Data Privacy Quiz 30

PRACTICUM PROCEDURE FORM 1A
Name: __________________________________ Year/Section/Group: ___________ Date: _______________
INSTRUCTION: Please check (/) on the space provided to assure whether the participant can perform the
procedure correctly or whether it is incorrectly done.
CD – Correctly Done ID – Incorrectly Done
PROCEDURE: SETTING UP IV
STEPS CD ID REMARKS
SETTING UP IV:
Note: CDC Universal precaution: Always wear gloves when doing any
venipuncture.
1.Verify written prescription.
2. Observe ten (10) Rs when preparing and administering IVF.
3. Explain procedure to reassure patient and/or significant other, secure
consent if necessary.
4. Assess patient’s vein; choose appropriate site, location, size/condition.
5. Prepare necessary materials for procedure (IV tray with IV solution,
administration set, IV cannula, forceps soaked in antiseptic solution, alcohol
swabs, cotton balls-soaked alcohol with cover (this should be exclusively
used for I.V.), plater, tourniquet, gloves, splint, and IV hook), sterile 2x3
gauze or transparent dressing.
6. Check the sterility and integrity of the IV solution, IV set and other
devices.
7. Place IV label on IVF bottle duly signed by RN who prepared it (patient’s
name, room no., solution, time, and date).
8. Do hand hygiene before and after the procedure.
9. Open IV administration set aseptically and close the roller clamp and
spike the infuscate container aseptically following the infection control
measures.
10. Fill drip chamber to at least half and prime it with IV fluid aseptically.
11. Expel air bubbles if any and put back the cover to the distal end of the IV
set (get ready for IV insertion).
TOTAL SCORE
PRACTICUM PROCEDURE FORM 1B
PROCEDURE: INSERTING IV UTILIZING THE DUMMY ARM

STEPS CD ID REMARKS
INSERTING IV CANNULA UTILIZING DUMMY ARM
Prepare complete IV tray with IV infusions: Dummy Arm and other safety
devices.
1.Verify written prescription for IV therapy; check prepared IVF and other
things needed.
2. Explain procedure to reassure patient and/or significant others and
observe the 10 Rs.
4. Choose site for IV.
5. Apply tourniquet 2-6 inches above injection site depending on condition of
patient.
6. Check for radial pulse below tourniquet.
7. Disinfect the insertion site with alcohol swab.
8. Using the appropriate IV cannula, pierce skin with the correct technique.
9. Upon backflow visualization, continue inserting the catheter into the vein.
10. Position the IV catheter parallel to the skin.
11. Hold stylet stationary and slowly advance the catheter until the hub is
1mm to the puncture site.
12. Slip a sterilize gauze under the hub. Release the tourniquet; remove the
stylet while applying digital pressure over the catheter with one finger about
1-2 inches from the tip of the inserted catheter.
13. Connect the infusion tubing of the prepared IVF aseptically too the IV
catheter.
14. Open the clamp and regulate the flow rate.
15. Reassure patient.
16. Anchor needle firmly in place.
17. Tape a small loop of IV tubing for additional anchoring. Apply splint if
needed.
18. Calibrate the IVF bottle and regulate flow of infusion according to
prescribed duration.
19. Label on IV tape near IV site to indicate the date of insertion, type, and
gauge of IV catheter and countersign.
20. Label with plaster on the IV tubing to indicate the date when to change
the IV tubing.
21. Observe patient and report any untoward effect.
22. Discard sharps and waste according to Health Care Waste Management
(DOH/DENR).
23. Document in the patient’s chart and endorse to incoming shift.
TOTAL SCORE
PRACTICUM PROCEDURE FORM 1C
PROCEDURE: CHANGING AN IV SOLUTION
STEPS CD ID REMARKS
CHANGING AN IV SOLUTION
1.Verify written prescription for in doctor’s order sheet; countercheck iv
label, iv tag, infusate /solution sequence, type, amount, additives (if any), and
duration of infusion.
2. Observe 10 Rs.
3. Explain procedure to reassure patient and/or significant others and assess
IV site for redness, swelling, pain, etc.
4. Change IV tubing and cannula within 72 hours after IV insertion or upon
the discretion of the attending medical doctor.
5. Wash hands before and after the procedure.
6. Prepare necessary materials; place on an I.V. tray.
7. Check sterility and integrity of IV solution.
8. Place IV label on the IV bottle.
9. Calibrate new IV bottle according to duration of infusion as per
prescription.
10. Open and connect the I.V. tubing into the solution bottle.
11. Close the roller clamp.
12. Regulate the flow rate according to the prescribed infusion rate. Expel air
bubbles, if evident.
13. Reiterate assurance to patient and significant others.
Discard all waste materials according to Health Care Waste Management
(DOH/DENR).
14. Document and endorse accordingly.
TOTAL SCORE
PRACTICUM PROCEDURE FORM 1D
PROCEDURE: DISCONTINUING AN IV INFUSION
STEPS CD ID REMARKS
DISCONTINUING AN IV INFUSION
1.Verify written doctor’s order to discontinue IV including iv medication.
2. Observe 10 Rs.
3. Assess and inform the patient of the discontinuation of IV infusion.
4. Prepare necessary materials; IV tray or injection tray with sterile cotton
balls with alcohol, plaster, pick-up forceps in antiseptic solution, kidney basin
and band aid.
5. Wash hands before and after procedure place on an I.V. tray.
6. Close the roller clamp of the IV administration set.
7. Moisten adhesive tapes around the IV catheter with cotton ball with
alcohol; remove plaster gently.
8. Use pick-up forceps to get cotton ball with alcohol and without applying
pressure, remove needle or IV catheter then immediately apply pressure,
over the venipuncture site.
9. Inspect IV catheter for completeness.
10. Place dressing over the venipuncture site.
11. Reassure patient.
12. Discard all waste materials including the IV cannula according to Health
Care Waste Management (DOH/DENR).
14. Document time of discontinuance, status of insertion site and integrity of
IV catheter and endorse accordingly.
TOTAL SCORE
PRACTICUM PROCEDURE FORM 1E
INSTRUCTION: Please check (/) on the space provided to assure whether the participant is able to perform the
PROCEDURE: BLOOD TRANSFUSION

