary.
Adult Complete Bed Bath
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Prepare environment. Close doors and windows, adjust temperature, and offer bed ban.
Lower side rail on the side close to you. Position client in a comfortable position close to the side near you.
Place bath blanket over top sheet. Remove top sheet from under bath blanket from shoulder to feet. Remove clients gown. Bath
blanket should be folded to expose only the area being cleaned at that time. (Top sheets may also be used for bath blankets.)
Place a bath blanket over the top sheet and remove the sheet from under the blanket.
Fill washbasin two-thirds full. Permit client to test temperature of water with his or her hand or check the temperature of water by
bath thermometer (43- 46 0C). Water should be changed when soap foam develops or water becomes dirty.
Remove the pillow from under the clients head, Place a dry towel under his or her head. Make a bath mitten with the washcloth. To
make a mitten.
Wash the face and neck.
Ask the client about preference for using soap on the face.
Use a separate corner of the washcloth for each eye, wiping and cleaning from inner to outer canthus.
Rinse the washcloth and wash the clients forehead, cheeks, and nose and around his or her mouth, rinse the client well and dry him
Rinse the washcloth and wash the clients outer ear, then the front and back of the neck.
Remove the bath towel from under the clients head and replace the pillow.
Wash arms, forearms, and hands.
Place the bath towel under the clients entire arm.
Wash forearms and arms using long, firm strokes in the direction of distal to proximal.
Wash axilla. Rinse and pat dry. Apply deodorant or powder if desired.
Place towel under a wash basin, immerse clients hand into basin of water. Allow hand to soak about 3 to 5 minutes. Wash hands,
between fingers, fingers, and fingernails. Rinse and pat dry.
Wash forearms and arms in the direction of the wrist to upper arm.
Wash chest and abdomen.
Place the bath towel over the clients chest underneath the bath blanket and fold bath blanket down to umbilicus.
Wash chest using long, firm strokes from top to bottom.
Wash skinfold under the female clients breast by lifting each breast. Rinse and pat dry.
Fold bath blanket down to suprapubic area. Use another towel to cover chest area. Wash abdomen using long, firm strokes. Rinse
and pat dry. Replace bath blanket over chest and abdomen. Cover chest or abdomen area in between washing, rinsing, and drying to
prevent chilling.
Wash legs and feet.
Expose leg farthest from you by folding bath blanket to midline (being careful to keep the perineum covered).
Bend the leg at the knee. Grasp the heel, elevate the leg from the bed and cover bed with bath towel.
Place washbasin on towel. Place clients foot into washbasin.
Allow foot to soak while washing the leg with long, firm strokes in the direction of distal to proximal (ankle to thigh).
Rinse and pat dry. Clean soles, interdigits, and toes. Rinse and pat dry.
Perform same procedure with the other leg and foot.
The client toenails may be trimmed at this time if needed.
Wash the leg and foot in the direction of distal to proximal.
Wash back and buttocks.
Assist client into prone or side-lying position facing away from you.
Wash the back and buttocks using long, firm strokes from shoulder to buttocks. Rinse and pat dry.
Give back rub and apply lotion if the skin is dry, if the skin greasy applies alcohol.
Perform perineal care:
Clean the perineal area if the client unable to complete self care.
Assist client to supine (dorsal recumbent) position.
Place white sheet and bedpan.
Pour warmed water (with antiseptic solution) gently over suprapubic area from a pitcher, using nondominant hand, and then use the
same hand to separate the labia.
Clean perineal area with cotton pad from front to back direction,
Dry perineal area in the same direction.
Apply lotion
Apply clean gown and change the bed linen

Give a Partial Bath

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STANDARD: DESIGNATED BODY AREAS, INCLUDING THE PERNEAL AREA, ARE WASHED,
RINSED AND DRIED.
This care must be provided to a resident.
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Performed beginning tasks.

Prepared resident for partial bath
Filled basin with water at correct temperature to resident preference..
Washed, rinsed and dried face, hands, axilla, perineal area and other areas as appropriate.
Removed linen used for bathing and placed in appropriate container.
Prepared the resident for dressing
Performed completion tasks.
Give a Shower or Tub Bath
STANDARD: BODY IS CLEAN USING A SHOWER OR TUB BATH.
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Prepared resident for shower or tub bath.

Adjusted water temperature to resident preference throughout bath.
Washed, rinsed and dried in appropriate head to toe sequence allowing for resident independence.
Shampooed hair as appropriate.
Prepared resident to leave shower or tub bath area.
Shave a Resident
STANDARD: RESIDENT IS FREE OF FACIAL HAIR WITH NO ABRASIONS OR
LACERATIONS.

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The student is assigned the task of shaving a residents (preferably male) face. The evaluator must
obtain list of residents who need to be shaved and for whom shaving is not contraindicated. Example:
Residents taking anticoagulants should not be assigned.
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Positioned resident.
Shaved resident:
A. Non-Electric Shave
a. Applied shaving cream or soap.
b. Shaved resident, holding skin taut and using
single, short strokes primarily in the direction of the hair growth rinsing razor
frequently.
c. Rinse face with warm cloth.
d. .Applied after shave product as appropriate.
e. Discarded razor into the appropriate container
Electric Shave
a. Checked to be sure that the razor was clean
b. Verified, that the resident was prepared with a clean dry face.
c. Turned on razor, observing precautions for using electrical equipment
d. Shaved resident by holding skin taut and moving the razor over a small area of
the face in the direction of the hair growth until the hair was removed.
e. Cleaned the razor after use.
f. Applied after shave product as appropriate.
Perform Nail Care
STANDARD: FINGERNAILS ARE CLEAN AND SMOOTH
NOTE: CNAs are NOT to trim toenails of residents. IMPORTANT: Do not assign residents with
diabetes to students for nail care. Facility policies may vary in the area in the area of nail care; at all

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times facility policies must be observed.
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Washed, soaked, and dried the residents hands
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Cleaned the nails.

Clipped one nail at a time, so that edges are smooth
according to residents preference.
Filed nails, if needed, smoothing rough areas.
Applied lotion as needed.
Perform Perineal Care
STANDARD: PERINEAL AREA IS CLEAN. This care must be provided to a resident.
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Filled basin with water at correct temperature to residents preference if applicable.
Covered the resident appropriately to avoid exposure and maintain dignity.
Placed a waterproof pad under buttocks.
Positioned resident appropriately.
Wet washcloths and applied cleansing solution.
Washed perineal area:

A. Females: Separated the labia, cleaned front to back using downward strokes. Used a clean
area of the cloth for each downward motion. Repeated using additional cloths, as needed.
B. Males: Retracted foreskin in uncircumcised male. Grasped penis, cleaned tip of penis
using a circular motion, washed down shaft of the penis and washed testicles. Replaced
foreskin of uncircumcised male.
Rinsed the perineal area, if applicable.
Turned the patient on their side facing away. Cleaned anal area by washing from front to back.
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Patted area dry, if applicable.
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Removed waterproof pad and discarded.
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Perform Hair Care
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Assess the condition of the clients hair and scalp.
Raise the bed to working height and cover the clients shoulders with a towel.
Fill a pitcher with warm water (430C- 460C), two pitchers may be needed.

