Critical Care Nursing Practical Plan

Program: Nursing
Year/Level: 2021/202 2
Semester: Second Semester
Course Name: Critical Care Nursing
Course Code: AMNU 324
Clinical Hours: 6 hours
Students’ numbers:

1
 Practical plan for Emergency Nursing

Practical plan description

This course is designed for third year undergraduate nursing students in nursing program to provide
basic and advance emergency and critical care nursing skills in lab and simulation environment.
This could be safer and allow chances for several trails of skills demonstration. Then, when a nurse
student comes to the clinical area and real world, she can manage her nursing practice with
patients. The course encourages students to utilize emergency and critical care knowledge in
practical divisions and emphasize the importance of safety, security and infection prevention during
practice.
Purposes of lab training in this course

By the end of this course the students will be able to:

1. Prepare the required equipment’s for each procedure properly.

2. Identify the indication of each procedure.
3. Apply Basic airway management and Bag mask ventilation

4. Apply Oropharyngeal/Nasopharyngeal Airway and Endotracheal Tube.

5. Assist in drawing of arterial blood sample

6. Perform Airway Suctioning: Endotracheal and Tracheostomy.

7. Assist and prepare in the insertion and care of arterial line and demonstrate measuring of
central venous pressure,

8. Assist and prepare for insertion of central venous and demonstrate measuring of central
venous pressure.

9. Provide ECG tracing.

10. Apply defibrillation and cardioversion safely and correctly

11. Apply cervical collar perfectly

2
 NURSING PROGRAM
Practical plan
Course Outline (14 Teaching Weeks)
Academic
Program Name: Nursing 2021
Year
Year Level: Third year Semester: Second
Course
Course Title: Critical Care Nursing
Code:
Lecture: Clinical: Practical: √
Check:
Tutorial Sessions: Self Study:

Professor / Lecturer /
Week Topics/Skills Covered
Instructor
 Basic airway management
Week 1  Bag mask ventilation Dr. Ishraga Abdelgadir
 Insertion of Oropharyngeal & Nasopharyngeal airway Dr. Ishraga Abdelgadir
Week 2
 Suctioning patient with an endotracheal tube & Dr. Ishraga Abdelgadir
Week 3
tracheostomy
 Sengstaken-blakemore tube Dr. Ishraga Abdelgadir
Week 4
 Assisting in drawing of arterial blood sample Dr. Ishraga Abdelgadir
Week 5
 Assist in arterial line insertion (Radial artery) Dr. Ishraga Abdelgadir
Week 6
 Central & arterial pressure monitoring Dr. Ishraga Abdelgadir
Week 7
Mid term Dr. Ishraga Abdelgadir
Week 8
 Nursing care of Central venous catheter Dr. Ishraga Abdelgadir
Week 9

 Provide ECG tracing.

Week 10 Dr. Ishraga Abdelgadir
 Defibrillation & Cardioversion
 Cervical collar Dr. Ishraga Abdelgadir
Week 12
 Revision Dr. Ishraga Abdelgadir
Week 13
Final lab exam Dr. Ishraga Abdelgadir
Week 14

3
Timing:

This plan will be conducted within the academic year 2021-2022 during the 1st semester

Student Skills Lab Responsibilities Guidelines:

1. NO FOOD OR DRINK – may cause damage to equipment.

2. NO CELL PHONES during Practical training or examination.

3. Wear student ID at all times while in the lab and follow the recommended dress code
of the college.

4. Respect lab personnel and equipment at all times.

5. Practice areas: Follow directions/signs for use of lab space and equipment. Ask for
directions and for location of practice or testing equipment.

6. Manikins:

 Use gloves when handling all manikins and parts

 DO NOT move manikins or manikin parts without the help of lab personnel.

 DO NOT use betadine on manikins. Use soap or K Y jell as lubricant for tubes.

