Procedure 85 Attaching The Humidifier To The Oxygen Flow Meter Or Regulator. Procedure 86 Administering Oxygen Through A Nasal Cannula

Transcription

1 Chapter 12 Respiratory Procedures Procedure 81 Checking Capillary Refill Procedure 82 Using A Pulse Oximeter Procedure 83 Preparing Wall-Outlet Oxygen Procedure 84 Preparing The Oxygen Cylinder Procedure 85 Attaching The Humidifier To The Oxygen Flow Meter Or Regulator Procedure 86 Administering Oxygen Through A Nasal Cannula Procedure 87 Administering Oxygen Through A Mask Procedure 88 Inserting The Oropharyngeal Airway Procedure 89 Inserting The Nasopharyngeal Airway Procedure 90 Oropharyngeal Suctioning Procedure 91 Nasopharyngeal Suctioning Procedure 92 Assisting With Postural Drainage

2 Procedure 81 Checking Capillary Refill PERFORMANCE REVIEW CHECKLIST Name of Patient Care Technician of Program to Social Security Number or Identification Number _ Program Code Number (if any) S=Satisfactory Performance U=Unsatisfactory Performance Place a full signature to correspond with each set of initials appearing below. Initials Corresponding Signature of Instructor Title Procedure Guidelines S/U Initials S/U Initials 1. Perform your beginning procedure 2. Inspect the nails, noting the color. 3. Press the nail for a few seconds, until the skin underneath blanches or turns white. 4. Release the nail and evaluate the time it takes for the skin to return to the normal color. In normal oxygenation, this will occur within 2 to 3 seconds. 5. Perform your procedure completion Instructor Signature Student Signature

3 Procedure 82 Using A Pulse Oximeter PERFORMANCE REVIEW CHECKLIST Name of Patient Care Technician of Program to Social Security Number or Identification Number _ Program Code Number (if any) S=Satisfactory Performance U=Unsatisfactory Performance Place a full signature to correspond with each set of initials appearing below. Initials Corresponding Signature of Instructor Title Supplies needed: Pulse oximeter unit Sensor appropriate to the site Adhesive tape, if needed, to secure the sensor Procedure Guidelines S/U Initials S/U Initials 1. Perform your beginning procedure 2. Select and apply the sensor. If the sensor has position markings, align them opposite each other to ensure an accurate reading. Fasten the sensor securely, or the reading will not be accurate. Make sure the sensor is not wrapped so tightly with tape that it restricts blood flow. 3. Attach the sensor to the patient cable on the oximeter. 4. Turn the unit on. You will hear a beep with each pulse beat. Adjust the volume as desired. Some units also have light bars, indicating the strength of the pulse. Note the percentage of oxygen saturation. Inform the RN, or document according to facility policy.

4 Procedure Guidelines S/U Initials S/U Initials 5. Note the patient s pulse rate, if the unit provides this reading. Compare with the patient s actual pulse to make sure the unit is picking up each beat. Inform the RN, or document according to facility policy. 6. Monitor the patient s respirations and general appearance. Inform the RN, or document according to facility policy. If the patient s general condition changes at any time, notify the RN. 7. Perform your procedure completion Instructor Signature Student Signature

5 Procedure 83 Preparing Wall-Outlet Oxygen PERFORMANCE REVIEW CHECKLIST Name of Patient Care Technician of Program to Social Security Number or Identification Number _ Program Code Number (if any) S=Satisfactory Performance U=Unsatisfactory Performance Place a full signature to correspond with each set of initials appearing below. Initials Corresponding Signature of Instructor Title Supplies needed: Flow meter Sterile humidifier bottle, if used Oxygen precautions sign(s) Triangular adapter, if necessary (this is commonly called a Christmas tree because of its shape and color) Procedure Guidelines S/U Initials S/U Initials 1. Perform your beginning procedure 2. Select the correct flow meter. Oxygen is color-coded green in the United States and air is coded black. You cannot put the flow meter in the wrong outlet because the connectors are different sizes. 3. Attach the male adapter in the flow meter to the female adapter in the oxygen plate in the wall by pushing it in securely. You may need to push hard. 4. Hold the flow meter in your hand as you gradually release the pressure. If the flow meter is not securely in place, it may pop out, causing injury. 5. Gently pull on the flow meter to make sure it will not fall off the wall.