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Lay the patient flat, remove pillow. Position client with head and shoulders near edge of bed. Cotton may be placed in the external ear
canal.
Place a linen protector and plastic head-washing tray (shampoo board) under the clients head.
Offer the client a towel to cover eyes,
Carefully pour water over the client hair until it become wet.
Shampoo hair beginning at the hair line and working toward the back of the head with massaging all over the scalp with your finger tips.
Rinse thoroughly to remove all residues from the scalp. Repeat washing and rinsing, comb through the hair with your fingers until it is
clean.
Squeeze excess water from hair. Wrap a towel around clients head.
Remove the towel from the patients eyes.
Remove linen protector and plastic tray (shampoo board).
Gently remove the towel from patients head and rub hair and scalp with another towel.
Comb the clients hair.
Change the wet linens and clients clothes if they are wet.
Lower the bed and raise the side rails.
PERFORM BACK CARE AND BACK MASSAGE
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Raise the bed to a position that is comfortable for you. Lower the side rail on your side.
Turn the patient to prone or side lying position with his\her back bare from head to buttocks, and drape the patient's genitalia and legs
with bath blanket.
4. Wash the back from shoulder to buttocks, rinse and dry well.
5. Make sure that your hands are warm by holding them under warm water or by rubbing them together.
6. Place 1 to 2 teaspoons of lotion in your hands.
7. Rub patient's back with your palms using a circular movement. Massage the back starting from the buttocks toward the shoulder and
back downward to the buttocks in slow continues strokes for several minutes.
8. Using the tips of the second and third fingers, exert friction in small circular motion using gentle pressure around the patient's bony
prominences such the sacrum, and scapula.
9. Keep both of your hands on the patient's back at all times.
10. Secure patients gown and return the patient to comfortable position.
11. Lower the bed and raise the side rails.
12. Performed completion tasks.
Performance Skills # 19
Perform Oral Hygiene
STANDARD: MOUTH, TEETH AND/OR DENTURES WILL BE FREE OF DEBRIS.
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Positioned resident.
Cleaned oral cavity using appropriate oral hygiene products.

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Rinsed oral cavity.

Repeated steps 3 and 4 until oral cavity was clean.
Cleaned and rinsed teeth, dentures if applicable.
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Assisted resident to clean and dry mouth

Dress a Resident
STANDARD: RESIDENT IS DRESSED IN OWN CLOTHING, INCLUDING FOOTWEAR,
WHICH IS NEAT, CLEAN. RESIDENT IS COMFORTABLE DURING DRESSING
PROCEDURE AND CHOOSES OWN CLOTHING WHEN ABLE.
Clothing should consist of undergarments, dress, or shirt or blouse and pants, socks, and
footwear.
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Asked resident preference and gathered residents own clean clothing.
Dressed the resident in undergarments, top, pants (or dress) and footwear,
as appropriate.
Make an Occupied Bed
STANDARD: OCCUPIED BED MUST BE NEAT, WRINKLE FREE WITH PERSON AND BED
PLACED IN THE APPROPRIATE POSITIONS.
May be tested in the classroom or clinical setting.
The person must be in bed with the side rails up (if applicable) while the bed is being made. If side
rails are not available, an alternative safety measure shall be used. When side rails are used as a safety
measure during this procedure, care must be taken to prevent personal injury. Dirty linen is defined as
linen that contains no visible body fluids. Gloves may be worn when handling dirty linen. Soiled linen
is defined as linen that may be contaminated with body fluids. Gloves shall be worn when handling

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soiled linen. At the completion of this task the bed must be left in the appropriate position with side
rails up or down as indicated by the needs of the individual (if side rails are available).
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Removed top linen, keeping person covered.
Positioned individual on one side of bed with side rail up (if applicable) using appropriate
safety measures on unprotected side, and using appropriate body mechanics.
Tucked dirty linen under individual. Used gloves if linen is contaminated with blood body
fluids.
Replaced bottom linen on first side. Tucked corners and sides neatly under mattress
Repositioned individual to other side using appropriate safety measures on unprotected side.
Removed dirty linen by rolling together, held away from clothing, and placed dirty linen in
appropriate container. Disposed of gloves, if used, and washed hands.
Completed tucking clean linen under mattress with corners and sides tucked neatly under
mattress on the second side.
Repositioned the individual to a comfortable position.
Placed top sheet over individual. Removed dirty covering. Tucked bottom corners and
bottom edge of sheet under mattress, as indicated.
Placed blanket/spread over person. Tucked bottom corners and bottom edge or blanket/spread
under mattress, as indicated. Pulled top edge of sheet over top edge of blanket/spread.
Removed and replaced pillowcase appropriately.
Replaced pillow under individual's head.
Placed bed in appropriate position.
Make Unoccupied Bed
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Adjust the bed to high position and drop bedside rails.
Disconnect call bell or any tubes from bed linens.
Put on gloves if linens are soiled. Loosen all linens as you move around the bed, from the head of the bed on the far side to the
head of the bed on the near side.
Fold reusable linens, such as sheets, blankets, or spread, in place on the bed in fourths and hang them over a clean chair.
Remove waterproof sheet and discard in appropriate container.
Snugly roll all the soiled linen inside the bottom sheet and place directly into the hamper, not on the floor or furniture. Do not
hold soiled linens against your uniform.
Adjust the mattress up to head of bed. If the mattress is soiled, clean and dry according to hospital policy before applying new
sheets.

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Remove your gloves and wash hands. Place bottom sheet with its centerfold in the center of bed. Open the sheet and fan-fold
to the center.
If using, place the draw sheet with its center fold in the center of the bed and
Positioned so it will be located under the patients midsection. Open the draw
Sheet and fan-fold to the center of the bed. If a protective pad is used, place it over the draw sheet in the proper area and open
to the centerfold.
For fitted bottom sheet
Pull the bottom sheet over the corners at the head and foot of the mattress. Tuck with the draw sheet securely under the
mattress.
For a flat bottom sheet
Tuck the head part and miter the corners.
a) Grasp the side edge of the sheet about 18 inches down from the mattress top.
b) Lay the sheet on top of the mattress to form a triangular, flat fold.
c) Tuck the portion of the sheet that is hanging loose below the mattress under the mattress without pulling on the triangular
fold.
d) Pick up the top of the triangle fold and place it over the side of the mattress.
e) Tuck this loose portion of the sheet under the mattress. Continue tucking the remaining bottom sheet and draw sheet
securely under the mattress.
Move to the other side of the bed to secure bottom linens. Pull the bottom sheet tightly and secure over the corners at the head
of the mattress. Pull the draw sheet tightly and tuck it securely under the mattress.
Place the top sheet on the bed with its center fold in the center of the bed and with the hem even with the head of the mattress.
Unfold the top sheet. Follow the same procedure with top blanket or spread, placing the upper edge about 6 inches below the
top of the sheet.
Tuck the top sheet and blanket under the foot of the bed on the near side. Miter the corners.
Fold the upper 6 inches of the top sheet down over the blanket and make a cuff.
Move to the other side of the bed and follow the same procedure for securing top sheet and making cuff.
Place the pillow on the bed. Gather the pillowcase over one hand toward the close end. Grasp the pillow with the hand inside
the pillowcase. Pull the case over the pillow.
Fan-fold or pie-fold the top linens.
Adjust bed to low position.
Apply body mechanics
Positioning a Client in Bed
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Fowlers (semi-sitting position)
Inform client of reason for the move and how to assist (if able).
Elevate bed to highest position.
Using two nurses, place turn (or draw) sheet under clients back and head.
Place bed in a 15degree to 30degree angle for low-Fowlers position, 45degree to 60degree angle for Fowlers
position, or 70to 90degree for high-Fowlers position.
Place small pillows at back, under ankles, under the arms, and under head of client. Keeping the spine straight.
Slightly elevate the gatch of the lower portion of the bed
Assess client for comfort
Lower height of bed and elevate side rails.
Supine Position (Dorsal Position)
Repeat steps 1-3.

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Place bed in a flat position

Place small pillows at back, under head and shoulders, and under ankles. Placing the arms and hands at the patients
side.
Assess clients comfort level
Lower height of bed and elevate side rails
Side-Lying Position (Lateral Position)
Repeat steps 1-3
The client lies on one side
Place a small pillow under clients head and shoulder. Place pillow or foam wedges behind clients back. Place a
pillow between clients legs. Put a pillow tucked by the clients abdomen
Run your hand under the clients dependent shoulder slightly forward
Assess the client for comfort
Lower the bed and elevate the side rails.
Prone Position
Repeat steps 1-3
Assist the client to lie on abdomen
Place a small pillow under clients head; turn head to side. The clients arms can be extended near side or flexed
toward head. Place a small pillow under chest for female clients and for clients with barrel chest
Place a small pillow under ankles or allow toes to rest in space between foot of bed and the mattress
Assess client for comfort
Lower the bed and elevate the side rails

Place Resident in Side-Lying Position
STANDARD: BODY ALIGNED WITH DEPENDENT EXTREMITIES SUPPORTED AND BONY
PROMINENCES PROTECTED
Either of two positions is acceptable: side-lying position or a variation in which knees are flexed with
appropriate padding between the knees and ankles.
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Raised side rail on unprotected side of bed.(If applicable.)
Positioned resident on side in the center of the bed in side-lying position.
Placed appropriate padding.
a.
Behind back.
b.
Under head.