 Ask for assistance for use of equipment

7. Attendance in Skill lab is mandatory

8. Use beds for practice and testing purposes only.

9. Individuals serving as patients are to remove their shoes when lying on the beds.

10. Report any malfunctioning, unsafe, or damaged equipment to lab personnel.

11. New equipment will be issued for most check-off (testing).

4
Testing (Check-off)/required Practice Guidelines

 Be on time and prepared for Examination.

 Sign – up for all testing – Submit requests as directed. Make sure that you have signed up
for all check – offs and lab requirements.
 NO testing or practice will be allowed during times that a student is scheduled to attend
any class.
 Bring all necessary checklists, and any necessary equipment, such as stethoscope or
penlight, for testing.
 Lack of preparation - including forms (i.e incorrect testing forms), or equipment may
result in re-scheduling or delay of testing and/or practice sessions.
 Most check – offs are independent, but some do require a partner. If a partner is indicated,
you still need to sign – up individually. If you do not have a partner by testing time,
instructor may be able to assist you. For skills that require a partner, you will be evaluated
on an individual basis.

5
 Nursing Lab Policies

1. Dress Code: The students should follow the uniform or a dress code.
A. Maintain personal hygiene at all times.
 Perfume: Perfume is not permitted during practical duty/ hours. Close attention to
achieving non-offensive breath and body odor is important.
 Hair: Should be covered with a white scarf for female. Long hair should be cut for male.
Nails: Clean, length not to extend beyond fingertips, any polish or artificial nails during
practical experience.
 Cosmetics: moderate use of makeup only.
 Chewing gum is not allowed in the clinical area.
 Jewelry: only the following types of Jewelry are allowed. Rings: Wedding ring only.
 Watch: Professional style; large face with second hand, small medium sized watchband.
B. Uniforms for girls
 Uniform should be worn over white underwear
 Appropriate length of uniform which should be below knees. Cleanly laundered& pressed
 Students should wear white professional shoes with rubber heels.
 Name plate is to be worn on lab coat at all times.
C. Dress code for boys
 White colored pant & shirt with white inner wear underneath the shirt.
 White shoes & socks.
 Clean shave & neat haircut of a professional look.
D. Practical Un-preparedness: Any student who is unprepared to safely fulfill her/his
practical assignment will not be allowed to participate in this lab session. The lab instructor
will determine the level of preparedness. Once the student has been informed by an
instructor that she/he is unprepared, the student is expected to leave the lab area. Absence
due to practical unpreparedness constitutes an unauthorized absence.

6
E. Skills Synthesis:
All the students are expected to re-demonstrate the skills under the supervision of the clinical
instructors.
F. Lab Orientation:
With each new nursing course, you may expect to be rotated to several and different nursing
labs in BMC. Your lab instructor will make arrangements for orientation and a tour of your
assigned lab. For each lab orientation, for the purpose of discussion and explanation by your
assigned lab instructor, the student should be aware of the following:
 Practical Clinical Handouts (lab skills)
 Lab Schedule
 Lab Evaluation
 Course Syllabus

7
COVID-19 precaution: All students must follow COVID-19 Precautions in diagram below during practical
training

Students' evaluation:

General Lab Grades: 15% of the Emergency and Critical Nursing Course

 Midterm exam (5%)

 Final lab exam (10%)

8
 BASIC AIRWAY MANAGEMENT
STUDENT’S NAME: ………………………………………..…… STUDENT’S NUMBER:
…………………………………………

Assigned Obtained
PROCEDURE CHECKLIST
Mark Mark
1 Uses universal precautions. 1
2
Head-tilt chin-lift maneuver: Applies downward
2
pressure on the forehead and uses fingers to lift mandible.