6 Procedure Guidelines S/U Initials S/U Initials 6. Attach the sterile humidifier bottle (Procedure 85), if used. 7. If the humidifier is not used, you must screw the triangular adapter to the bottom of the flow meter. Connect the tubing to the point of the triangle. 8. Post the oxygen precautions sign(s) according to facility policy. 9. Perform your procedure completion Instructor Signature Student Signature

7 Procedure 84 Preparing The Oxygen Cylinder PERFORMANCE REVIEW CHECKLIST Name of Patient Care Technician of Program to Social Security Number or Identification Number _ Program Code Number (if any) S=Satisfactory Performance U=Unsatisfactory Performance Place a full signature to correspond with each set of initials appearing below. Initials Corresponding Signature of Instructor Title Supplies needed: Oxygen cylinder Wrench, depending on type of flow meter used Handle or wrench for opening cylinder valve Flow meter to fit cylinder Sterile humidifier bottle, if used Sterile distilled water for humidifier Tubing and delivery device Oxygen precautions sign(s) Procedure Guidelines S/U Initials S/U Initials 1. Perform your beginning procedure 2. Obtain the cylinder. Check the color and read the label to identify the contents. 3. Transport the cylinder to the designated area, chained to a wheeled dolly, if necessary. 4. Position the cylinder upright on the dolly, upright in a base, or chained to the wall. 5. Stand to the side. Do not stand directly over the cylinder. Remove the metal or plastic cap, or wrapper protecting the outlet.

8 Procedure Guidelines S/U Initials S/U Initials 6. Attach the handle to the cylinder. Crack the main valve for one second. Close the valve. 7. Position the cylinder valve gasket on the regulator port. 8. Check the regulator. Turn the knob to make sure the regulator port is closed. 9. Align the two holes in the outlet with the two pins in the regulator, or thread the nut onto the male adapter on the outlet. Tighten the t-screw for the pin yolk, or use a wrench to tighten the threaded outlet. Note: for small, cylinder-type regulators, a Teflon O ring must be in place, or the connection will leak. 10. Turn the cylinder on and check the pressure gauge. Make sure the cylinder is full. Listen for air leaks. If a leak is present, turn the cylinder off, remove the regulator, and reapply. 11. Attach the humidifier filled with sterile distilled water, tubing, and delivery device, if ordered. 12. Post the oxygen precautions sign(s) according to facility policy. 13. Perform your procedure completion Instructor Signature Student Signature

9 Procedure 85 PERFORMANCE REVIEW CHECKLIST Attaching The Humidifier To The Oxygen Flow Meter Or Regulator Name of Patient Care Technician of Program to Social Security Number or Identification Number _ Program Code Number (if any) S=Satisfactory Performance U=Unsatisfactory Performance Place a full signature to correspond with each set of initials appearing below. Initials Corresponding Signature of Instructor Title Supplies needed: Sterile disposable or refillable humidifier bottle Sterile distilled water for refillable humidifier Procedure Guidelines S/U Initials S/U Initials 1. Perform your procedure completion 2. Open the package for the humidifier and remove the bottle. 3. If a refillable humidifier is used, obtain a fresh bottle that has been washed and sterilized. Unscrew the lid and place it with the clean inside up on the table. Fill the bottle with sterile distilled water, then replace the lid. Do not touch the inside of the bottle or lid with your fingers. 4. Connect the female adapter in the top of the humidifier bottle to the male adapter on the flow meter. Tighten the nut securely. 5. Connect the tubing on the cannula or mask to the male adapter on the side of the humidifier bottle.

10 Procedure Guidelines S/U Initials S/U Initials 6. Turn on the flow of oxygen. Pinch the connecting tubing to ensure that the safety valve pops off. 7. Perform your procedure completion Instructor Signature Student Signature

11 Procedure 86 PERFORMANCE REVIEW CHECKLIST Administering Oxygen Through A Nasal Cannula Name of Patient Care Technician of Program to Social Security Number or Identification Number _ Program Code Number (if any) S=Satisfactory Performance U=Unsatisfactory Performance Place a full signature to correspond with each set of initials appearing below. Initials Corresponding Signature of Instructor Title Supplies needed: Oxygen cannula Procedure Guidelines S/U Initials S/U Initials 1. Perform your beginning procedure 2. Connect the end of the cannula tubing to the male adapter on the humidifier or flow meter by pushing it securely in place. 3. Turn the oxygen on to the designated flow rate by adjusting the knob on the flow meter. 4. Place your hand in front of the nasal prongs to feel the flow of oxygen. 5. Position the cannula in the patient s nostrils. Tighten the adjustment on the strap so it is secure, but not too tight. 6. Perform your procedure completion Instructor Signature Student Signature

12 Procedure 87 Administering Oxygen Through A Mask PERFORMANCE REVIEW CHECKLIST Name of Patient Care Technician of Program to Social Security Number or Identification Number _ Program Code Number (if any) S=Satisfactory Performance U=Unsatisfactory Performance Place a full signature to correspond with each set of initials appearing below. Initials Corresponding Signature of Instructor Title Supplies needed: Oxygen mask Procedure Guidelines S/U Initials S/U Initials 1. Perform your beginning procedure 2. Connect the end of the mask tubing to the male adapter on the humidifier or flow meter by pushing it securely into place. 3. Turn the oxygen on to the designated flow rate by adjusting the knob on the flow meter. 4. Place your hand in front of the inlet and feel for the flow of oxygen. 5. Position the mask over the patient s nose, mouth, and chin. Mold the metal band at the top of the mask to the patient s nose. 6. Slip the elastic strap behind the patient s head. 7. Tighten the adjustment on the elastic strap so that the mask is secure, but not too tight.