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c.
Between legs.
d.
Supporting dependent arm.
Ensured resident is in good body alignment.
Raised side rails, if ordered.
MOVING A PATIENT UP IN BED
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Identify any movement limitations.
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Close the door and curtain.
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-Place level of bed at comfortable working height.

-Adjust the head of the bed to a flat position (if not contraindicated) or as low as the patient can tolerate.
-Placing the bed in slight Trendelenburg position aids movement(if not contraindicated)
Remove all pillows from under the patient. Leave one at the head of the bed, leaning upright against the headboard.
Position at least one nurse on each side of bed and lower side rails.
Place a drawsheet under the patient's midsection.
Ask the patient (if able) to bend her legs and put her feet flat on the bed to assist with the movement.
Have the patient fold the arms across the chest and if able, lift the head with chin on chest.
Position yourself at the patient's mid section with your feet spread shoulder width apart and one foot slightly in front of the other.
Fold or bunch the drawsheet close to the patient before grasping it securely and preparing to move the patient.
Flex your knees and hips. Tighten your abdominal and gluteal muscles and keep your back straight.
Shift your weight back and forth from your back leg to your front leg and count to three. On the count of three, move the patient up
in bed. If possible, the patient can assist with the move by pushing with her legs. Repeat the process if necessary to get the patient to

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the right position.
5 15. Have client use a bed trapeze, if available.

16.
*Ask the patient to:

a. Grasp the head of the bed with both hands and pull during the move.
b. Raise the upper part of the body on the elbows and push with the hands and forearms during the move.
c. Grasp the overhead trapeze with both hands and lift and pull during the move.
6 17. The lead nurse gives the signal to move. Nurses lift up on the draw sheet. The move is coordinated to transfer the client up toward
the head of the bed.
Position in bed can be maintained using bed gatch, if tolerated by client.
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Elevate head of bed, if tolerated by client.
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Assess client for comfort.
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10 Lower bed and elevate side rails.
11a) Performed completion tasks.
Transferring Between Bed and Chair
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Position the equipment appropriately.
a. Lower the bed to its lowest position so that the patient's feet will rest on the floor.
b. Place the wheelchair parallel to the bed as close as possible.
c. Lock the wheels of the bed as well as the wheelchair.
Prepare to:
a. Assist the patient in sitting position on the side of the bed.
b. Assess for orthostatic hypotension before moving the patient from the bed.
c. Assist in putting on a bathrobe and nonskid slippers or shoes.
d. Place a transfer belt snugly around the Patients waist.
Give explicit instructions to the patient.
Ask patient to:
a. Move forward and sit on the edge of the bed.
b. Lean forward slightly from the hips.
c. Place the foot of the stronger leg beneath the edge of the bed and put the other foot forward patient.
Position yourself correctly.
a. Stand directly in front of the patient. Lean the trunk forward from the hips.
b. Flex the hips, knees, and ankles. Place one foot forward and one back.
c. Encircle the client's waist with your arms, and grasp the transfer belt at the back.
- Tighten your gluteal, abdominal leg, and arm muscles.

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6
Assist the patient to stand and then move together toward the wheelchair.
Ask the patient to push with the back foot, and then pull the patient into standing position.
Support the patient in an upright position for a few moments.
Together, pivot or take a few steps toward the wheelchair.
Assist the patient to sit.
a. Stand directly in front of patient. Place one foot forward and one back.
b. Ask the patient to:
-Back up to the wheelchair and place the legs against the seat.
-Place the foot of the stronger leg slightly behind the other.
-Keep the other foot forward.
-Place both hands on the wheelchair arms or on your shoulders.
Ensure patient safety.
a. Ask the patient to push back into the
Wheelchair seat.
b. Lower the footplates, and place the patients feet on them.
c. Apply a seat belt as required.
Transferring Between Bed and Stretcher
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Adjust the patient's bed.

a. Lower the head of the bed.
b. Raise the bed to 0.5 inch higher than the stretcher.
c. Ensure that the wheels on the bed are locked.
d. Pull the draw sheet out from the sides the bed.
e. Lower side rails.
Place the bath blanket over the patient; remove the top sheet from underneath.
Have the patient fold arms against the chest.
Move the patient to the edge of the bed and position the stretcher.
a. Roll the draw sheet as close to the patient's side as possible
b. Pull the patient to the edge of the bed, where the stretcher will be placed next to, parallel to the bed (lock the wheels on
the stretcher)
Remove the pillow from the bed and place it on the stretcher.
Two nurses should stand on the stretcher side, the third nurse should stand on the side of the bed.
Position the transfer board under the patient.
Transfer the patient securely to the stretcher.
In unison with the other staff members, press your body tightly against the stretcher.
Roll the pull sheet tightly against the
patient.
Flex your hips and pull the patient on the pull sheet toward you and onto the stretcher.
Ask the patient to flex the neck during the move, the arms across the chest.
Ensure patient comfort and safety.

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a. Make the patient comfortable, unlock the stretcher wheels, and move the stretcher away from the bed.
b. Immediately raise the stretcher side rails and/or fasten safety straps across the patient.
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Transfer Resident to Wheelchair using a Transfer Belt
STANDARD: APPLIED TRANSFER BELT; ASSISTED RESIDENT TO STAND, PIVOT
AND SIT IN WHEELCHAIR WITH BODY ALIGNED.
Resident must be transferred from the bed to a wheelchair with the use of a transfer belt which is
referred to as a gait belt.
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Lowered bed to appropriate position.
Positioned wheelchair at bedside
Locked brakes.
Assisted resident to sitting position.
Applied gait/transfer belt firmly around the residents waist (should be adjusted to allow
evaluator to place one or two fingers between the belt and the resident).
Adjusted belt over clothing so that buckle is off center.
Applied non-skid footwear to resident.
Grasped transfer belt on both sides with underhand grasp.
Assisted resident to stand, pivot, and sit in wheelchair.
Placed residents feet on foot rests, if applicable.
Aligned residents body in wheelchair
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Transfer Using a Mechanical Lift
STANDARD: TRANSFERRED PERSON SAFELY UTILIZING A MECHANICAL LIFT.
May be tested in the classroom or in the clinical setting. Follow facility policy for use of the lift
according to the manufacturer's instructions.
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Identified appropriate lift for resident.
Applied correct sling/belt.
Attached sling/belt to mechanical lift.
Verified resident's readiness for transfer.
Operated the mechanical lift controls according to manufacturer's instructions.
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Maneuvered the lift safely

Lowered resident safely.
Disconnected sling/belt from lift.
Removed sling/belt if applicable.
Ambulate with Transfer Belt
STANDARD: AMBULATED PERSON SAFELY UTILIZING TRANSFER BELT.

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Locked bed or chair wheels, if appropriate.
Ensured the person was appropriately attired including non-skid footwear.
Applied transfer belt firmly around person's waist (should be adjusted to allow evaluator to place two fingers
between the belt and the person.)
Assisted the person to standing position.
Stood at the person's affected side (if applicable) while balance is gained.
Ensured the person stood erect with head up and back straight, as tolerated.
Assisted the person to walk. Walked to the side and slightly behind the person. Held transfer belt using under hand
grasp.
Encouraged the person to ambulate normally with the heel striking the floor first. Discouraged shuffling or sliding,
if noted.
Ambulated the required distance, if tolerated.
Assisted the person to return to bed or chair.
Removed transfer belt appropriately.
Perform Passive Range of Motion
STANDARD: COMPLETED THREE DIFFERENT EXERCISES WITHOUT GOING PAST THE
POINT OF RESISTANCE OR PAIN.
The body part to be exercised must be supported. The student is not to force a joint beyond its
present range of motion or to the point of pain. The student is required to name the exercise being
performed (e.g., abduction, flexion). The approved evaluator will verify the number of repetitions
for the selected ROM exercise with the student.
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Demonstrated three different range of motion movements.
a.
Flexion and extension.
b.
Abduction and adduction
c.
Pronation and supination.
d.
Dorsal and plantar flexion.
e.
Opposition.
f.
Internal/External rotation.
g. Radial deviation and ulnar deviation.
Supported the proximal and distal ends of the extremity or the joint itself.
Observed the residents reaction during the procedure.
Demonstrated or verbalized the need to stop moving if pain or resistance was
noted.