Jaw-thrust maneuver: Places heels of hands-on sides of the 2

3 patient's head and grasps angles of mandible with fingers and push
jaw anteriorly.
1
Oropharyngeal airway (OPA) insertion: Selects
4
correct size OPA (from mouth to the angle of the mandible).
Inserts OPA inverted, then rotates 180 degrees at the posterior 1
5
pharynx.
1
Nasopharyngeal airway (NPA) insertion: Selects
6
correct size NPA (from tip of nose to angle of mandible).
1
7 Lubricates NPA and inserts along floor of the nasal cavity.
1
Bag-valve mask ventilation: Opens airway, then applies mask
8 using either one- or two-handed technique ventilates at rate of 10
to 12 breaths per minute, at a tidal volume of 8 to 10 mL/kg.

Total Mark 10

Grade:
………………………………………………………………………………………………………………………
……..
Date of evaluation:
………………………………………………………………………………………………………….
Clinical supervisor:
…………………………………………………………………………………………………………..

9
 BAG MASK VENTILATION
STUDENT’S NAME: ..………………………… STUDENT’S NUMBER:
…………………………………………

Assigned Obtained
PROCEDURE CHECKLIST
Mark Mark
1 Provides O2 supplementation and monitoring 1
2 Observes universal precautions. 1
2
3 Opens the patient's airway with head-tilt or jaw-thrust.
1
4 Chooses a proper size face mask and connects to oxygen
2
One-handed technique: (C E )
5 Holds the mask with the thumb and forefinger in a "C"
shape and hold the jaw with the other fingers (E )
2
Two-handed technique: Places thumb and of one hand on
one side of the mask and places other hand similarly on the
6
other side of the mask. Uses remaining fingers to pull the
mandible into the mask
1
Uses correct sized bag to ventilate: 250 mL for neonates,
7
500 mL for pediatric, 1000 to 1500 mL for adults

Total Mark 10

Grade :
………………………………………………………………………………………………………………………
…..
Date of evaluation:
………………………………………………………………………………………………………….
Clinical supervisor:
…………………………………………………………………………………………………………..

10
 Inserting Naso-pharyngeal airway (NPA)
STUDENT’S NAME: ……….………………………………… STUDENT’S NUMBER:
…………………………………………

Assigned
PROCEDURE CHECKLIST Obtained Mark
Mark
Washes hands before contact with the patient. 1
1

2 Selects the proper size NPA. 1

Lubricates the airway with a water-soluble lubricant. 1
3
Inserts the airway through the nostril in a posterior 3
direction opposite the plane of the face.

Passes it gently along the floor of the nasopharynx.

4 In case of resistance:
 Slightly rotates the tube.
 Attempts placement through the other nostril.

5 Washes hands after finishing. 1

6 Writes down the significant observations. 2
7 Rechecks the patient to evaluate the procedures. 1
Total Mark 10

Grade:
………………………………………………………………………………………………………………………
……..
Date of evaluation:
………………………………………………………………………………………………………….
Clinical supervisor:
…………………………………………………………………………………………………………..

11
 Inserting Oropharyngeal airway (OPA)

STUDENT’S NAME:………………………………… STUDENT’S NUMBER:

…………………………………………

Assigned Obtained
PROCEDURE CHECKLIST
Mark Mark
Washes hands before contact with the patient. 1
1

Clears the mouth and pharynx of secretions, blood, or 2

vomitus using a rigid pharyngeal suction tip if possible.
2

Selects the proper size OPA. 1

3
Places the OPA against the side of the face. When the tip of 1
4 the OPA is at the corner of the mouth, the phalange is at the
angle of the mandible.
Rotates the OPA 180° when it reaches the posterior wall of 2
the pharynx.
5
Another method is to insert the OPA straight in the mouth
while using a tongue depressor.
6 Washes hands after finishing. 1
7 Writes down the significant observations. 1
8 Rechecks the patient to evaluate the procedures. 1
Total Mark 10

Grade:
…………………………………………………………………………………………………………………
Date of evaluation:
…………………………………………………………………………………………………………………
Clinical supervisor:
…………………………………………………………………………………………………………............