STEPS CD ID REMARKS
BLOOD TRANSFUSION
1. Verify doctor’s written prescription and make a treatment card according
to hospital policy.
2. Observe 10 Rs when preparing and administering Blood and blood
components.
3. Explain the procedure/rationale for giving blood transfusion to reassure
patient and significant others and secure consent. Get patient histories
regarding previous transfusion.
4. Explain the importance of the benefits on Voluntary Blood donation (RA
7719-National Blood Service Act of 1994)
5. Request prescribed blood/blood components from blood bank to include
blood typing and x-matching and blood result of transmissible disease.
6. Use a clean and safe container to get the prescribed blood or blood
product from hospital blood bank and keep it at room temperature.
7. Assess patient condition. The doctor and the nurse should countercheck
the compatible blood and blood product to be transfused against x-matching
sheet noting ABO grouping and RH, serial no. of each blood unit, and expiry
date with the blood bag label and other laboratory blood exams as required
before transfusion (Hgb and Hct)
8. Get the baseline vital signs- BP, RR, and temperature before transfusion.
Refer to MD accordingly.
9. Give pre-med 30 minutes before transfusion as prescribed.
10. Prepare equipment needed for BT (IV injection tray, compatible BT set, IV
catheter/G 16 to 19 and/or as appropriate, plaster, tourniquet, blood, blood
components to be transfused, Plain NSS, 500 cc, IV set, needle gauge 16 to 18
(only if needed), IV hook, gloves, sterile 2x2 gauze or transparent dressing,
etc.
12. If main IVF is with dextrose 5% initiate an IV line with appropriate IV
catheterlG18 to 19 and or as appropriate, with Plain NSS on another site,
anchor catheter properly and regulate IV drops.
13. Open compatible blood set aseptically and close roller clamp. Spike blood
bag carefully; fill the drip chamber at least half full; prime tubing and remove
air bubbles (if any). Use needle g.16 to 19 and/or as appropriate for adults or
g.22 to 24 for Pedia (if blood is given through the Y injection port.)
14. Disinfect the Y-injection port of IV tubing (plain NSS) and insert the
needle form BT administration set and secure with adhesive tape.
15. Close roller clamp of IV fluid of Plain NSS or regulate to KVO while
transfusion is going on.
16. Transfuse the blood via the injection port and regulate at 10-15gtts/min.
Initially for 15 minutes and then at the prescribed rate (usually based on the
patient’s condition).
17. Monitor the patient within the first 5-10 minutes of transfusion and refer
immediately to the MD for any adverse reaction.
18. Observe/assess patient on an on-going basis for any untoward signs and
symptoms such as flushed skin, chills, elevated temperature, itchiness,
urticarial and dyspnea. If any of these symptoms occur, stop the transfusion.
Open the IV line with Plain NSS and regulate accordingly, and report to the
doctor immediately.
19. Swirl the bag gently from time to time to mix the solid with the plasma
N.B. one B.T. set should be used for 1-2 units of blood.
20. When blood is consumed, close the roller clamp of BT, and disconnect
from IV lines then regulate the IVF of plain NSS as prescribed.
21. Continue to observe and monitor patient post transfusion, for delayed
reaction could still occur.
22. Re-check Hgb and Hct, bleeding time, serial platelet count within
specified hours as prescribed and/or per institution’s policy.
23. Discard blood bag and BT set and sharps according to Health Care waste
Management (DOH/DENR).
24. Fill-out adverse reaction sheet as per institutional policy and return the
blood bag and whole set to the blood bank or laboratory for examination.
25. remind the doctor about the administration of calcium Gluconate if
patient has several units of blood transfusion (3-5 more units of blood).
26. Document time of discontinuance, status of insertion site and integrity of
IV catheter and endorse accordingly.
TOTAL SCORE
PRACTICUM PROCEDURE FORM 1F