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6
ADMINISTERING AN ORAL MEDICATION
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Check doctor's medication order and compare with MAR

Observe the six Rights
Assess the client for potential problem (e.g., absence of a gag reflex)
Move medication cart to medication room and prepare for medication administration.
6.
Prepare the medications for one client at a time.
7.
Read the MAR and select the prescribed drug from the patient's medication drawer.
8.
Compare the label with the MAR. Check expiration dates and perform calculations, if necessary.
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16.
Double-check calculations for accuracy.

Prepare the prescribed medications:
Unit dose packages: Place unit dose-packed in a disposable plastic cup. Do not open wrapper until at the bedside.
Multi dose containers: When removing tablets or capsules from a multi dose bottle, pour the necessary number into the bottle cap and
then place the tablets in a medicine cup.
Break only scored tablets, if necessary, to obtain the proper dosage. Do not touch tablets with hands.
Liquid medication in multi dose bottle: When pouring liquid medications in a multi dose bottle, hold the bottle so the label is against
the palm.
Use appropriate measuring device when pouring liquids, and read the amount of medication at the bottom of the meniscus at eye level.
Wipe the lip of the bottle with a paper towel.

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18.
19.
20.
21.
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When all medications for one patient have been prepared, recheck the label with the MAR before taking them to the patient.
Replace any multi dose containers in the patient's drawer.
Transport medications to the patient's bed side carefully, and keep the medications in sight at all times.
Ensure that the patient receives the medications at the correct time.
Identify the patient.
Complete necessary assessments before administering medications. Explain the purpose and action of each medication to patient.
Assist the patient to an upright or lateral position.
Administer medications.
a) Offer water or other permitted fluids with pills, capsules, tablets, and some liquid medications
b) Ask whether the patient prefers to take the medications by hand or cup.
25. Remain with the patient until each medication is swallowed. Never leave medications at the patient's bedside.
26. Performed completion tasks
27. Check on the patient within 30 minutes or time appropriate for drug, to verify response to medication.
Applying Transdermal Patches
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Assess patient's skin where the patch is to be placed, look for signs of irritation or breakdown.
Remove the old patch before applying new. Fold patch in half with adhesive sides sticking together
Gently wash the site where the old patch was with soap and water.
Remove the patch from package. Write your initials and the date and time of administration on the label side of the patch.
Remove the covering without touching the medication surface.
- Apply patch to the patient's skin.
- Use the palm of your hand to press firmly for about 10seconds.
- Do not massage.
- Rotate application sites.
Evaluate patient's response to medication. Assess potential for adverse reaction.
Check for dislodgement of the patch.
Assess for any skin irritation at site. If necessary, remove patch, wash area and allow drying. Apply new patch at different site.
Administering an Eye Medication

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.If the eye has crust or drainage along the margins or inner canthus, gently wash eye. Always wipe from inner canthus to outer
.Use warm soaks to soften material if necessary
.Place client in a supine position with the head slightly hyperextended .4
Instilling Eye drops
.Remove cap from eye bottle and place cap on its side
.Squeeze the prescribed amount of medication into the eyedropper
.Place a tissue below the lower lid
.With dominant hand, hold eyedropper1/2 to 3/4 inch above the eyeball; rest hand on clients forehead to stabilize
Place nondominant hand on cheekbone and expose lower conjunctival sac by pulling on cheek while applying slight pressure to
.the inner canthus
Instruct the client to look up, and drop prescribed number of drops into center of conjunctival sac
.If the client blinks and the drops land on the outer lid or eyelash, repeat the procedure
.Instruct client to gently close eyes and move eyes
.Apply gentle pressure with your gloved finger over the inner canthus to prevent the Eyedrop from flowing into the tear duct
:Eye Ointment
.Repeat steps 18
:Lower lid
With non dominant hand, gently separate clients eyelids with thumb and finger, and grasp lower lid near margin below the
.lashes; exert pressure downward over the bony prominence of the cheek
.Instruct the client to look up
Apply eye ointment along inside edge of the entire lower eyelid, from inner to outer
:Upper lid
.Instruct client to look down
With nondominant hand, gently grasp clients lashes near center of upper lid with thumb and index finger, and draw lid up
.and away from eyeball
.Squeeze ointment along upper lid starting at inner canthus
Repeat steps 11-12 .18
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Instilling an Ear Medication
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Place the client in a side-lying position with the affected ear facing up. Offer a tissue to the patient. Clean the external
ear with cotton balls moistened with saline, as necessary. Draw up the amount of solution needed in the dropper.
Monodrip plastic container may also be used.
Straighten the ear canal by pulling the pinna down and back for children or upward and outward for adults.
Instill the drops into the ear canal by holding the dropper at least 1/2 inch above the ear canal.
Gently press on the tragus a few times.
Ask the client to maintain the position for 2 to 3 minutes.
Place a cotton ball on the outermost part of the canal if necessary. Wait 5 minutes before instilling drops in the second
ear (if ordered).
Nasal Instillations
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Provide the patient with tissue paper and instruct client to blow nose unless contraindicated by client
condition (such as recent nosebleed).
Explain that the client may feel a burning sensation to the mucosa or a choking sensation, or both, as the
drop trickles back into the throat.
Have the patient sit up with head Hyperextended. If patient is lying down, tilt the head back over a pillow.
Draw sufficient amount of solution into the dropper for both nares. Excess should never be returned into
stock bottle.
Ask patient to breathe through her mouth.
Insert the nasal drops about 3/8 inch into nostril, keeping the tip of the dropper away from the sides of the
nares. Instill the prescribed dosage of medication in one nares and then into the other nares and observe
the client for signs of discomfort.
Instruct the patient to remain in the same position for 5 minutes.
Provide the client with the emesis basin and tissue to expectorate any medication that flows into the
oropharynx and mouth
Observe patient for side effects for 30 minutes after administration.
Rectal Medication
standard.

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Ask patient if she needs to void.
Place patient in Sim's, left-lateral position, with lower leg extended; upper leg flexed.
- Drape properly, exposing only the rectum.
Remove the suppository from its wrapper. Apply lubricant to the rounded end. Lubricate the index finger of your dominant hand.
Separate the buttocks with your Non dominant hand.
- Instruct the patient to breathe slowly and deeply through the mouth while suppository is being inserted.
Using your index finger, insert the suppository, round end first, along the rectal wall.
Insert about 3 to 4 inches.
Withdraw the finger and wipe anal area with tissue. Release the buttocks.
Instruct the patient to remain in bed for 15 minutes and to resist urge to defecate.
Observe for effect of suppository after administration.
Withdrawing Medication from an Ampule

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Check medication order against the original doctor's order or according to policy. Check patient's chart for allergies.
Prepare the medication in the medication area. Prepare medications for one patient at a time
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Read the MAR and select the proper medication from the patient's medication drawer.
Compare the label with the MAR. Check expiration dates and perform calculations, if necessary.
Hold the Ampule and quickly and lightly tap the top chamber until all fluid flows into the bottom chamber.
Wrap gauze around the neck of the Ampule.
Firmly grasp the neck of the ampule and quickly snap the top off away from your body. Place the ampule on a flat surface
Withdraw the medication from the Ampule, maintaining sterile technique.
Check connection of needle to syringe by turning barrel to right while holding needle guard.
Use a filter needle if recommended.
Remove needle guard, and hold syringe in dominant hand.
With nondominant hand grasp Ampule and turn upside down, or stabilize Ampule on a flat surface.
Insert the needle into the center of the ampule; do not allow the needle tip or shaft to touch the rim of the Ampule.
Keep needle tip below level of meniscus
Aspirate the medication by gently pulling on the plunger.
If air bubbles are aspirated, remove the needle from the ampule.
- Hold syringe with needle pointing up and tap sides of the syringe.
- Draw back slightly on plunger, and gently push the plunger upward to eject air.
- Reinsert the needle in the middle of the ampule and continue to withdraw the medication.
Remove excess air from the syringe and Check the dosage of medication in the syringe.
- Recap.
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Mixing and Removing Medication from a Vial

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Check medication order against the original doctor's order or according to policy. Check patient's chart for allergies.
Prepare the medication in the medication area. Prepare medications for one patient at a time
Read the MAR and select the proper medication from the patient's medication drawer.