12
 SUCTIONING A PATIENT WITH AN ENDOCTRACHEAL TUBE (ETT)
Objectives:

At the end of this LAB student will be able to:

 Perform Hand hygiene and wear PPEs properly.
 Verbalize the importance of ventilating patient with Ambu-bag using 100%
oxygen
 Prepare the suction machine and the appropriate catheter.
 Utilize septic technique while inserting the catheter through the tube and preform rotating
motion.
 Monitor oxygen saturation and breathing patterns.
 Document effectiveness of the suctioning.

13
 SUCTIONING A PATIENT WITH AN ENDOCTRACHEAL TUBE (ETT)
STUDENT’S NAME:………………………… STUDENT’S NUMBER:
…………………………………………

Assigned Obtained
PROCEDURE CHECKLIST
Mark Mark
1 Explains the procedure to the patient. 0.5
2 Observes aseptic technique 0.5
3 Opens sterile gloves and suction catheter. 0.5
4 Places clean Latex glove on non-dominate hand. 0.5
5 Monitors oxygen saturation during procedure. 1
1
6 Pre-oxygenates patient with AMBU bag on a 100% O2 for 2 minutes
Turns on suctioning equipment with suction tubing and places near head 0.5
7
of patient.
Places sterile gloves on dominate hand and connects suction catheter to 0.5
8
suction tubing.
1
Using aseptic technique passes suction catheter, while occluded, through
9
ET tube until patient coughs.
Applies suction and withdraws suction catheter with a rotating motion at 1
10
5 second intervals.
0.5
11 Ventilates patient with ambu bag using 100% oxygen
0.5
12 Cleans patient oropharyngeal airway with suction catheter.
13 Discards suction catheter 0.5
14 Rinses suction tubing with water. 0.5
0.5
15 Monitors patients breathing and oxygen saturation.
0.5
16 Notes amount, color and consistency of tracheal aspiration
Total Mark 10

Grade:
………………………………………………………………………………………………………………………
…..
Date of evaluation:
………………………………………………………………………………………………………….
Clinical supervisor:
…………………………………………………………………………………………………………..

14
 Arterial blood gas sampling

Objectives

At the end of this lab student will be able to:

 Identify the indication of arterial blood gas.
 Performing Allen’s test to identify the site of insertion.
 Re-demonstrate the insertion of the needle and extracting the blood sample.
 Interpret the ABG reading.

15
 Assisting in drawing of arterial blood sample

STUDENT’S NAME: …………………………………… STUDENT’S NUMBER:

…………………………………………
Assigned
PROCEDURE CHECKLIST Obtained Mark
Mark
1. Check that all necessary equipment is available. 0.5
2. Confirms correct patient (student states) 0.5
3. Obtain informed consent 0.5
 Indication for test
 Complications – pain, bleeding, nerve damage, fainting

4. Wash hands 0.5

5. Put on gloves 0.5
6. Identify location of radial artery with palpation, not using 0.5
thumb
7. Demonstrate Allen’s Test 0.5
 Hold patient’s hand up and have patient clench and
unclench hand several times to drain blood from the
hand.
 Compress the radial and ulnar arteries while patient is
clenching the hand
 Lower hand and have patient relax the arm to alleviate
tension which can cause inaccurate results
 Release pressure on the ulnar artery and observe for brisk
return of color to the hand

8. Describe positive result “color returns to the hand in 14 0.5

seconds or less and procedure can be done”
9. Describe negative result “color returns to the hand in 15 seconds or 0.5
more and procedure must be aborted. Assess the other hand”.

10. Prepare area with sterile wipe, states “would leave in place 0.5
for 2 minutes until dry before puncturing the skin”
11. Palpate artery with index finger of non-dominant hand 0.5
proximal to / above planned puncture site
12. Using a Heparinized syringe, remove residual air from syringe and 0.5
pull back to 1cc mark. Cap must be removed.
13. Slightly adduct the arm and dorsiflex the wrist approximately 30 1
degree. Insert needle at a 60-degree angle to the skin and advance to
the artery with bevel side up. Student may be prompted to verbal
proper positioning.

