ie sTuoeNT NAME roma mi { Student Signature and Date -Level 1: by signing, focknowledge that have demonstrated oebserved th sil {6 sninglocnouiedge Wet hove demonstrate or Indicated hued the il neste. ‘Student Signature and Date -Level3 Student Signature and Date - Level: ‘by signing 2cknowlege that have semonstated or observed thesis fy sningloctowledge at hove demonstrate or Indicates. bee the ils nected ‘i heels canbe found nthe textbook lla Nursing Skil and Techalques, Sth ed by Pry, Potter, and Ostendort= = SR eee stupentname: Grelirnw Colaba v Gina Setting Student ab Faculty Printed Nar below aft eae |_| student has sucess Clinician Printed Name, Signature, and Date 3 4 Observed Required Level 1 Lab i rior to demonstration nna Documentation and Informaties OGer~ 2nali4s \ | Giving a handoff report Ota ANAM Thadverse event incident reporting | Our mesa Sftelia LSA S164 3 ve ang Day Tomperre [peste nen 20 @ Tw 2 Uniareneo seh és fe 2 RO eB ere _Mreno 2a No ‘5. - Once oe A Hite) ° Laprecesttr / 7 si rg restos doles OIS AS 1 \o- @ ChuDecsto tla ‘ 2. anaha 4 Assessing manual blood pressure Okemos st Qlsuse NAME: Srelnon Beret pressure electronic # beg “Measuring oxygen saturation (pulse oximetr 7) (Wen! oA ae Mie Kite Health Asse = KCeniQno mer err Tore | C) | me err Sle (cq T LKQmO0os eis Os = W0IS, Men Qero Areks Dr “iw. OSs 14 Oger _lonel4 *PBA-- Head to-Tod Assessment (Level) S877. whittg[com OPrno me ga 11019 *Perineal care Wild bye ky ahs ° Cker 274 = ° * Oar . ° Laat (eabagt, WEI 0 “- ° Suds Caaheoge aby 6 oa ° Po OOera Mens gar iors! MSA £181 Q Noa @ Moving and positioning clients i bed : = oe eee Px» “1110191 Co personal Care and Bed Making bathing aclent 5 Mngt. FEMI S ° es MAL pa Fjolare | 0 “ oo nestuvent mame: Exclinn Balohyle Oral hygiene “AGS 22/4 “Care of dentures Sabb, S227) "Performing mouth care for unconscious/debilitatedjclient vw Lbs Assist with oral feeding beP tpt, Lf 4 48 | KO QRivo NEO 25 Lo *Making an unoccupied bed Loe £19 KO Olirro S10 19 ANHW-19 AQ en OO Ring BIN 110-1 *Use of a urinal (Wl, CAD mer fe + OR sr "Making an occupie« uit z] hn gt $1614 Oder 4129114 KOo Otis rns Dot noe i wT we te ODS. 4722 15 e spirometry or (abl bag oo Jo jo oo Je Nie |e fe) [e):\0 fey le le fo le fo |eMedicati stuentname: EMCUhoR Bathe | Ce ° 3 iy | ° { MA, 3 an Obnxtee 1722114 Db Veoh Ucirte alls 5 “ingiling eye and ear migdeations | ° EE Coed Me EAA silty x ae > Urtmmdy mewn alails i “Using metered-dose {nbalers > — Goew mised */31 [14 © *Administering rectal suppositories . Ochmstay Mss On laclig i: Parenteral Medications) Preparing injections: Ampules and vals eX aa f Ke Qlis NHONON BVN9 I Ki “Administering intradermal injections Keetfii. Men ON S119 “Administering subcutaneous injections Ktellus Ter dd $119 tengo era lrale oS lointramuscular rection KO eGQers MY OH &115 = cat and Cold > | Fines, ass 0) Sew 3 “Applying cold D WA AO ves ste Storey A. O0ue Ae 2 Specimen Collection A Ut Midstream urine; Urine specimen from (wide Wy, Ww ble (hi 10 