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Compare the label with the MAR.

Check expiration dates and perform calculations, if necessary.
Aspirate in a syringe the exact amount of diluents needed to dilute the powdered medication in the vial.
Remove the metal or plastic cap on the vial that protects the rubber stopper.
Swab the rubber top with the antimicrobial swab and allow to dry.
Insert needle into the rubber seal of the vial. Add the diluent into the vial.
Mix medication by rolling the vial between hands until powdered Medication is completely dissolved.
Take syringe and remove cap. Draw back an amount of air that is equal to the specific dose of medication to be withdrawn.
Place Vial on a flat surface. Pierce the rubber stopper in the center with the needle tip and inject the measured air into the space
above the solution. Do not inject air into the solution.
Invert the vial. Keep the tip of the needle below the fluid level.
Hold the vial in one hand and use other hand to withdraw medication.
Draw up the prescribed amount of medication while holding the syringe vertically and at eye level.
If any air bubbles accumulate in the syringe, tap the barrel sharply and move the needle past the fluid into the air space to re-inject
the air bubble into vial. Return the needle tip to the solution and continue withdrawal of the medication.
After the exact dose is withdrawn, remove the needle from the vial.
*If multidose vial, label vial with date and time opened, amount of remaining solution and nurse's initials.
* Cover rubber seal with sterile gauze or cotton. Keep in refrigerator or as recommended
Check the amount of medication in the syringe with the medication dose. Discard surplus (if not multidose).
Recheck the label with the MAR.
Perform hand hygiene and proceed to administration, based on prescribed route.
Mixing Insulin in One Syringe
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Check with the client and the chart for known allergies or medical conditions that would contraindicate the use of the drug.
Check the MAR against written health care orders.
Follow the five rights of medication administration. Check the clients identification band.
Remove caps from insulin vials (if not already off).
Slowly rotate each bottle of insulin. Never shake. Make sure suspensions are thoroughly mixed. (Cloudy insulin such as NPH
should be completely mixed.)
Clean the rubber stoppers of the vials with an alcohol swab.

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Remove cap from the needle. Draw air into the syringe equal to the dose of insulin to be given.
Insert needle into vial of the suspension, being careful not to touch the needle to the medication in the vial. Inject the air into
the vial and remove the needle. Do not withdraw any insulin yet.
Fill syringe with air equal to dose of regular insulin. Insert needle into bottle and inject air into vial. Invert bottle and pull
plunger down to withdraw the appropriate dose of insulin.
With needle in the bottle, hold it up to the light and look for air bubbles. To remove air bubbles, tap or flick the syringe with
your finger to cause air to rise. Push plunger to push air and some insulin back into the vial. Pull back to get the appropriate
dose of insulin free of air. Remove the needle.
Insert needle into the vial of
longer-acting insulin; be sure the tip of the needle is below the surface of the fluid level. Invert
the bottle, and slowly draw back dose of insulin required. Remove needle.
Have another nurse check the prescribed dose.
Store insulin vials according to your agency policy.
Administering Intradermal injection
standard.
Check medication order
Prepare the medication for one patient at a time
Select appropriate site. Assist the patient to appropriate position and drape the patient
Clean the site with antimicrobial swab with affirm, circular motion
Remove the needle cap with the non dominant hand by pulling it straight off
Use non dominant hand to spread the skin out over the injection site
Hold the syringe in the dominant hand, between the thumb and forefinger with the bevel of the needle up
Hold the syringe at a 1015 degree angle from the site.
Place the needle almost flat against the patients skin, bevel side up and insert needle into the skin so that the point of needle can
be seen through the skin. Insert the needle only about 1/8 with entire bevel under the skin
Once the needle is in place, fixed the lower end of the syringe and slide your dominant hand to the end of plunger

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Slowly inject the agent while watching for a small wheal or blister to appear
Withdraw the needle quickly at the same angle that it was inserted
Do not massage area after removing the needle. Tell the patient not to rub or scratch the site. Do not apply pressure or rub the Site
draw a circle around injection siteDo not recap the used needle. Discard the needle and syringe in appropriate receptacle
Assist patient to a position of Comfort
Observe the areas for signs of a reaction at determined intervals after administration.
Administering subcutaneous injection

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Follow the 5 rights of drug administration Check the medication order for Accuracy.
Prepare the medication from the vial or ampule
Drape as needed to expose only area of site to be used.
Select an appropriate administration site
Clean the area around the injection site with an antimicrobial swab, use affirm circular motion
Inject the medication:
- Grasp the syringe in your dominant hand by holding between your thumb and fingers with palm upward.
- Inject the needle quickly at 45 90 degree angle insertions.
- Using non dominant hand, pinch or spread the skin at the site and insert needle in a firm steady push.
- Aspirate by pulling back on the plunger, if blood appear in the syringe, withdraw the needle, discard the syringe and prepare
new injection.
Remove the needle quickly and smoothly pulling along the line of insertion while the pressing the skin with your non
dominant hand
Apply gentle pressure on the site after the needle is withdrawn. Do not massage the site. Specially If the drug is anticoagulant
Assess the effectiveness of the medication at the time it's expected to act.
Administering intramuscular injection
standard.
Prepare medications for one patient at a time: Read the medication record and select the proper medication from the patients
drawer or unit stock. Compare the label with the medication record.
Check expiration date and perform calculations.
Withdraw medication from an ampule or vial
Recheck the label before taking them to the patient
Position the patient properly by exposing the area to be injected and land mark for the site chosen
Select appropriate site
- clean the area around the injection site with antimicrobial swab.
-Use a firm, circular motion while moving outward from the injection site.
-Allow area to dry.
10. Remove the needle cap, hold syringe in your dominant hand between the thumb and forefinger.
11. Displace the skin in a z-track manner by pulling the skin down or to one side about 2.5 cm with your non dominant hand and

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hold the skin and tissue in this position and quickly insert the needle sharply at right angle to the surface (90 degree)
As soon as the needle is in place ,use your thumb and forefinger of your nondominant hand to hold the lower end of the syringe,
slide your dominant hand to the end of the plunger
Aspirate by slowly, pulling back on the plunger to determine whether the needle is in blood vessels.
If no blood is aspirated inject the solution slowly (10 seconds per millimeter of medication.
Once the medication has been instilled, wait 10 second before withdrawing the needle.
Withdraw the needle smoothly and steadily at the same angle, supporting tissue around the injection site with your non dominant
hand.
Apply gentle pressure at the site with a dry gauze
Do not recap the used needle. Engage the safety shield or needle guard, if present. Discard the needle and syringe in the appropriate
receptacle.
22. Assess site after 2-4 hours after administration to evaluate patients response
Preparing and administering of IV infusion (plain) With IV cannula

insertion
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Verify the IV order against the doctor's order. Check patient's chart for allergies. Check for color, clarity, expiration date, sterility.
Know the techniques for IV insertion, precautions, purpose and medications.
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Ask the patient if he/she is allergic to any medication, iodine, or tape.