14. Assess for flashback of blood into the syringe, then allow syringe 0.5
to fill. (about 1cc – assessor should tell examinee that a smaller
amount is sufficient for the purpose of the exam. Assessor may
prompt for aspiration)

16
 15. Place 2x2 gauze pad over puncture site and withdraw needle and 0.5
syringe. Syringe is capped.
16. Slowly inverts the syringe 10 times, and then roll between palms to 0.5
mix.
17. Labels the specimen and places in biohazard bag, transport on ice. 0.5

18. Examiner to ask “How long must pressure be applied?” 0.5

Response “5 minutes or until bleeding stops”.
19. Documents procedure in patient’s chart (examinee can state this) 0.5
including location of puncture, result of Allen’s test, and any
complications.
Total Mark 10

Grade:
………………………………………………………………………………………………………………………
…..
Date of evaluation: ………………………….. Clinical supervisor: ….……………………………….

17
 Assist in ARTERIAL LINE INSERTION (Radial artery)
Objectives:

At the end of this LAB student will be able to:

 Explain the indication of the arterial line.
 Prepare the arterial line insertion kit.
 Identify the sites of insertion and prepare it.
 Describe current recommendations for arterial catheters insertion and management.
 Describe an innovative strategy for inserting and managing arterial lines that has reduced CLABSI
 Demonstrate connecting the arterial line to the transducer and properly operating Transduction system.
 Applying sterile dressing.
 Monitor patient blood pressure.

18
ARTERIAL LINE INSERTION (Radial artery)
STUDENT’S NAME:…………………………………… STUDENT’S NUMBER:
…………………………………………

Assigned Obtained
PROCEDURE CHECKLIST
Mark Mark
1 Explains procedure and obtains consent. 1
Positions limb for arterial cannulation: 1
2
supinates the arm and dorsiflexes the wrist
3 Follows aseptic technique 1
4 Palpates the artery. 1
5 Infiltrates the insertion site with 1% lidocaine. 1
1
Uses Catheter-over-needle technique: Inserts needle and catheter at
a 20- to 40-degree angle to the skin. When a flash of blood appears
in the hub, drops angle to near 0 degrees and advances about 1 mm.
6
Slides the catheter off the needle into the artery. Puts pressure on
the artery and removes the needle from the
catheter.

1
Connects the catheter to the transduction system and observes
7
arterial waveform and pressure.
Zeroing the transducer and measuring the reading of blood 1
8
pressure.
1
9 Extracting blood from the arterial line and flushing back the line.
1
10 Secures the catheter with sterile dressing and tape.
10
Total Mark

Grade :
………………………………………………………………………………………………………………………
…..
Date of evaluation: ………………………… Clinical supervisor: ………………………………..

19
 Assist and care of central venous catheter

Objectives:

At the end of this LAB student will be able to:

 Measure and interpret central venous pressure
 Prepare the dressing kit and sterile the dressing site.
 Assess the CVC site from any signs of inflammation.
 Demonstrate aseptic technique while preparing the IV line and flushing the tubes.
 Preform the CVC dressing properly and secure the line.

20
 Central Venous Pressure
STUDENT NAME: …………………………………. STUDENT NUMBER;
……………………………………………….

For insertion:
Assigned Obtained
1- Explain the procedure to patient. Mark Mark

2- Position patient appropriately. (supine position)

3- Flush IV infusion set and manometer.

4-Place ECG monitoring.

5-*The CVP site is surgically cleaned.

6-Assist the patient to remaining motionless during insertion.

7-* Monitor for dysrhythmias, tachypnea, tachycardia as catheter is threaded to great

veins.

8- Connect primed IV tubing to catheter and allow IV solution to flow.

9- *The catheters should be suture in place.

10- Place a sterile occlusive dressing over site.

11-* Obtain a chest x-ray.

To measure CVP:

1- Place the patient in supine position.