13 Procedure Guidelines S/U Initials S/U Initials 8. Perform your procedure completion Instructor Signature Student Signature

14 Procedure 88 Inserting The Oropharyngeal Airway PERFORMANCE REVIEW CHECKLIST Name of Patient Care Technician of Program to Social Security Number or Identification Number _ Program Code Number (if any) S=Satisfactory Performance U=Unsatisfactory Performance Place a full signature to correspond with each set of initials appearing below. Initials Corresponding Signature of Instructor Title Supplies needed: Disposable exam gloves Oral airways of various sizes Tongue blade (optional) Procedure Guidelines S/U Initials S/U Initials 1. Perform your beginning procedure 2. If the patient s mouth is not open, use a tongue blade or cross the thumb and forefinger of one gloved hand. Position your fingers in the corner of the mouth, on the upper and lower teeth. Spread your fingers apart to open the mouth. 3. Select the airway size and position it with the tip pointing sideways, toward the cheek.

15 Procedure Guidelines S/U Initials S/U Initials 4. Insert the airway into the mouth, sliding it along the tongue past the tissue in the back of the throat until you meet resistance. Check the tongue to make sure it is not against the back of the throat. An alternate method is to press the tongue down and forward with the tongue blade. Insert the airway with the tip pointing downward. This method is preferred in infants and children. 5. Gently rotate the airway 90 degrees, until the tip is pointing down. 6. Check the tongue to make sure it is not against the back of the throat. The flange of the airway should be between the patient s lips. 7. Check the patient s respirations to ensure that they are adequate. 8. Perform your procedure completion Instructor Signature Student Signature

16 Procedure 89 Inserting The Nasopharyngeal Airway PERFORMANCE REVIEW CHECKLIST Name of Patient Care Technician of Program to Social Security Number or Identification Number _ Program Code Number (if any) S=Satisfactory Performance U=Unsatisfactory Performance Place a full signature to correspond with each set of initials appearing below. Initials Corresponding Signature of Instructor Title Supplies needed: Disposable exam gloves Water-soluble lubricant Nasopharyngeal airways, assortment of sizes Tongue blade Procedure Guidelines S/U Initials S/U Initials 1. Perform your beginning procedure 2. Select the correct size airway: slightly smaller than the diameter of the nostril, and approximately 1 inch longer than the distance from the tip of the nose to the earlobe. 3. Lubricate the distal half of the airway with water-soluble lubricant. 4. With your nondominant index finger, push up on the tip of the patient s nose. 5. Hold the airway in your dominant hand. Insert it into the nostril and gently thread the tube until the flange is at the tip of the nose. Avoid forcing the airway. If you meet resistance, remove the airway and notify the RN.

17 Procedure Guidelines S/U Initials S/U Initials 6. After the airway is inserted, depress the tongue with a tongue blade. Look for the airway behind the soft tissue at the back of the throat. Next, close the patient s mouth. Place your finger in front of the airway to feel for air movement. 7. Perform your procedure completion Instructor Signature Student Signature

18 Procedure 90 Oropharyngeal Suctioning PERFORMANCE REVIEW CHECKLIST Name of Patient Care Technician of Program to Social Security Number or Identification Number _ Program Code Number (if any) S=Satisfactory Performance U=Unsatisfactory Performance Place a full signature to correspond with each set of initials appearing below. Initials Corresponding Signature of Instructor Title Supplies needed: Suction regulator Sterile gloves Other personal protective equipment as needed or according to facility policy Yankauer suction catheter, or sterile #12 or #14 French suction catheter for an adult Sterile water or normal saline Small sterile basin Plastic bag for used supplies Procedure Guidelines S/U Initials S/U Initials 1. Perform your beginning procedure 2. Open the sterile water. Pour some into the sterile basin. 3. Attach the connecting tubing to the suction regulator, if this has not been done. Turn the suction on. Place your finger over the distal end of the connecting tubing to check the suction while the tube is blocked. 4. Open the suction catheter. Attach the connecting tubing to the proximal suction catheter. Maintain sterility by exposing only the connecting end of the catheter. Keep the distal (patient) end covered inside the wrapper.

19 Procedure Guidelines S/U Initials S/U Initials 5. Apply sterile gloves. Consider your dominant hand sterile and your nondominant hand unsterile. Use your nondominant hand to pick up objects and to open the catheter package so you can remove it with your sterile hand. You can use your nondominant hand to open and close the thumb valve while your dominant hand controls the position of the catheter. 6. Pick up the catheter with your sterile hand. Connect it to the connecting tubing. 7. Gently insert the catheter 3 to 4 inches along the side of the patient s mouth, or until you reach the pool of secretions, without applying suction. 8. Cover the thumb valve, or open the catheter and suction the secretions, and both sides of the mouth in a continuous rotating motion. 9. Suction for no longer than 10 seconds, including the time it takes you to withdraw the catheter. 10. Allow the patient to breathe normally before reinserting the catheter. If you will be reinserting the catheter, wrap it around your dominant hand, leaving the distal end free, to avoid contamination. 11. If secretions are thick, insert the tip of the catheter into the sterile water, suctioning water into the catheter and connecting tubing to clear it. 12. Repeat the suctioning until gurgling or bubbling stops and the patient s respirations are silent. 13. Perform your procedure completion Instructor Signature Student Signature

20 Procedure 91 Nasopharyngeal Suctioning PERFORMANCE REVIEW CHECKLIST Name of Patient Care Technician of Program to Social Security Number or Identification Number _ Program Code Number (if any) S=Satisfactory Performance U=Unsatisfactory Performance Place a full signature to correspond with each set of initials appearing below. Initials Corresponding Signature of Instructor Title Supplies needed: Suction regulator Sterile gloves Other personal protective equipment as needed or according to facility policy Sterile #12 or #14 French suction catheter for an adult Sterile water or normal saline Small sterile basin Water-soluble lubricant Plastic bag for used supplies Procedure Guidelines S/U Initials S/U Initials 1. Perform your beginning procedure 2. Open the sterile water and sterile basin. Pour some water into the sterile basin. 3. Attach the connecting tubing to the suction regulator, if this has not been done. Turn the suction on. Place your finger over the distal end, then remove it to check the suction. 4. Open the suction catheter. Attach the connecting tubing to the proximal suction catheter. Maintain sterility by exposing only the connecting end to the catheter. Keep the distal (patient) end covered inside the wrapper.

21 Procedure Guidelines S/U Initials S/U Initials 5. Apply sterile gloves. Consider your dominant hand sterile and your nondominant hand unsterile. Use your nondominant hand to pick up objects and to open the catheter package so you can remove it with your sterile hand. Use your nondominant hand to open and close the thumb valve while your dominant hand controls the position of the catheter. 6. With your nondominant hand, apply a small amount of water-soluble lubricant on the sterile area. 7. Pick up the catheter with your sterile hand. Lubricate the tip with the watersoluble lubricant. 8. With your nondominant index finger, push up on the tip of the patient s nose. If a nasopharyngeal airway is in place, omit this step. 9. Gently insert the catheter into the nostril. If the patient has a nasopharyngeal airway in place, insert the catheter through the lumen of the airway. Thread it carefully, 5 to 6 inches, until you reach the pool of secretions, or the patient begins to cough. Do not force the catheter. Withdraw if you meet resistance. Do not apply suction during catheter insertion. 10. Cover the thumb valve, or open the catheter and suction the secretions, in a continuous rotating motion. 11. Suction for no longer than 10 seconds, including the time it takes you to withdraw the catheter. 12. Allow the patient to breathe normally before reinserting the catheter. If you will be reinserting the catheter, wrap it around your dominant hand, leaving the distal end free, to avoid contamination. 13. If secretions are thick, insert the tip of the catheter into the sterile water, suctioning water into the catheter and connecting tubing to clear it.

22 Procedure Guidelines S/U Initials S/U Initials 14. Repeat the suctioning until gurgling or bubbling stops and the patient s respirations are silent. 15. Perform your procedure completion Instructor Signature Student Signature

23 Procedure 92 Assisting With Postural Drainage PERFORMANCE REVIEW CHECKLIST Name of Patient Care Technician of Program to Social Security Number or Identification Number _ Program Code Number (if any) S=Satisfactory Performance U=Unsatisfactory Performance Place a full signature to correspond with each set of initials appearing below. Initials Corresponding Signature of Instructor Title Supplies needed: Disposable exam gloves Emesis basin Tissues Mouthwash Cup Straw Pillows Props Plastic bag for used supplies Procedure Guidelines S/U Initials S/U Initials 1. Perform your beginning procedure 2. Position and support the patient as directed, using foam wedges or pillows. 3. Provide an emesis basin, tissues, and bag in which to discard secretions. 4. Remain in the room with the patient during and after the procedure. Monitor for signs and symptoms of respiratory distress. Monitor vital signs as directed. Provide comfort measures as necessary. 5. Offer the patient mouthwash to rinse the mouth.

24 Procedure Guidelines S/U Initials S/U Initials 6. Perform your procedure completion Instructor Signature Student Signature