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Paediatric Critical Care Nursing Competency Care of patient with Noninvasive Positive Pressure Ventilation (BiPAP) Name:... .

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Competency statement: The nurse will: a) Correctly prepare patient for NIV (BiPAP) ventilation b) Safely assess patient with NIV (BiPAP) ventilation c) Provide patient and family with information and education. d) Performance criteria: Y= YES N=NO NA= Not Applicable No Observation / Interview Date

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Wash hands and put on appropriate personal protective equipment Check doctors order. Assess patients requirement for BiPAP ventilation. Prepare equipment necessary - BiPAP machine with tubing and humidifier. - correct mask size and strap. Explain procedure to patient and family. Connect ventilator to oxygen and electrical outlet (ventilator and humidifier) Perform a pre- use ventilator check and set humidifier temperature. Inform doctor to set parameters on ventilator and verify proper operation. Put on headstrap Place mask on patient (with or without oxygen connected). Connect circuit to the mask. Tighten headstrap snugly to secure the mask. Assess patients breathing and ventilator synchronizes with patient efforts.

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Observation / Interview Set alarms appropriately to signal disconnect or mask malposition. Tidy and position patient appropriately Document in the NIV chart. Re-assess the patient hourly or as needed in response to changes in orders, changes in patient condition, and in response to ventilator alarms. Assessment criteria includes: -respiratory rate -patients effort -air entry -synchronize with ventilator flow -minute volume -air leak -humidification temperature -condensation in the circuit Notify doctor of changes in patients condition and respiratory status.

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Total mark Percentage Signature of assessor Name of assessor/ stamp

Competent: Yes No Comment:.. ..

Paediatric Critical Care Nursing Competency Continous medication infusions Name:... Staff No:

Competency statement: The nurse will: 1. Administer correct dilution of medication. 2. Practice 6 R during drug administration. 3. Maintain a constant infusion of medication. 4. Know the importance of safe medication practice. Performance criteria: Y= YES N=NO NA= Not Applicable No Observation / Interview Date 1. Check doctors order for the medication 2. Review the 6 Rights and patients allergy. 3. Wash hands 4. Assure site of infusion-through peripheral IV/CVL 5. Prepare the medication for infusion: a) Verify the concentration for the infusion b) Recheck the dose for patients weight c) States the rate of administration d) Aspirate desired dose of medication from ampoules/vials (prepare sterile if through CVL) e) Correctly dilute with 0.9% N/Saline or D5% or IV solution which is compatible with the medication. 6. Connect the diluted medication with perfusor tubing 7. 8. 9. 10 11 12 No 13 Clears all air bubbles along tubing Attach the syringe to the infusion pump Ensure patency of IV line / CVL with 2cc 0.9% N/S flush Using aseptic technique, attach the IV tubing to the catheter hub Activate the infusion pump. Check the infusion pump every hour. Monitor patients vital signs and IV site for redness, blanching, difficulty flushing, swelling. Observation / Interview States the need to change the IV tubing every 72 hours 3 Date Date Date

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and prepare a new medication infusion every 24 hrs 14 Document and sign in IV cardex, NCP, Nursing report (Date, time infusion was started, patients name, R/N, Concentration, dosage and flow rate, IV catheter location utilized) Identify problem and report any abnormality. Total mark Percentage Signature of assessor Name of assessor/ stamp

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Competent: Yes No Comment:.. ..

Paediatric Critical Care Nursing Competency

Caring for ventilated patients Name:... Staff No:

Competency statement: The nurse will: Provide comprehensive and safe care of patients who require Mechanical ventilation. Performance criteria: Y= YES N=NO NA= Not Applicable No Observation / Interview Date 1. Identifies indication for mechanical ventilation 2. Select the desired ventilator type (consider patient diagnosis and the approximate length of time mechanical ventilation will be required). 3. Select the desired humidification system autofiller / Manual. Consider length of time mechanical Ventilation will be required. 4. Pre-use check the ventilator. 5. Assure that the airway ( Orotracheal.Nasotracheal.tracheostomy tube..) is properly positioned and taped. 6. Explains the function of the following ventilator control - Fi02, Rate, PIP. PEEP, TV, Sensitivity, Alarms and how to correct problem. 7. Correctly describes modes of ventilation: -SIMV, PC, PRVC, Pls, CPAP, HFOV. 8. States advantages / disadvantages of PEEP. 9. Initiate mechanical ventilation. 10. Assess vital signs and breath sounds. 11. Note the patients response to mechanical ventilation. 12. Perform ventilator check hourly a) Setting b) Humidification temperature c) Alarms are on and functioning d) VTe and VTi variations 13. Check for fluid accumulation in tubing 14. Disconnect and drain fluid in tubing into a receptacle as necessary. 15. Correctly assess the need for suctioning and chest physio. No Observation / Interview Date