2- Position the zero point of the manometer should be on level with the patient right
atrium.

3- Turn the stopcock so the IV solutions flow into manometer, to about 20 – 25 cm level.
And the turn stopcock so the solution in manometer flow to the patient
4- Record the level at which the solution stabilizes. This CVP reading

5- CVP catheter connects to transducer and electrical monitor with CVP wave read out.

6- CVP may range from 5 to 12 cmH2O of or 2 to 6 mm Hg.

7- Assess patient condition.

8- Turn the stopcock again to allow IV solution to follow to patient veins and should
monitor infusion hourly.
21
 Follow-up
1- Prevent and observe for complication.
a. From catheter insertion: pneumothorax. Hemothorax, air embolism. Hematoma and
cardiac tamponade.
b. From indwelling catheter: infection, air embolism, central venous thrombosis
2- Make sure cap is secure
3- If air embolism is suspected, immediately place patient in left lateral Trendelenburg
position and administer O2. 4- Carry out ongoing
nursing intervention of the insertion site and maintain aseptic technique:
a. Inspect site twice daily for signs of local inflammation and phlebitis, Remove the
catheter immediately if there are signs of infection.
b. Make sure sutures are intact
c. Change dressing as prescribed.
d. label to show date and time of change.
e. Send the catheter tip for bacteriological culture.

5- When discontinued, remove central line.

a. Position patient flat with head down.
b. Remove dressing and suture.
c. Have patient take deep breath.
d. Apply pressure at catheter site
e. Monitor site and vital signs for signs of bleeding or hematoma formation.

Grade:
………………………………………………………………………………………………………………………
…..
Date of evaluation:
………………………………………………………………………………………………………….
Clinical supervisor:
………………………………………………………………………………………………………….

22
 12 leads ECG Application
STUDENT NAME: ………………………………….. STUDENT NUMBER;
……………………………………………….

No Action Obtained Assigned

Mark Mark
1- Perform hand hygiene.
2- Remove patient's clothing to expose only chest and arms.
3- Place patient in supine position.
4- Instruct patient to lie still without talking and not to cross legs.
5- Cleanse and prepare skin, wipe sites with alcohol. It is often
necessary to clip hair from the chest if large amounts of hair are
present.
6- Apply self-sticking electrode, being careful to use pressure on the
perimeter only, and attach Leads.
a. Chest (pericardial leads):
V1 Red lead 4th Intercostal space to the right of the sternum •
V2 Yellow Lead4th Intercostal space to the left of the sternum •
V3 Green Lead Midway between V2 and V4
V4 Brown lead 5th Intercostal space at the midclavicular line •
V5 Black lead Anterior axillary line at the same level as V4 •
V6 Violet lead Midaxillary line at the same level as V4 and V5
b. Extremities:
One lead on each extremity. Place on lower portion of each
extremity, avoiding any bone prominences.
(1) AVR - Right wrist
(2) AVL - Left wrist
(3) AVF - Left ankle
(4) RL- Right ankle
7- Turn on machine, enter required demographic information, and
obtain tracing.
8- Disconnect leads, and wipe off excess electrode paste from chest.
9- Deliver ECG tracing to appropriate laboratory, physician, or
health care provider.
10- Documentation of date, time patient response, nurse signature.

Grade: …………………………………………………………………………………………………………………………..
Date of evaluation: ………………………………………………………………………………………………………….
Clinical supervisor: ………………………………………………………………………………………………………….

23
 Performing Defibrillation and Cardioversion

Objectives

At the end of the lab student will be able to:

 Identify the criteria for defibrillating patient.

 Identify the pads sites for pediatric and adult.

 Operate the defibrillator machine.

 Interpret the ECG strep properly.

 Identify the shockable and non-shockable rhythm.

 Prepare and administer IV medication.

24
 Performing Defibrillator check

STUDENT’S NAME: …………………………… STUDENT’S NUMBER:

…………………………………………

Assigned Obtained
PROCEDURE CHECKLIST
Mark Mark
Remember to keep defibrillator paddles in their brackets 1
1. for all tests.