PROCEDURE: PARENTERAL NUTRITION INFUSION UTILIZING CVA
STEPS CD ID REMARKS
PARENTERAL NUTRITION INFUSION UTILIZING CVA
1. Verify doctor’s written prescription
2. Observe the 10 Rs in safe drug administration
3. Explain the procedure to reassure patient and significant others (benefits,
risks, duration, changes in volume and flow rate, etc.)
4. Secure consent from patient or/and authorized member of the family.
5. Do hand hygiene and maintain asepsis throughout the procedure
6. Prepare parenteral solution and all other devices needed for the
parenteral administration. Taking into consideration the mode of
administration such as: peripheral access and central access
7. Check the integrity and functionality of the parenteral solution and IV
devices.
8. Assess patient and choose suitable vein, location and get baseline vital
signs.
9. Prepare Parenteral nutrition solution (follow procedure in Setting up)
10. Insert the IV catheter aseptically (large, bore catheter, follow procedure
in IV insertion).
11. Connect the tubing to the prepared parenteral solution and regulate the
flow rate as prescribed.
12. Dress IV sites as per IV standard
13. Label IV site and solution as per IV standard.
14. Continue to reassure patient and do pertinent health education.
15. Dispose waste materials according to Health care waste Management
(DOH/DENR).
16. Monitor patient periodically and report unusual findings if there are signs
of infection, hyper and hypoglycemia, change of color and consistency of
solution, etc.
15 Document procedure and observations with corresponding nursing
intervention in the patient’s chart like I and O, weigh daily, etc.
TOTAL SCORE
PRACTICUM PROCEDURE FORM 1G
PROCEDURE: MEDICATION INCORPORATION INTO VOLUMETRIC CHAMBER
STEPS CD ID REMARKS
Medication Incorporation into Volumetric Chamber
1. Verify the written medication card against the M.D. prescription; observe
hospital policy on drug administration
2.Observe 10 Rs when preparing and administering medication
3. Explain procedure (medication and action) to reassure patient and
significant others and check patency and IV site. Verify if skin test is
necessary before IV drug incorporation
5. Prepare the necessary materials for the procedure such as right drug and
dose, right diluent needed, IV injection tray, syringe, and needles.
6. Check present IV fluid label, and the incorporated medicine in Volumetric
Chamber or IV bottle if with incorporated medicine, check for drug-drug
incompatibility and if the on-going IV fluid in the Volumetric Chamber is to be
consumed in 6-8 hours, request a prescription, and keep the whole set sterile
for succeeding doses.
7. Aspirate prepared right drug with correct dose.
8. Add desired IVF diluent into volumetric chamber by opening the sliding
clamp from the bottle then close the clamp.
9. Disinfect rubber injection port for the volumetric chamber and incorporate
the drug. Mix gently.
10. Open the clamp of the airway at the volumetric chamber and incorporate
the drug. Mix gently.
11. Regulate the flow rate of IVF infusion accordingly.
12. Place the IV label on volumetric chamber indicating drug incorporate and
flow rate.
13. Reassure/monitor patient when incorporated medicine is consumed;
clamp airway of volumetric Chamber, add IVF and regulate flow rate of main
IVF as prescribed.
11. Discard waste according to Health Care Waste Management
(DOH/DENR).
12. Document the procedure done on the patient’s chart.
TOTAL SCORE
PRACTICUM PROCEDURE FORM 1H
PROCEDURE: INCORPORATING MEDICATIONS INTO IV SOLUTION
STEPS CD ID REMARKS
INCORPORATING MEDICATIONS INTO IV SOLUTION
1. Verify the written medication card against the M.D. prescription; observe
hospital policy on drug administration
2. Observe 10 Rs when preparing and administering medication.
3. Explain procedure (medication and action) to reassure patient and
significant others and check patency and IV site.
4. Verify if skin test is necessary before IV drug incorporation
5. Prepare the necessary materials needed for the
procedure such as: injection tray, syringes needed, right
drug to be incorporated either vial or ampule.
6. Do hand hygiene before and after the procedure
7. Disinfect injection port of the vial and the ampule before
breaking then aspirate the right dose aseptically.
8. Remove the cover of the administration set, maintain
sterility and incorporate prepared drug into the airway
aseptically. Recap airway after.
Note: If the administration set has no airway, pull out the set and
incorporate the prepared drug and re-spike the IV set to the bottle then
place the label (all this should be done aseptically)
9. Swirl the IV bottle gently to mix the drug with IVF and
regulate the flow rate accordingly.
10. Observe for 5-10 min for any drug interaction while
reassuring the patient; monitor VS.
11. Discard sharp and other wastes according to Health
care Waste management (DOH/DENR).
12. Document the procedure done on the patient’s chart
TOTAL SCORE
PRACTICUM PROCEDURE FORM 1I
PROCEDURE: IV MEDICATION PUSH THROUGH THE IV PORT
STEPS CD ID REMARKS
IV MEDICATION PUSH THROUGH THE IV PORT
1. Verify medication card against the written doctor’s prescription.
2. Observe 10 Rs when preparing and administering medication.
3. Explain procedure to reassure patient and significant others (the name of
medicine and action/interaction of medication) before administration.
4. Do hand hygiene before and after the procedure (use gloves especially for
chemotherapeutic and other vesicant drugs).
5. Check patency and other reaction signs of swelling, redness, phlebitis,
etc… if any of these are evident, do not give the drug.
6. Check for skin test result of drug for IV push, drug-drug, drug IV fluid
incompatibility, dosage (computation).
7. Prepare the necessary materials for the procedure such as: right drug right
diluent needed, IV injection tray, syringes with needles, alcohol, etc.
8. Disinfect injection port of the diluent, vial or ampule as may be
appropriate.
9. Aspirate right amount of diluent for the drug (if the drug needs to be
diluted).
10. Aspirate the right drug dose; disinfect the Y-injection port of the IV
administration set/catheter IV port.
11. Close the roller clamp of the IV tubing from the bottle and push IV drug
aseptically and slowly according to the manufacturer’s recommendation.
12. Using the same syringe, aspirate 1-2 cc of IVF to flush the medicine given.
13. Regulate rate of IV fluid infusion as prescribed (If needed).
14. Reassure patient and observe for signs and symptoms of adverse drug
reaction.
15. Discard sharp and other wastes according to Health care Waste
management (DOH/DENR).
12. Document the procedure done on the patient’s chart.
TOTAL SCORE
PRACTICUM PROCEDURE FORM 1J
PROCEDURE: IV MEDICATION PUSH THROUGH THE HEPARIN-LOCK DEVICE