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Correctly assess and evaluate: a) GI system for development of stress ulcer b) Level of consciousness c) Response to pain and sedation measures d) Intake and output e) Vital signs f) Respiratory system and ABG g) Invasive lines. Utilize safety practice when nursing a ventilated patient: a) Assure that the ETT / tracheostomy tube is stabilizes securely at all times. a) Prevention of infections. b) Hyperoxigenate adequantely while suctioning. c) Reduce Fi02 when indicated d) Safely giving in hale medication / INO Safely assess patient on weaning trial Encourage and assist patient in pulmonary toilet once extubated: - coughing, turning, deep breathing, incentive spirometry Record any finding and report ab normalities.. Total mark Percentage Signature of assessor Name of assessor/ stamp

Competent: Yes No Comment:.. . Paediatric Critical Care Nursing Competency

Neurological monitoring Name:... PKHU:

Competency statement: The nurse will: safely assist in insertion of intravenous catheter and care of patient with intravenous catheter. Performance criteria: Y= YES N=NO NA= Not Applicable Observation / Interview Date 1. Perform neurological assessment every 3 hourly. In patient with neurological disorder /DKA assess every hour. 2. Evaluate level of consciousness /responsiveness to verbal and tactile stimuli. 3. Evaluate motor response and abnormality eg: hemiplegia, spasticity or seizures. 4. Correlate to the Glasgow Coma Scale ( <5 year old and >5 year old) 5. Assess cranial nerve IX and X (cough and gag reflex). 6. Watch for sign and symptoms of raised ICP : change in level of consciousness, pupil dilation with decreased response to light, hypertension(with widen pulse pressure), bradycardia, apnea and deterioration in reflexive posturing. 7. For patient with ICP catheter : -a) inform doctor if any increased in ICP associated with or without clinical deterioration. b) inspect ICP catheter and site for any csf leakage, bleeding, inflammation and dressing. c) Check csf drainage for color, amount and characteristic. 8. Document in Neurological observation chart and Nursing record and report any abnormality. Paediatric Critical Care Nursing Competency

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Insertion of intravenous catheter Name:... PKHU:

Competency statement: The nurse will: safely assist in insertion of iv catheter and care for patient with iv catheter Performance criteria: Y= YES N=NO NA= Not Applicable Observation / Interview Date 1) Prepare equipment: tray, alcohol swabs, gauze, transparent dressing(tegaderm), adhesive tape, T- piece with 2 cc normal saline flush, splint, 1cc N/S flush, appropriate catheter. 2) Wash hands 3) Inform patient/ parents 4) Provide privacy 5) Select the venipuncture site 6) Apply tourniquet 4 inches above the proposed insertion site 7) Swab the skin with alcohol swab 8) Assist Dr. in iv insertion 9) Secure iv catheter (refer CD) 10) Label date of insertion at iv site 11)Discard needle and waste material in appropriate disposal bin. 12)Inspect the tissue around the dressing every 2 hour to 4 hours for redness, discoloration, leakage,tenderness. 13) Assess the catheter patency by flushing with 2cc N/S. 14) Document in nursing report : Date and time of insertion, site of insertion, skin condition, patency. 15) Report any abnormality findings. 16) Identified and manage unexpected outcomes 17) Maintain sterility while handling iv catheter

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Pediatric Critical Care Nursing Competency

Insertion of Arterial catheter and transducer system Name:... PKHU:

Competency statement: The nurse will: safely assist in insertion of arterial catheter and monitor blood pressure with transducer system. Performance criteria: Y= YES N=NO NA= Not Applicable Observation / Interview Date 1) Prepare equipment: tray, alcohol swabs, povidone swabs, gauze, transparent dressing(tegaderm), adhesive tape, Red 3 way (pre flush with 2 cc N/S) , splint, 1cc N/S flush, appropriate catheter, arterial line label, Sterile Transducer set, Pressure bag, 1 cc syringe, Heparin sodium, 500cc N/S,transducer holder mounted on intravenous pole. 2) Inform patient/ parents 3) Provide privacy 4) Wash hands 5) Select the puncture site 6) Support and dorsiflex limbs with rolled linen 7)Wash hands 8) Assist Dr. in arterial insertion 9) Secure arterial catheter 10) Label date and arterial line at insertion site 11) Wash hands 12) Open transducer set , 1cc syringe, alcohol swab and sterile gloves on sterile field. 13) Wash hands 14)Wear sterile gloves 15) Prepare 500 iu Heparin sodium in 500cc N/S 16) Spike the Heparinised solution with the pre assembled pressure tubing. 17) Tighten all connections 18) Prime the entire system with the flush solution 19) Remove all air bubbles from the system 20) Replace all caps with sterile occlusive caps 21) Place the flush solution into the pressure bag 22) Inflate the pressure bag to 100 mmhg 23) Hang transducer system to iv pole 24) Connect the pressure line to the arterial catheter. 25) Secure the tubing 26) Remove all air bubbles with 3cc syringe