2. Turn the monitor ON. 1

3. Select 50 Joules. 1

4. Select Sync button. 1

5. Press Charge button 1

6. Press and briefly hold both discharge buttons at once. 1
Verify that the defibrillator does not discharge.

7. Press Sync button again, the machine will be returned to 1

defibrillation mode.
8. Press "Apex" paddle discharge button alone. Verify that 1
the defibrillator does not discharge.

9. Press "Sternal" paddle discharge button alone. Verify that 1

the defibrillator does not discharge again.

10. Press and briefly hold both discharge buttons at once. 1

Verify that the defibrillator discharge and print out a test
report.

Total Mark 10

Grade:
………………………………………………………………………………………………………………………
…..
Date of evaluation: …………………………… Clinical supervisor: ………………………………………..

25
 Performing Defibrillation

STUDENT’S NAME: …………………………… STUDENT’S NUMBER: ………………………

Assigned Obtained
PROCEDURE CHECKLIST
Mark Mark
Assess the patient to determine if he lacks a pulse. Call for help and perform 0.5
1. cardiopulmonary resuscitation (CPR) until the defibrillator and other emergency
equipment arrive.
Connect the monitoring leads of the defibrillator to the patient, and assess his cardiac 0.5
2.
rhythm.
1
Expose the patient's chest, and apply conductive pads or KY gel at the paddle
placement positions.
3.
Place one paddle to the right of the upper sternum, just below the right clavicle.
The other over the fifth or sixth intercostal space at the left anterior axillary line.

Turn on the defibrillator and, if performing external defibrillation, set the energy level 1
4.
for 360 joules for an adult (Monophasic).
Charge the paddles by pressing the charge buttons, which are located either on the 1
5.
machine or on the paddles themselves.
Place the paddles over the conductive pads and press firmly against the patient's chest, 1
6.
using 11 kg of pressure.
7. Reassess the patient's cardiac rhythm. 1
1
If the patient remains in ventricular fibrillation or pulseless ventricular tachycardia,
8.
instruct all personnel to stand clear of the patient and the bed.
1
9. Discharge the current by pressing both paddle charge buttons simultaneously.
10. Resume CPR for 5 cycles. 1
Check rhythm shockable rhythm? 1
If shockable;
a. Place the paddles over the conductive pads and press firmly against the
patient's chest, using 11 kg of pressure and deliver 1 shock 360 Joules
b. Resume CPR immediately after the shock for 5 cycles, when I.V/I.O available
gives medications.
11. Check rhythm shockable rhythm?
 If still shockable Repeat a and b.
If not shockable;
Act as the type of the rhythm:
 A systole
 PEA
Pulse present
10
Total Mark
Grade:
………………………………………………………………………………………………………………………
…..
Date of evaluation: …………………………… Clinical supervisor: ………………………………………..
26
 Performing Cardioversion
STUDENT’S NAME: …………………………… STUDENT’S NUMBER:
…………………………………………

Assigned Obtained
PROCEDURE CHECKLIST
Mark Mark
1. Explain the procedure to the patient, and make sure he has signed a 0.25
consent form.
2. Check the patient's recent serum potassium and magnesium levels 0.25
and arterial blood gas results. Also check recent digoxin levels.

3. Withhold all food and fluids for 6 to 12 hours before the procedure. 0.50
If the cardioversion is urgent, withhold the previous meal.

4. Obtain a 12-lead ECG. 0.50

5. Check to see if the physician has ordered administration of any 0.50

cardiac drugs before the procedure. Also verify that the patient has a
patent I.V. site.

6. Connect the patient to a pulse oximeter and automatic blood 0.50

pressure cuff, if available.

7.  Consider administering oxygen for 5 to 10 minutes before the 0.50

cardioversion.