STEPS CD ID REMARKS
IV MEDICATION PUSH THROUGH THE HEPARIN-LOCK DEVICE
(Note: Some Hospitals does not use Heparin anymore)
1. Observe 10 Golden Rules Rs when administering medication.
2. Verify doctor’s prescription.
3. Preparing and administering doctor’s prescription.
4. Check medication card against the written doctor’s prescription.
5. Explain procedure to the patient (name of the medicine and action) before
administration.
6. Do hand hygiene before and after the procedure (use gloves especially for
chemotherapeutic drugs).
7. Gather equipment to include/ but not limited to IV tray, Normal Saline
diluent or Isotonic solution, 2.5 cc syringes (2-3 pcs) as needed.
8. Prepare medication to be administered, e.g. antibiotic, and draw it up into
a syringe.
9. Fill a tuberculin syringe with Heparin solution. N.B. Heparin solution is
usually prepared with 0.1cc. Heparin plus 0.9 Normal Saline or Isotonic
solution as prescribed by the Doctor.
10. Fill the 2.5cc syringe with Isotonic solution or Normal Saline solution ;
each 1cc each.
11. If using Heparin Lock device with 3-way stop cock with Luer-lock, rotate
the stop cock so that the line going to the patient is closed (This will prevent
backflow of blood.)
12. Remove the cover of the injection port aseptically and keep the sterility
of the cover.
13. Check the patency, open the IV line and inject NSS or Isotonic Solution to
flush the Heparin Solution as prescribed by the Doctor.
14. Close the IV line and remove saline syringe and insert medication syringe
into the port. Give I.V push 5-10 minutes for I.V. potent drug. For 2-3 I.V
medications, give at least 30 minutes to 1 hour interval. After each drug
administered via I.V push, flush with 2-3cc saline solution.
15. Observe patient for any adverse reactions and do nursing intervention
accordingly.
16. Discard waste according to Health care Waste management (DOH/DENR).
12. Document in the patient’s chart.
Note: Normal Saline can take place Heparin. Studies shown the efficacy of
NSS. Heparin solution can be used if Normal saline or Isotonic solution is
not available and as prescribed by the MD.
TOTAL SCORE