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27) Flush any backflow of blood in the system 28) Level the transducer to the patient ( stopcock to the phlebostatic axis) 29) Turn the selected stopcock for off to patient and open to air. 30) Zero the transducer and monitor 31) Return stopcock to normal position 32) Calibrate and check transducer and flush system every syift / after tubing change / when dramatic change in wave form. 33) Identify the need to change transducer system every week 34) Label the flush system ( date, concentration of heparin in N/S 35) Observe insertion site for redness, blanching, pulse, color, sensation, skin temperature 36) Set monitor alarms 37) Document in NCP and nursing report. 38) Report abnormalities

Paediatric Critical Care Nursing Competency

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Endotracheal extubation Name:... PKHU:

Competency statement: The nurse will: successfully and safely assist Dr. in ETT extubation Performance criteria: Y= YES N=NO NA= Not Applicable Date Date Date Date

Observation / Interview 1. Prepare equipment: Oxygen source and device (Facemask, HF mask., Headbox,Bipap..,NCPAP..) Suction apparatus, Suction catheter, Sterile gloves, Bag-valve-mask, Intubation equipment with ETT same size and one size smaller. 2. Assess respiratory status and readiness for extubation 3. Assess HR, BP, Perfussion, SPO2, Level of consciousness. 4. Make sure patient: -NBM 4 hours prior extubatio - iv line in good condition - iv dexamethasone if indicated - stop all sedations - Normal ABG - Good air entry 5. Explain to patient/ parents 6. Prepare oxygen and ventilation after extubation 7. Pre-oxygenate adequately 8. Suction the ETT and nasopharynx thoroughly 9. Loosen the adhesive tape securing the tube 10. Deflate cuff if any 11. Apply PEEP during removal of tube 12. Suction the oro-pharynx 13. Put on humidified oxygen / CPAP / Bipap mask and anaesthetic bag. 14. Continue ventilation with humidified oxygen, NCPAP, Bipap. 15. Put patient on low fowlers or fowlers position 16. Observe patients respiratory effort, RR, Spo2, BP, HR, Color, chest expansion, level of consciousness. 17. Note any respiratory stridor, inspiratory stridor or hoarseness of voice 18. Instruct patient in coughing and breathing technique

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19. Obtain ABG within 30 minutes to 1 hour after extubation 20. Document in NCP, N. report, Ventilation chart: Date, time, name of Dr., effectiveness of coughing, oxygen concentration, characteristic of secretions, Bipap/ NCPAP setting, positioning, comfortness.

Paediatric Critical Care Nursing Competency

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Skin Care Name:... PKHU:

Competency statement: The nurse will: a) Identify causative factors in the development of pressure ulcer. b) Provide consistent skin care and manage pressure ulcer based on staging. Performance criteria: Y= YES N=NO NA= Not Applicable Date Date Date Date

Observation / Interview 1. Assess skin daily with attention to body prominences 2. Institute a turning schedule every 3 to 4 hours 3.Keep skin clean, moist and supple 4. Apply pressure relieving devices: Ripple mattress, Aquacool/ jelly mattress, E-gell for head, 5. Bath with octenisan (baby > 1 week) 6. Place absorbent liner between patient and bed sheet 7. Treat incontinence / leakage 8. Treat pressure ulcer based on staging (refer DS) 9. Document in pressure sore chart and nursing report. 10. Report if worsening of pressure sore. 11. Monitor temperature for sign of infection

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Paediatric Critical Care Nursing Competency Kemasukan pesakit ke wad PICU Name:... Competency statement: The nurse will: Performance criteria: Y= YES N=NO NA= Not Applicable No Observation / Interview Date 1. Menerima arahan kemasukan dari doktor yang bertugas. 2. Menerima maklumat tentang pesakit ( Nama, umur, diagnosis) menggunakan ventilator / tidak. 3. Unit Trauma dan kecemasan diberitahu jika pesakit dari hospital lain. 4. Beritahu pakar perunding / pensyarah wad. 5. Persediaan untuk menerima pesakit: a) katil yang sesuai dengan tilam mencegah tekanan. b) Anaesthetic bag dan oksigen c) Alat intubasi d) Ventilator e) Pam infusi f) Monitor g) Arterial monitoring (transducer) h) IV line / CVL 6. Tugasan jururawat yang akan menjaga pesakit. 7. Menerima pesakit. Pastikan pendaftaran pesakit 8. Minta ibu bapa / waris menunggu di bilik perbincangan 9. Beritahu doktor 10. Beri bantuan oksigen 11. Pasang monitor kepada pesakit 12. Pasang pemanas (jika perlu) 13. Pastikan kedudukan ETT (jika perlu) 14. Rekod pemerhatian tanda-tanda vital semasa kemasukan. 15. Ambil lapuran daripada jururawat yang mengiringi pesakit. 16. Bantu dalam intubasi dan resusitasi. 17. Susun nota pesakit dan dokumen berkaitan dalam PKHU:

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flder. Sedia dan rancang perawatan dalam NCP. Tulis lapuran dalam rekod perawatan. Lakukan pemerhatian kerap sehingga Orientasi wad dan kad DIL diberi kepada ibu bapa / penjaga. Penerangan oleh doctor mengenai keadaan dari rawatan pesakit Dokumen kemasukan dalam buku kemasakan dan banci 24 jam

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