 If the patient wears dentures, evaluate whether they support his

airway or might cause an airway obstruction
8. Place the patient in the supine position and assess his: 0.50
a. Vital signs.
b. Level of consciousness (LOC).
c. Cardiac rhythm.
d. Peripheral pulses.
e.
9. Remove any oxygen delivery device just before cardioversion. 0.25
10. Have epinephrine, lidocaine, and atropine at the patient's bedside. 0.25

11. Administer a sedative, as ordered. 0.50

12. Carefully monitor the patient's blood pressure and respiratory rate 0.50
until he recovers.

13. Expose the patient's chest, and apply conductive pads or KY gel at 0.50
the paddle placement positions.
 Place one paddle to the right of the upper sternum, just below the
right clavicle.
The other over the fifth or sixth intercostal space at the left anterior
27
 axillary line.
14. Press the POWER button to turn on the defibrillator. 0.50

15. Push the SYNC button to synchronize the machine with the patient's 0.50
QRS complexes.

16. Make sure the SYNC button flashes with each of the patient's QRS 0.50
complexes. You should also see a bright green flag flash on the
monitor.

17. Turn the ENERGY SELECT dial to the ordered amount of energy. 0.50

18. Expose the patient's chest, and apply conductive pads or KY gel at 0.50
the paddle placement positions.
 Place one paddle to the right of the upper sternum, just below the
right clavicle.
 The other over the fifth or sixth intercostal space at the left anterior
axillary line.
19. Make sure everyone stands away from the bed; then push the 0.25
discharge buttons.
20. Hold the paddles in place and wait for the energy to be discharged, 0.25
the machine has to synchronize the discharge with the QRS
complex.

21. Check the waveform on the monitor. If the arrhythmia fails to 0.25
convert, repeat the procedure two or three more times at 3-minute
intervals. Gradually increase the energy level with each additional
counter shock.
22. After the cardioversion, frequently assess the patient's LOC and 0.25
respiratory status, including airway patency, respiratory rate and
depth, and the need for supplemental oxygen.

23. Record a post cardioversion 12-lead ECG, and monitor the patient's 0.50
ECG rhythm for 2 hours.

24. Check the patient's chest for electrical burns. 0.50

Total Mark 10

Grade:
………………………………………………………………………………………………………………………
…..
Date of evaluation: …………………………… Clinical supervisor: ………………………………………..

28
 Cervical Collar Application Performance Checklist: -
Application of external fixation and support for cervical injury
STUDENT’S NAME: …………………………… STUDENT’S NUMBER:
No Steps Assigned Mark Obtained Mark
1 Inform and reassure patient.
2 Lie the patient supine and have someone stand or kneel at the
head of the patient.
3 Ask patient not to move head or neck.
4 Inform patient that to report any increase in pain or other
symptoms occur.
5 Manually stabilize patient’s head in neutral position.
6 Select appropriate collar size.
8 Adjust the collar, lock the collar so that the collar size is fixed.
9 Remove any patient neck or ear wear. Cut away or reposition
clothing.
10 A apply collar to seated or standing patient – slide the collar up
the chest wall until the chin is firmly seated on the chin piece.
11 Apply collar to supine patient – slide back portion of collar
under neck until it is just visible. Then slide the collar up the
chest wall until the chin is firmly seated on the chin piece.
12 Tightening collar – grasp the corner of the tracheal opening then
pull the Velcro fastener and secure it to the front of the collar.
13 Inspect and readjust/resize the collar as necessary- the head and
neck should be in neutral alignment and the chin should be flush
with the end of the chin piece.
14 Ensure collar fits firmly, Velcro well secured and head and neck
are supported.
15 On adjustable collars, completely remove the collar, readjust,
then reapply.
16 Check:
- Comfort. Alignment. No pressure on soft tissues of neck.
- Correct sizing.
- Mandible support section.
17 Documentation.
Date of evaluation:
………………………………………………………………………………………………………….
Clinical supervisor:
…………………………………………………………………………………………………………..

29
30