wee lt | Rr Blood glucose monitoring *(Level 1 and 3) walls Mesh) FAME [Ah KAoOVI5 WEI Wd T1015) KM M112 MS > aA Al 2} o| 09} 9 > o| © (Wal jue bestuoent ame. Earclines Salchge Optional Additional skills to Demonstrate in Clinical Anytime During or After Level 1 \ssessment ‘and rectum assessment Vi Mad -» Yofso20 Qo Fr ‘and Ambulation erforming range-of- motion et anc, SzzTA| Aube ledhage Wits 60 Lied Fire ba Feith lukuges DEN 2 he OSes 712904 lo |oNo Jo W Odgers Sarre Jo Jo jo jo23-14 4 Qorpe A lo jo |o jo 50319 lo jo Jo jo ‘Airway Management Performing oropharyngeal suctioning [ ul Fae 10 3 Oto Bee ania [ee hip elastic bandagesSTUDENT NAME: [Specimen Collection Measuring occult blood in stool SL, they Sputum collection Elimination Emptying of ostomy bag lilo yew Malte Is.*these skis must be signed off n lab Required Level 2 Lab SI don ofan G Tubes the required prior to demonstration in clini section-Add peak flow as option ions Qa phere W714 GS *PBA - Per kal Intravenous Insertion (Kevel 2) Nox Insertion (Level 2) y_— Ba easeAdditional Optional skills to be Demonstrated in Clinical lo jo jo Changing infusion tubing lo Jo Jo jo jo Av" sae wv Discontinuing short peripheral inti ya Cadiiggi TET EM lo wheal dGiksessSNOSOOUES pis ER\ TRA Checking fedilg tube residuals, \ealiq lo Jo Jo Jo jo jo Jo Jo 2 Giro JONGHI pis -Eal-elSTUDENT NAME: Administering enteral nation: Nasoenter, gastrostomy, oF ejunostomy tube : eae Geo S WENT Hetero ° ‘Ostomy Care \ Pouching a colostomy or anileostomy Perioperative Care Preparing a client for surgery lo ‘Wound Care Pirie: wand acenner MAL Ww FIpjnm ( (fegpa ee ‘Managing wound drains lo Jo Jo Jo Jo jo | | | Urinary Elimination Insertion of a straight or indwelling urinary catheter Fatt leaks EH EF ° Care and removal of an indwelling catheter D Rome Fawn ®‘STUDENT NAME: Required Level 3 Lab Skills-*these skills must be signed off in lab nical Evelina a istration (Level 3) Tee BL) [Aieway Mopadement forming tracheostomy care Hihiod Closed Chest branage Systems *Managihe closed. chest drainage system t 2 Sigil = Antes ipleparum/asptn Be L Eee Lp Aajawe | Ze (WAL (Fela ooYd. Cede Yopsaro| DEEZ ooo Mii Aa Tafoh 3STUDENT NAME: Optional Skills to be Demonstrated i During or After Level 3 ical Anytime ‘Oxygen Therapy ‘Administering oxygen to a client with an artificial airway bab te! ~ [bse ppdifow peter > A ° Gi ng peanial enor amas carver a . ey es jrwa I D © Perlorson Pbipgeal tbe care D Cee rae ho Pantven 1 Tminitering parSoeral ution through a cena ine 5 o Famiarng parenteral nuttin Trough a perpherl ine : ° sdprinvation to pedi clet- parenteral : ° ried 2 © Required Level 4/Lab Skills--these sls must be signed off in ° °ee, CO Rawigut Cink e026 Qo vase 2”) Of Orne to hg WA __Fanste lode Boone Vote s— Ang r? AP Oe ae Ben, BW Cae Sf, MP0 £0 Sees fi ke Nano te) Por ination, nse), 8 - Lorame ater Sutron wine RO — ht, pire, n0/ bh Foe Se eae retry Calling, XQekQevo Mor [Maulpages HaO-td AC LeSqeovmsrzamns | Teska Agen BP cuslech Croker SMIY