Data Privacy Quiz 30

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Data Privacy Quiz 30

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PRACTICUM PROCEDURE FORM 1A

Name: ____________________________ Year/Section/Group: _ Date: ___________

PROCEDURE: INSERTING IV UTILIZING THE DUMMY ARM

Name: ____________________________ Year/Section/Group: _ Date: ___________

PROCEDURE: CHANGING AN IV SOLUTION

Name: ____________________________ Year/Section/Group: _ Date: ___________

PROCEDURE: DISCONTINUING AN IV INFUSION

PROCEDURE: BLOOD TRANSFUSION

PRACTICUM PROCEDURE FORM 1F

PROCEDURE: PARENTERAL NUTRITION INFUSION UTILIZING CVA

Name: ____________________________ Year/Section/Group: _ Date: ___________

PROCEDURE: MEDICATION INCORPORATION INTO VOLUMETRIC CHAMBER

Name: ____________________________ Year/Section/Group: _ Date: ___________

PROCEDURE: INCORPORATING MEDICATIONS INTO IV SOLUTION

Name: ____________________________ Year/Section/Group: _ Date: ___________

PROCEDURE: IV MEDICATION PUSH THROUGH THE IV PORT

Name: ____________________________ Year/Section/Group: _ Date: ___________

PROCEDURE: IV MEDICATION PUSH THROUGH THE HEPARIN-LOCK DEVICE

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