Prepare IV solution and tubing.
a. Maintain strict aseptic technique when opening sterile packages and IV fluid.
b. Clamp IV tubing, uncap spike and insert into the entry site on the IV bottle.
c. Squeeze the drip chamber and allow to fill at least halfway.
d. Remove the cap at the end of the tubing, while maintaining sterility, open the IV tubing clamp and allow fluid to flow until all air
bubbles disappear and the entire tubing is primed (filled).
e. If an electronic device is to be used, follow manufacturer's instructions.
f. Apply the label if medication was added. Label the tubing with the date and time that tubing was hung. Hang the IV on the pole.

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Prepare the 3-way stopcock.

a. Aspirate normal saline or sterile water for injection in a 5cc syringe.
b. Remove the needle of the syringe.
c. Uncap the 3-way stopcock and attach the hub of the syringe into the stopcock.
d. Open the 3-way and push the plunger of the syringe to fill the stopcock with fluid.
Place patient in low Fowler's position in bed. Place protective pad under the patient's arm. Close the door or pull the curtains.
Provide for emotional support as needed.
Select and palpate for an appropriate vein. Avoid an arm that has been compromised, such as with AV fistula.
If the site is hairy and hospital policy permits, clip 2-inch area around the site.
Apply a tourniquet 3 to 4 inches above the venipuncture site. Direct the ends of the tourniquet away from site.
Make sure the radial pulse is still present.
Instruct the patient to hold the arm lower than the heart.
Ask the patient to open and close the fist.
Observe and palpate for suitable vein.
Try these techniques if vein cannot be felt:
a) Massage the patient's arm from proximal to distal and gently tap over the vein.
b) Remove the tourniquet and place a warm moist compress over the vein for 10 to15 minutes.
Put on clean gloves.
Cleanse the site with an antiseptic solution according to hospital policy. Use a circular motion to move from the center outward for
several inches.
Use the nondominant hand, placed about 1 or 2 inches below the entry site. Avoid touching the prepared site. Ask patient to remain still
while venipuncture is performed.
Enter the skin gently, holding the catheter by the hub in your dominant hand, bevel side up, at a 10-to 15-degree angle.
The catheter may be inserted from directly over the vein or the side of the vein.
While following the course of the vein, advance the catheter into the vein.
When blood returns through the flashback chamber of the catheter, advance device to inch farther into the vein.
A catheter needs to be advanced until the hub is at the venipuncture site.
Release the tourniquet as soon as possible. Quickly remove the cap from the IV tubing and attach the tubing to the catheter.
Stabilize the catheter with your nondominant hand.
Start the flow of solution promptly by releasing the clamp on the tubing. Examine the tissue around the entry site for signs of infiltration.
Secure catheter with narrow nonallergenic tape placed with the sticky side up under the hub and crossed over the top of hub.
Place sterile dressing over the venipuncture site according to hospital policy.
Loop the tubing near the site of entry and anchor.
Label the IV dressing with the date, time, site, and type and size of catheter used for the infusion on the tape anchoring tubing.
Adjust infusion rate as ordered.
Recheck the flow rate and observe the IV site for infiltration, 30 minutes after starting the infusion. Ask the patient if experiencing any
pain or discomfort related to the IV infusion.
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Preparing and Administering of Intravenous (IV) Solution with Medication
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Check and verify medication order against original doctor's order.

Check patient's chart for allergies. Verify the compatibility of the medication and intravenous fluid.
Move the medication cart to the outside of the patient's room or prepare in the medication room according to hospital policy.
Unlock medication cart or drawer.
Prepare medication for one patient at a time.
Read the MAR and select the proper medication from patient's medication drawer.
Compare the label with the MAR. Check Expiration date and perform calculations.
If necessary, withdraw medication from a vial or an ampoule.
Recheck the label with the MAR before adding the medication into the IV fluid.
Remove the protective cap on the IV fluid container; uncap the needle or the needleless device. Insert into the port and inject the
medication. Withdraw. Do not recap used needle.
Gently rotate the container.

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Attach the label to the container so that the dose of medication that has been added is apparent.
Discard the needle and syringe in the appropriate receptacle.
IV Medication Using 3-Way Stopcock
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standard.
Check doctors order.
Prepare medication in medication room using aseptic technique
Tell patient to report any symptoms of discomfort at IV site during injection
Cleanse injection port of IV access with antiseptic swab after removing the cap.
Attach the 3 ml syringe with flushing solution to the 3- way stopcock.
Open the 3-way stopcock going thru the vein. Aspirate gently to observe for blood return.
Remove medication syringe and connect back the syringe with flushing solution to flush all the medication inside.
If with blood return, connect the syringe filled with medication in the 3-way stopcock and inject medication slowly.
After removing the syringe, be sure to put back the cap of 3-way stop and close properly.
IV Medication Using Volume Control Set-Soluset
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standard.
Check doctor order to determine type of medication, dosage and type of solution to be used.
Assess patency of existing IV infusion line by noting infusion rate of main line.
Assess insertion site for signs of infiltration or phlebitis.
Prepare medication in syringe in the medication area.
Fill Soluset with desired amount of fluid (50-100 ml) by opening the clamp between Soluset and main IV bag/bottle.
Close clamp and check to be sure clamp in air vent of soluset chamber is open.
Clean injection port on top of soluset with antiseptic swab.
Remove needle cap and insert syringe needle through port, and then inject medication.
Gently rotate Soluset between hands.
Connect the end of IV tubing to the IV port of the main IV line or 3- way stopcock.
Regulate infusion rate appropriate for medication. Follow doctor, manufacturers recommendation for infusion rates.
Label Soluset with name of drug, dose, total volume including diluent, and time of administration.
Dispose of uncapped needle and syringe in proper container.
During infusion, periodically check infusion rate and condition of IV site.

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Perform Venipuncture
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Place client in a sitting or supine position; lower side rail.
Prepare supplies:
Open sterile packages.
Label specimen tubes with the clients data.
Position arm straight. If possible place extremity in dependent position.
Apply the tourniquet 6 to 10 cm above the elbow.
Tourniquet should only obstruct venous blood flow, not arterial. Check for a distal pulse.
Select a dilated vein. If a vein is not visible, instruct client to open and close a fist; or stroke extremity from proximal to distal, tap
lightly over a vein, apply warmth.
Palpate the vein for size and pliancy; be sure it is well seated.
Release the tourniquet.
Cleanse puncture site with isopropanol, let dry and cleanse with povidone-iodine, let dry or wipe with sterile gauze, do not touch
site after cleansing. If the client is allergic to iodine, only use isopropanol and cleanse skin for 30 seconds.
Place equipment in easy reach and position yourself to access the puncture site.
Reapply the tourniquet (time should not exceed 3 minutes).

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Don gloves.
Perform venipuncture:
Remove cap from 20- or 21-gauge needle.
With nondominant hand, stabilize the vein by holding the skin taut over the puncture site (apply downward tension on the forearm
with your thumb).
With dominant hand, hold the needle bevel facing upward at an approximate 30 angle to the arm.
Puncture the skin into the straightest part of vein with a steady, moderately fast movement.
(When the vein is entered you will feel a slight give and can see blood at the needles hub.)
Apply moderate negative pressure by puncturing the vacuum tube or by gently retracting the syringe plunger. (When first
performing a venipuncture, use a syringe. It takes greater dexterity to puncture the vacuum tube with a two-sided needle; if you
apply too much pressure you will go through the vein.)
Remove the tourniquet once blood is flowing into the tube or syringe; collect the specimen(s).
Remove the needle and immediately apply pressure to site for 2 to 3 minutes or 5 to 10 minutes if client is taking anticoagulant
medication. Keep the arm straight.
Have the client maintain pressure on the puncture site.
Note: Green stoppers contain sodium heparin (anticoagulant); they must be mixed promptly after collection.
Apply a sterile bandage or adhesive bandage to puncture site.
If using a needle and syringe, transfer the blood into test tube under moderate pressure.
Administering Oxygen by Nasal Cannula

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Check Doctors order.

Review safety precautions. Place no smoking signs in appropriate areas.
Connect nasal cannula to oxygen setup with humidification.
(O2 humidified before it is delivered to patient, thus preventing dehydration of mucous membranes.)
Adjust flow rate as ordered by the doctor.
Check if oxygen is flowing out of prongs.
Place prongs in patients nostril and adjust properly.
Encourage patient to breathe through nose with mouth closed.
Assess and record patients response to therapy. Patients respiration, color, breathing pattern, and chest movements indicate
effectiveness of O2 therapy.)
Remove and clean cannula and assess nares at least every 8 hours. Check nares for irritation and bleeding.

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Administering Oxygen by Mask
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Check Sao2, Pao2.
Review safety precaution when oxygen in use. Place no smoking signs in appropriate areas.
Attach face mask to oxygen setup with humidification.
Start flow of oxygen at specified rate.
For a mask with reservoir, allow oxygen to fill the bag before placing the mask to patient.
Position face mask over patients nose and mouth.
Remove mask and dry skin every 2-3 hrs. If oxygen is running continuously. Do not put powder around the mask. (There is danger
of inhaling the powder.)
Assess and record patients response to therapy.
Administration of Small Volume Nebulizer
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Monitor the heart rate before and after the treatment for patient using Bronchodilator drug.
Place the patient in a comfortable sitting or semi Fowlers position.
Attach humidifier to Flow meter
Connect Flow meter to oxygen source
Add the prescribed amount of Medication and Normal saline solution to the Nebulizer kit
Connect the Nebulizer kit to humidified O2 source and set the flow as ordered by the doctor.
Position mask over patients mouth and nose. Instruct the patient to exhale
Tell the patient to take in a deep breath from the mouthpiece (if mask is not use) hold breath briefly, and then exhale.
Observe expansion of chest to ascertain that patient is taking deep breaths.
Instruct the patient to breathe slowly and deeply until all the Medication is nebulized.
On completion of the treatment, encourage the patient to cough after several deep breaths
Turn off the oxygen
Remove the nebulizer mask

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COLLECTING MIDSTREAM URINE SPECIMEN
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Assist or allow patient to cleanse perennial site.
Set up sterile kit and prepare properly.
Wear gloves.
Open specimen container by placing cap with inside area facing up.
Tell the patient not to touch the inside of the cup, cap, or straw on the inside of the cap. Take the cap off of the cup and place it on
the counter with the straw facing upward.
Apply antiseptic to gauze or cotton balls.
Let male patient cleanse perennial site or assist in the process and collect specimen:
Wipe head of penis in a single motion with first toilette.
Urinate a small amount into toilet.
Pass container into stream after patient starts to urinate without stopping flow, and gather 30-60 ml of urine into cup.
Before urine flow ends, remove container.
Replace cap tightly on cup, making sure not to touch inside of rim of cup.
Wipe off excess urine outside of container.
Put container in a plastic specimen bag.
If applicable, remove bedpan and help patient assume a comfortable position.
Properly label specimen; attach laboratory requisition slip.
Immediately bring specimen to laboratory within 15-30 min.
Insertion of Urinary Catheter for Male Patient
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Elevate side rail located on bed's opposite side. Bring down side rail on working side.
Put under patient the waterproof pad.
Put patient to proper position:
For male patient, help patient to supine position with slightly abducted thighs.
Drape patient:
For male patient, drape upper trunk of patient using bath blanket.
Cover lower extremities using bed sheets, leaving genitalia exposed.
Wear disposable gloves.
As needed, cleanse perineal area of patient using soap and water and completely dry area.
Take gloves off.
To illuminate perennial area, position light.
After opening draining system package, put drainage bag on top of edge of bed frame's bottom.
Position drainage tube up between mattress and side rail (indwelling catheter only).
As per instructions, open catheterization kit, maintaining container's bottom sterile.
Wear sterile gloves.
Prepare supplies on sterile field.
Open inner sterile package containing catheter. Apply sterile antiseptic solution to the appropriate compartment containing sterile
cotton balls and open packet containing lubricant.
Take specimen container off (lid must be loosely put above) and pre-filled syringe from tray's collection compartment. Put them

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aside on sterile field.
Try balloon. Inject fluid from prefilled syringe into balloon port.
For male patients, lubricate 12.5-17.5 cm.
Put sterile drape:
For male patient: Using the first method, place drape over thighs of patient and below penis without totally opening fenestrated
drape. Using the second method, place drape over thighs of patient slightly under penis. Lift fenestrated sterile drape, let it unfold,
and drape it on penis, with fenestrated slit placed over penis.
Put sterile tray and content on sterile drape between the thighs of patient and open specimen container.
Cleanse urethral meatus:
For male patient, use non dominant hand to retract foreskin of the penis of patient and hold penis at shaft slightly under glans.
Retract urethral meatus between thumb and forefinger and sustain non dominant hand's position throughout the process. Pick up
antiseptic solution-saturated cotton balls using forceps and clean penis. In circular motion, move cotton ball starting from urethral
meatus toward glans' base. Repeat procedure three more times using a new cotton ball for each instance.
Using gloved dominant hand; pick up catheter 7.5-10 cm from catheter tip. Hold catheter's end loosely coiled in dominant hand's
palm.
Insert catheter:
For male patient: Raise penis of patient to a perpendicular position to his body and put light traction.
Advance the catheter into the patient's urinary meatus. You may encounter resistance at the prostatic sphincter.
(1) Pause and allow the sphincter to relax.
(2) Lower the penis and continue to advance the catheter.
NOTE: Never force the catheter to advance. Discontinue the procedure if the catheter will not advance or the patient has unusual
discomfort. Get assistance from the charge nurse or physician.
When the catheter has passed through the prostatic sphincter into the bladder, urine will start to flow into the collection bag if it is
reconnected. If it is not reconnected, collect a specimen if required, and then place the end of the catheter into the tubing of the
sterile receptacle.
Attach the syringe to the balloon port and inject the water slowly to inflate the balloon. Connect the urine collection bag if it is not
reconnected.
Anchor the catheter tubing to the lateral abdomen with tape.
Secure the urinary collection bag below the level of the bladder and off the floor. Coil any extra tubing on the bed.
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Removal of Urinary Catheter for Male Patient
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Check doctors order

Ask the patient to lie in a supine position.
Place waterproof sheet under the patient's buttocks and provide proper draping.
Wash hands and put on exam gloves.
Place a container between patients legs.
If necessary, clean around the meatus and catheter using appropriate solution, always swabbing away from the urethral opening.
Release any leg support system
Change gloves and attach syringe to catheter valve to deflate balloon.
Empty the balloon by inserting the barrel of the syringe and allow the solution to come back naturally withdrawing the amount of
fluid used during inflation.
Ask patient to relax and to breathe in and out. As the patient exhales, pinch off and gently pull on the catheter near the point where
it exits from the meatus.
Male patients should be warned of potential discomfort as the deflated balloon passes through the prostatic urethra.
Inspect the removed catheter for any signs of encrustation, especially if a new catheter is to be inserted.
Clean the perineum or penis with soap and water. Dry the area well.
Inspect the catheter.
If the catheter is not totally intact, report this promptly and save the catheter for further inspection.
Empty the drainage bag. Measure the amount of urine and record on the intake and output (I&O) sheet.
Note the amount, color, and clarity of the urine in the drainage bag.

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After removal of the catheter, assess the patient for 24 hours for patterns of urinary elimination. Note the time and amount of the
first voided urine. Report any of the following:
(1) Inability to void within 8 to 10 hours.
(2) Frequency, burning, dribbling, or hesitation in starting the stream of urine.
(3) Cloudiness or any other unusual color or characteristic of the urine.
Provide a level of fluids similar to the intake when the catheter was in place.
PERFORMING ROUTINE CATHETER CARE
standard.
Evaluate bowel incontinence or discomfort of patient at insertion site of catheter.
Put waterproof pad under patient.
Drape patient.
Wear disposable gloves.
Unfasten anchor tapes to free tubing of catheter.
Expose and examine urethral meatus of patient.
Wash perennial tissues of patient with soap and water.
For male patient, first wash around catheter, going toward glans and meatus in circular manner.
Reevaluate meatus of patient for discharge.
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IRRIGATING A WOUND
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Confirm the physicians order for wound irrigation, note the type and strength of the ordered irrigation solution

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Assess the clients pain level and medicate with analgesic 30 minutes before procedure if the medication is to be given PO or IM.
Place a waterproof pad on the bed. Assist the client onto the pad .Then assist the client into a position that will allow the irrigation
to flow through the wound and into the basin.
- Close the door, pull curtains
Wash hands and don the disposable gloves, remove and discard the old dressing.
Assess the wounds appearance and note quality, quantity, color and odor of drainage.
Remove and discard the disposable gloves, and wash hands.
Prepare the sterile irrigation tray and dressing supplies. Pour the room temperature irrigation solution into the solution container.
Don sterile gloves.
Position the sterile basin against the lower edge of the wound to catch the irrigate fluid.
Fill the piston or bulb syringe with irrigate and gently flush the wound. Refill the syringe and continue to flush the wound until the
solution returns clear and no exudates is noted.
Dry the edges of the wound.
Assess the wounds appearance and drainage.
Apply sterile dressing.
APPLYING A DRY STERILE DRESSING
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Review physician orders for dressing change procedure and list of needed supplies.
Position the client. Using a bath blanket, drape the client so that only the wound is exposed.
Place the moisture proof bag within easy reach.
- Make a cuff on the bag by folding the top over.
Wash hands and don disposable gloves.
Remove the soiled dressing.
If Montgomery straps or a binder were used, untie the tapes. If tape was used, gently remove tape by pulling up small sections
at a time while holding down the skin in front of the tape (provides counter traction on the skin.) If resistance is met, you may
need to use adhesive remover (if skin is torn during tape removal, you have created another wound)
Carefully remove the outer protective dressing. Then remove the inner the inner layers of gauze. If there is a drain present, use
caution so that drains are not accidentally removed or dislodged.
Place the soiled dressings and disposable gloves in the moisture-proof bag.
Assess the wound; note the odor and presence of any drainage.
Open sterile dressing tray or set up sterile supplies and cleansing solution.
Pour solution into sterile basin.
Don sterile gloves.
Clean the wound with the cleaning solution and gauze. Gauze may be held with the forceps or swabs may be used
If a drain is present, apply precut dressing around the drain. Apply a thick second layer of gauze over the drain
Apply sterile dressing over wound
Then cover with the surgical pads.
Secure the dressing with either tape or the ties from the Montgomery straps. Tape should be placed at the edges of the dressing so

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that the edges cannot be lifted to expose the wound. Paper tape should be used on clients with thin fragile skin and clients who
have sensitive skin
Reassess client following dressing change to determine status and comfort level.
APPLYING A MOISTENED DRESSING
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Review doctors order for the application of a saline moistened dressing

Assess the patient for possible need for non pharmacologic pain-reducing medication prior to wound care dressing change.
Administer appropriate analgesic, consulting the physicians orders, and allow enough time for analgesic to achieve its
effectiveness before beginning the procedure.
Close the room door or curtains. Place bed at a comfortable working height. Place a waste receptacle or bag at a convenient
location for use during procedure.
Assist the patient to a comfortable position that provides easy access to the wound area. Position the patient so the irrigation
solution will flow from the clean end of the wound toward the dirtier end, if wound irrigation is necessary. Expose the area and
drape the patient with the bath blanket if needed. Put the water proof pad under the wound area to protect the bed
Put clean disposable gloves and gently remove the soiled dressings. If the dressing adheres to the underlying tissues, moisten it
with saline to loosen it.
After removing the dressing, note the presence, amount, type, color, and odor of any drainage on the dressings. Place soiled
dressings in the appropriate waste receptacle.
Assess the wound for appearance, stage, the presence of eschar, granulation tissue, epithelialization, tunneling, necrosis, sinus
tract, and drainage. Assess the appearance of the surrounding tissue.
Remove your gloves and put them in the receptacle.
Using sterile technique, open the supplies and dressings. Place the fine-mesh gauze into the basin and pour the ordered solution
over the mesh to saturate it.
Put on the sterile gloves
Clean the wound. If needed, use forceps to clean the area. Clean the wound from top to bottom and from the center to the outside.
Following this pattern, use new gauze for each wipe, placing the used gauze in the waste receptacle. Do not touch any surface
with the gloves or forceps. Irrigate as needed.

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Dry the surrounding skin with sterile gauze dressings

Squeeze excess fluid from the gauze dressing. Unfold and fluff the dressing.
Gently press to loosely pack the moistened gauze into the wound. If necessary, use the forceps or cotton tip applicators to press
the gauze into all wound surfaces.
Apply several dry sterile gauze pads over the wet gauze. Place the ABD pad over the gauze.
Remove and discard your sterile gloves. Apply tape or tie tapes to secure the dressing

Feed a Resident
STANDARD: RESIDENT IS FED PRESCRIBED DIET IN A COURTEOUS AND SAFE
MANNER.
The student should be assigned to feed someone with out any special feeding techniques required.
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Prepared the resident for the meal (i.e., allowed resident to use toilet and wash hands).
Positioned resident in sitting position as appropriate.
Matched food tray/diet items with residents diet order.
Matched food tray/dietary items with appropriate resident.
Protected residents clothing as needed or as resident prefers.
Noted temperature of food and liquids to avoid food that is too hot or too cold.
10
Fed moderate-sized bites with appropriate utensil.

Interacted with resident as appropriate (i.e., conversation, coaxing, cueing, being positioned at
eye level with the resident).
Alternated liquids with solids, asking resident preference.
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Ensure the resident has swallowed food before proceeding.
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Cleaned resident as appropriate when completed.
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Removed tray, cleaned area.
14

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Performance Skill# 60
Calculate Intake and Output
STANDARD: TOTAL INTAKE AND OUTPUT QUANTITIES CALCULATED WITHOUT
ERROR. May be tested in the classroom or the clinical setting.
The student is to measure intake and output in cubic centimeters (cc) or milliliters (ml). The student
may be told the fluid capacity of the containers (glasses, cups, and bowls).
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Wrote down the intake and output amounts in the units used to measure the intake and output quantities (i.e., cc
= cubic centimeters, ml = milliliters, oz = ounces).
Converted the measured unit into the units to be recorded on resident intake and output chart
Calculated all the measured quantities listed as resident intake to obtain a total amount of intake for the time period.
Added all the measured quantities listed as resident output to obtain a total amount of output for the time period.
Recorded the total intake and output to be compared to the recorded intake and output calculation of the evaluator.

Nursing Performance Skills

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Kingdom of Saudi Arabia

Ministry of Higher Education

Get a firm footing by keeping feet 10 to 12 inch (25 to 30 cm) apart.

Stood so that clothes did not touch sink.

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Performed beginning tasks

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MEASURE ORAL TEMPERATURE:

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Performed beginning tasks

Deflated the cuff in a timely manner.

Recorded blood pressure measurement to be compared with the blood

Performed completion tasks

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Performed beginning tasks

a. Placed paper towel on scale platform.

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Performed beginning tasks

Performed completion tasks

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Performed beginning tasks

Performance Skill #12

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Performed beginning tasks.

Performed beginning tasks

Prepared resident for shower or tub bath.

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Performed beginning tasks.

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Performed beginning tasks.

Washed, soaked, and dried the residents hands

Cleaned the nails.

Performed beginning tasks

Filled basin with water at correct temperature to residents preference if applicable.

Covered the resident appropriately to avoid exposure and maintain dignity.

Placed a waterproof pad under buttocks.

Positioned resident appropriately.

Wet washcloths and applied cleansing solution.

Washed perineal area:

Patted area dry, if applicable.

Removed waterproof pad and discarded.

Performed completion tasks.

Performed beginning tasks.

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Performed beginning tasks.

Performed beginning tasks

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Rinsed oral cavity.

Assisted resident to clean and dry mouth

Performed beginning tasks.

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Performed beginning tasks

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Performed beginning tasks

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Place bed in a flat position

Performance Skill #24

Performed beginning tasks

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-Place level of bed at comfortable working height.

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5 15. Have client use a bed trapeze, if available.

*Ask the patient to: