Critical Care Nursing Practical

3rd Year – 1st semester

Assistant prof/ Mariam Sabry Shehab

2023 - 2024

1
 Critical and Emergency Department

Student Name:

Year of Graduation:

Telephone number in case of Emergency:

Blood Group of Student:

Degree : Total Degree [ / 80 marks ]

Log book

Year :- 2023 – 2024

Assistant prof/ Mariam Sabry Shehab

2
 Logbook Content

Title Page No.

Introduction

Purpose of logbook

Objectives of this course

Logbook Instructions

Course Specification

Candidate’s Personal Information

Clinical Evaluation Sheet and Record

Nursing care plan

Performance Checklist for Clinical Procedures

Case Studies

Technical, analytical and management

3
INTRODUCTION
This logbook is designed to provide a guideline for nurse students during the internship
program.
The logbook includes a list of major skills/procedures to ensure the achievement of clinical
objectives of each specific unit.
Each specific procedure checklist differs from one hospital to another thus refer to policy
& procedure for details.
The student will acquire the competency of the task by observing the preceptor/staff nurse
and practice them several times.
The log book is kept by the Nurse Intern. After completion of task, it is responsibility of
nurse intern to check and to take the signature from immediate staff nurse trainer.
Purpose of the log book:

1- To emphasize major competencies and clinical skills in each unit rotation

2- To assist in the follow up / progress of nurse intern throughout internship

Objectives of Emergency Care Nursing

Overall aim of the course

The course aims to help nursing students to receive training in different intensive care units which
enrich their knowledge

Intended learning outcomes:

A- Knowledge and Understanding

A.1 Recall knowledge related to different critical care conditions.
A.2 Explain causes and risk factors of different critical care conditions.
A.3 Recognize the effect of different critical conditions on body systems.
A.4 Identify appropriate nursing intervention for critical ill patients with
different critical conditions.
B- Intellectual Skills
B.1 Integrate knowledge from different disciplines into critical ill patient care.

4
 B.2 Differentiate between pathophysiology, clinical manifestations, diagnostic
studies and management of different critical conditions.
B.3 Develop critical thinking and problem-solving abilities in prioritizing,
planning, providing and evaluating nursing care for different critical conditions.
B.4 Select appropriate nutrition for different critical care conditions.
B.5 Interpret critical ill patients' parameters to identify appropriate
management.
B.6 Design health teaching plans for critical ill patients with different medical
diagnosis.
B.7 Utilize nursing process as a framework for planning, implementing and
evaluating critical ill patient care.

C- Professional and practical skills

C.1 Perform complete physical assessment for critical ill patients C2.
Assess patients with critical condition using triage system.
C.3 Monitor hemodynamic parameters of critical ill patients in critical care
units.
C.4 Perform nursing procedures for critical ill patients efficiently.
C.5 Demonstrate technical skills in managing equipment and machines in
critical care units.
C.6 Apply ethical, legal and professional standards when caring for critical ill
patients.
D- General and transferable skills
D.1 Show responsibility for learning to be an active team member in critical
care units
D.2 Demonstrate effective communication skills when dealing with patients
and their families, health care team, colleagues and faculty teachers
D. 3 Demonstrate skills in dealing with technology, machines, and
equipment in critical care unit
E.1 Apply the principles of privacy and confidentiality in dealing
with critical ill patients.
E.2 Show professional respect in communicating with teachers,
colleagues, patients, families, and health care team.

5
 Logbook Instructions

Logbook Overall Aim:

The course aims to help nursing students to receive training in different intensive
care units which enrich their knowledge

Personal Information:

Please fill in all your personnel information on the

following page (6).
Themes and Assessment Methods:
 Theme 1: Clinical Evaluation Sheet
 Theme 2: Clinical procedures
 Theme 2: Case Studies
Important Regulations:
 Attend more than 75% of overall emergency training.
 Fulfil and demonstrate more than 80% of the practical skills documented in
the logbook correctly to obtain satisfactory practice.
 Contact your supervisors for any clarification and difficulties.
 If your performance is unsatisfactory in any procedure, you will be
retrained and reassessed for this procedure.

6
 COURSE SPECIFICATION
1. BASIC INFORMATION:
Course Title : Critical Care Nursing Practical
Course Code : NUR312
Credit Hours : 4 / week
Course Level : First year

2. COURSE DESCRIPTION:

This course will develop the skills and knowledge obtained in

NURSING 312 Foundations of Care. This course considers the
pathophysiology of complex patient conditions requiring intensive
care, as well as assessment, monitoring and advanced therapeutics.
The content builds on the foundation knowledge from NURSING
312 Foundations of Critical Care. By continuing a systems approach
to the development of advanced intensive care nursing knowledge
and practice

3. OVER ALL AIM OF COURSE:

The aim of this course is to help nursing students to receive training in different
intensive care units, which enrich their knowledge.
4. INTENDED LEARNING OUTCOMES OF COURSE (ILOS)
By the end of this course, each student will be able to:

Level ILOs ‫مخرجات التعلم المستهدفة‬

4.a.Knowledge and understanding ‫المعلومات والمفاهيم‬

a1. Identify indication of chest tube

a2. Identify indication of cvp
a3. Discuss the management of patients undergoing chest tube
a.4. Describe critical care as a collaborative and holistic approach
that includes the patient, the family, and significant others.
a.5. Recognize the different types mechanical ventilation
a.6. Understand the concept of leadership in critical nursing

7
 practice.
a.7. Prioritizing skills in order to identify health problems in the
critical phase of disasters
4.b. Intellectual Skills ‫المهارات الذهنية‬
b.1. Utilize mechanical ventilation to identify patient health
problems for patients with cardiovascular and critical life
threatening problems.
b.2. Classify life threatening condition in critical department
b.3. Identify the appropriate action for the critical situation
b.4. Compare between types of drainage
b.5. Compare and contrast different critical patient conditions
based on functional body systems and priority of emergency care
b.6. Measures accurately the effect of nursing actions which can
be reflected by vital signs or improving of patients' health
condition.
b.7. Writes accurately the implemented nursing actions which
should be complete, precise, accurate, and relevant.
4. c. Transferable Skills ‫المهارات المهنية‬
c.1. Utilize evidence-based practices in application of critical
nursing care.
c.2. Utilize different informational resources in critical nursing
c.3.Employ accurate documentation while providing and/or
managing for client needs
c.4. Utilize critical thinking and problem solving in planning and
implementing nursing care for individuals, families, and groups
c.5. Demonstrate skills in handling various equipment's utilized in
critical care settings
c. 5. Demonstrates ethical principles and legal concepts related to
critical care nursing.
C.6. Apply basic principles of health teaching of patient.
4.d. General Skills ‫المهارات العامة‬
d.1. Demonstrate decision-making skills in critical situations.
d.2. Develop leadership skills
d.3. Apply appropriate nursing management principles based on
assessment findings
d.4. Communicate effectively with health care team, patient and
the patient’s support network.
d.5. Produce safe and secure environment.

d.6. Shares information, scientific materials and experiences with

colleagues.

8
5. COURSE OUTLIN

COURSE CONTENTS

1. Chest tube management

2. C V P management
3. Tracheostomy care
4. Drainage
5. Mechanical ventilation
6. Mechanical ventilation
7. Pac maker
8. Defibrillator

6. TEACHING AND LEARNING METHODS

1. Interactive Lecture

2. Procedure application in Skill Lab Simulator

3. Demonstration of clinical skills hospital clinical

settings

7. EVALUATION

Evaluation Weight
Periodic Exam (Quizzes) 40%= 80 grades

Midterm Exam 10% = 20 grades

Final Exam 50 % = 100 grades

Total grades 200

9
8.TIME

 Mid-Term exam at week 7th

 Final written exam at week 15th

Academic Year: 2023/ 2024

Head of department:

Lecturer: …………………………..

10
 Candidate’s Personal Information

 Candidate's Name:
 Academic Card Number:
 License Number:

 Cellular Phone
Number:

 E-mailAddress:
Address:
 Date of Registration: / /

 Supervisor's Name:

 Candidate's Signature:

 Supervisor's Signature:

11
 Assessment Sheet for Critical Ill Patient ( / 10 marks)

Student's name: ................................................................... Group:…………………

Hospital: ................................................................... Unit: …………………………………………..

Part I: Patient's Admission Data ( /2)

Patient's name:…………………………………………………………………………
Date of admission:………………………………………………………
Chief Complaint:
…………………………………………………………………………………………………………………………………………………………………
Diagnosis:…………………………………………………………………………………………………………………………………………………………
Gender: Male Female
Age: …………………………………
Part II: Patient's History
Patient's History: (major illnesses/operations/major injuries) ( /1.5)
Past medical history: …………………………………………………………………………………………………….
Past surgical history: ……………………………………………………………………………………………………
Family history: ………………………………………………………………………………………………………………….

Part III: Physical examination

Neurological ( /4)
Modified GCS
Activity Score Activity Score Activity Score
A. Eye opening B. Verbal response D. Motor response

Spontaneous 4  Oriented 5 Obeyed commands 6

To voice 3  Confused 4 Localized pain 5
To pain 2  Inappropriate words 3 Withdraw to pain 4
None 1  Incomprehensible words 2 Flexion to pain 3
 None 1 Extension to pain 2
C. Grimace None
1
 Spontaneous normal
facial/ or motor activity. 5
 Less than usual
spontaneous ability or only 4
responds to touch
 Vigorous grimace to pain.
 Mild grimace or some 3
change in facial expression 2
to pain.
 No response to pain. 1

12
 GCS= A+(B or C)+d 13-15 conscious 9-12 semiconscious 3-8 unconscious

Pupil: ( /1.5)

Equality: Equal Unequal

Pinpoint: Right pupil Left pupil
Dilated: Right pupil Left pupil
Reactive: Right pupil Left pupil
corneal reflexes: Present Absent

Airway, Breathing ( /5)

Airway Maintain own BIPAP/CPAP

ETT: size: …………….

Tracheotomy: size: ……………….
oxygen therapy ml/min (……) Mechanical ventilation
Mouth condition: Intact Abnormal coating inflammation
ulcer
Cough: spontaneous stimulated by suction absent

Respiratory rate: ……………………… regular irregular

Chest sound Clear Crackles Wheeze

Chest sound Diminished chest sound Rt lung Lt lung

Cardiovascular ( /3)

Heart rate: ……………….b/m rhythm:……………….

Skin color:
pink Pale Flushed Mottled
Cyanotic Jaundice
Delayed capillary refill: Upper extremities Lower extremities

Edema: Generalized Specific

EEN (Eye, Ear, Nose) ( /3)

Eye

Redness Jaundice Sunken

13
 Racoon eye Discharge Edematous eye lid
Blurred vision
Ear
Ottorrhea Battle's sign Bleeding Discharges
Tinnitus Deafness Decreased acuity

Nose
Rhinorrhea Deformity Discharges Epistaxis

Pain ( /4)

Denies Present Unable to assess due to: ………………………….

Pericipitatng Factors:………………………………………………………………………………………………………………………………………

Alleviating factors:……………………………………………………………………………………………………………
Quality: Ache Dull Sharp Stabbing
Cramping Burning Throbbing
Region/Radiation: ………………………………………………………………………………………………………………………………………….
Severity : Mild Moderate Severe very severe worest

Time: Intermittent Continous

Nonverbal Pain Scale (NVPS) for Nonverbal Patients
Face  No particular expression or smile 0
 Ocassional grimace, tearing, frowning, wrinkled forehead 1
 Frequent grimace, tearing, frowning, wrinkled forehead 2

Activity  Lying quietly, normal position 0

(movement)  Seeking attetion through movement or slow, cautious movement 1
 Restless, excessive activity and/ or withdrawal reflexes 2
Guarding  Lying quietly, no positionimg of hands over areas of the body 0
 Splinting areas of the body, tense 1
 Rigid, stiff 2
Physiology (vitalsigns)  Baseline vital signs unchanged 0
 Change in SBP>20mmhg or HR>20bpm 1
 Change in SBP>30mmhg or HR>25bpm 2

Respiratory  BaselineRR/SPO2 synchronous with ventilator 0

 RR> 10 bpm over basline, 5% decrease spo2 or mild ventilatorasynchrony 1
 RR> 20 bpm over basline, 10% decrease spo2 or severe ventilator asynchrony 2

3-6 moderate pain ≥ 6 severe pain

≤ 2 no pain

14
GIT ( /2.5)
Abdomen:
Soft Firm Flat Rounded

Distended Guarding Rebound Tenderness

Bowel sound :
Normal Hypoactive Hyperactive Absent

Bowel elimination:
Incontinence Diarrhea Constipation

Melena Fecal impaction Diaper

Nutrition:
Polydepsia Dysphagia Anorexia
Nausea Vomiting Delayed gastric emptying

Feeding method:
Oral NGT feeding Parenteral feeding (TPN)NPO
special diet …………………………………………………………………………………………………………………

Integumentary ( /2.5)

General Good elasticity Poor elasticity

Redness Scar
Decubitus ulcer Abrasion

Ecchymosis Hematoma

Swelling Diaphoretic
Sacrum Intact heels Intact elbow Intact

Marked Marked Marked

Broken Broken Broken

Urinary elimination ( /1)

Retention Incontinence Urgency Frequency

Dysuria Polyuria Oliguria Urinary catheter

15
Extremities (Assess mobility, joint function) ( /3)
Deformity Crepitus Tenderness Stiffness
Weak muscles Paralysis Loss of sensation Numbness

Restrain Upper extremities lower extremities Both

Peripheral pulse: Strong Weak Absent

psychological status ( /1)

Anxiety Depressed Irritable Agitated

Communication ( /2)

Aphasic Speaking Clear Slurred

Reading and Writing Using signs Not able to communicate

Barriers to communication …………………………………………………………………………………………..

Rest ( /1)

Sleep aids:
Pillows Medication Drinks Others ……………………
Sleep latency /remaining asleep (Insomnia)

Fall Risk ( /1)

Age > 65
History of fall
Taking fall related medication ( analgesics, diuretics, …)
Physical impairement
Cognitive impairement

Part IV: Diagnostic Procedures ( /2)

Diagnostics

ECG (interprete) ………………………………………………………………………………………………………..

X- ray
C.T scan
Others: ……………………………………………………………………………………………………………………………………………………

16
 Part VI: Patient's Nursing Diagnosis

1……………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………….

2…………………………………………………………………………………………………………………………………………...

…………………………………………………………………………………………………………………………………………….

3……………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………….

4…………………………………………………………………………………………………………………………………………….

………………………………………………………………………………………………………………………………………………

5…………………………………………………………………………………………………………………………………………….

…………………………………………………………………………………………………………………………………………….

6…………………………………………………………………………………………………………………………………………….

……………………………………………………………………………………………………………………………………………….

17
 Nursing Record for Patient at Critical unit / 5 marks)

Patient's name: Student's name:

Diagnosis: Group no:
Admission date: Supervisor's name:
ICU: Date:
Bed No:
Weight:
MV starting date:

Invasive tubes Invasive catheters( /0.5)

Type Date site size Type Date site Size
TT/ETT CVC
ICT PC
GT AL
Drainage T UC
Others Others

Time / Vital signs ( /0.5) 9 am 10 am 11 am 12 pm 1 pm

40 190
Temperature * 39
38
180
170
37 160
36 150
35 140
Pulse . 130
120
110
100
Blood pressure ۷ 90
│ 80
^ 70
60
50
40
Respiration = 30
25
24
23

CVP ⁄⁄ 22
21
20
19
18
17
16
15
14
13
12
11
10
9
8
7
6
5
4
3
2
1
0
-1
-2
-3

19
 Time 9 am 10 am 11 am 12 pm 1 pm

M.V Mode
( /1) Fio2
RR
Pt.R
MV.R
VE
Vt.
PEEP/ CPAP
I:E
Hum.Temp.
A.B.G.( PH
/1) PaCO2
HCO3
PaO2
O2 Sat.
Interpretation

Tracheal secretions Color

Amount
( /0.5)
Consistency
GCS( /0.25) Total score
Pain assessment Pain score (0-10)
( /0.25)
GIT( /0.25) Gastric residual
Stool
Fluid I&O Intake Oral Type
( /0.75) Amount
NG Type
Amount
IV Type
Amount

Total intake
Output Urine
Drainage
Vomiting
Insensibleloss

Total output
Balance
Lab investigations Type
( /0.5)

Result

Medications( Name
/0.5) Dose
Route

19
 Nursing Notes

Patient's Name:……………………………. Date: …………

Time Item Description

Patients' Receiving

General Care

Specific Care

Signature
 NURSING CARE PLAN [ / 10 MARTS ]
Student name ………………………………………………………………
Patient name ………………………………………………………………..
Age …………………………………………….. gender ……………………………………….
DOA ……………………………………………. DOD …………………………………………

ASSESSMENT NURSING PLAN INTERVENTION EVALUATION

DIAGNOSIS
INSTRUCTOR NAME …………………………………………………………………………………………

SIGNATURE …………………………………………………………………………………………………..
 Clinical evaluation sheet

Student name: ___________________________ Clinical area: __________________

Group number: __________________________ Date:_________________________

N Items Mark Student

grade
A Professional behavior & sense of responsibility: 5
General appearance &uniform. 2
Punctuality& respect of time. 1
Sense of responsibility& Response to comments 1
Cooperation, respect and good relation with colleague and supervisors 1
B Record and report 5
C Nursing care plan: 10
- Prioritize the patient problems 2
- Problem defined correctly in relation to collected data & objectives 2
- Formulate actual, potential and collaborative problems in form of nursing 1
diagnosis
- Setting of achievable & a realistic outcomes (short and long term goals 1
- Write nursing actions for actual, potential and collaborative problems 2
(nursing implementation)
- Give rationale for each intervention 1
- Evaluate nursing care plan in the light of expected outcomes 1
D Clinical (practice) ( skills) 5
- Provide basic nursing skills 4
- Provide patient care according patient needs safely and completely 1
E Nursing sheet 10
F Scientific knowledge 5
Total 40

Comment:__________________________________________________________________
Student signature:________________________ Staff signature:…………………………...
 Presentation Evaluation Checklist (critical care nursing practical)
Student's name: ………………………… Group: ….… Student's Number: …………
Date: / / Topic Title: ………………… Student assigned to:………….………

Student's
Items Grade Comment
grade

Introduction:
- Introduction of self, starting with warm and precise opening 2
indicating content and capture audience attention
Content
- Objectives clearly stated, comprehensive, accurate and 1.5
organized
- Content good prepared 1.5

Presentation skills

- Using teaching aid methods 1

- Body movements and self-confidence. 1

- Ability to answer questions and collaboration within the

1
group.
- Evaluating audience response and paraphrasing if some points
1
are vague.
- Summary, conclusion and feedback 1

Total degree 10

Student Signature: …………….………………………

Instructor Signature: …………………..……………..

 3rd Year - 1st semester
Anti-Embolism Compression Application Checklist [ / 15 ]

Student’s Name: ……………………………………………………….

Group: --------------------------------- Date: ----------------------------
Steps 0 1 2 3
1. Review medical order 1
2. Identify patient. 1
3. Explain what you are going to do. ½
4. Maintain patient's privacy. ½
5. Wash hands and apply gloves 1

6. Position client in supine position for a half-hour before applying 1

stockings.
7. Measure for proper fit before first application. Measure length (heel 1
to groin) and width (calf and thigh) and compare to manufacturer's
printed material to ensure proper fit.
8. Clean patient leg then dry it well and apply talcum powder to leg and 1
feet.
9. Turn the stocking inside out, tucking the foot inside. 1

9. Ease foot section over the client's toe and heel, adjusting as 1
necessary for proper smooth fit.
10. Gently pull the stocking over the leg, removing all wrinkles. 1

11.Assess toes for circulation and warmth. Check area at top of 1

stocking for binding.
12.Antiembolic stockings should be removed at least twice daily or 1
every eight hours to allow for adequate circulation.
14. Assist the patient into a comfortable position. 1

15. Remove gloves and hand washing. 1

16. Documentation: 1

- Patients response during the procedure.

- Record any nursing assessment data.
- Record when the stockings are removed and reapplied .
Key: 0 ≡ 0 Mark (Not done) 1 ≡ 1mark (Needs Practice) 2≡ 2marks (Satisfactory) 3≡ 3 marks (Excellent)

Comment----------------------------------------------------------------------------

Total Degree ……………………………………………………………..

Student’s Signature-………………………………………………………

Instructor’s Signature …………………………………………………….

 Pacemaker Checklist [ / 15 ]

Student’s Name: ………………………………………………………………

Group: --------------------------------- Date: -----------------------------------
Steps 0 1 2 3
1. Bring necessary equipment to the bedside stand or over bed table.
½
2. Perform hand hygiene and put on PPE, if indicated.
½
3. Identify the patient.
½
4. If the patient is responsive, explain the procedure to the patient. Explain
½
that it involves some discomfort and that you will administer medication to
keep him or her comfortable and help him or her to relax. Administer
analgesia and sedation, as ordered, if not an emergency situation.
5. Close curtains around bed and close the door to the room, if possible.
½
6. If necessary, clip the hair over the areas of electrode placement. Do not
½
shave the area.
7. Attach cardiac monitoring electrodes to the patient in the lead I, II, and III
½
positions. Do this even if the patient is already on telemetry monitoring. If
you select the lead II position, adjust the LL (left leg) electrode placement to
accommodate the anterior pacing electrode and the patient’s anatomy.
8. Attach the patient monitoring electrodes to the ECG cable and into the
½
ECG input connection on the front of the pacing generator. Set the selector
switch to the ‘Monitor on ‘position.
9. Note the ECG waveform on the monitor. Adjust the R-wave beeper
½
volume to a suitable level and activate the alarm by pressing the ‘Alarm on’
button. Set the alarm for 10 to 20 beats lower and 20 to 30 beats higher than
the intrinsic rate.
10. Press the ‘Start/Stop’ button for a printout of the waveform.
½
11. Apply the two pacing electrodes. Make sure the patient’s skin is clean
½
and dry to ensure good skin contact. Pull the protective strip from the
posterior electrode (marked ‘Back’) and apply the electrode on the left side
of the thoracic spinal column, just below the scapula
12. Apply the anterior pacing electrode (marked ‘Front’), which has two
½
protective strips—one covering the gelled area and one covering the outer
rim. Expose the gelled area and apply it to the skin in the anterior position,
to the left side of the sternum in the usual V2 to V5 position, centered close
to the point of maximal cardiac impulse. Move this electrode around to get
the best waveform. Then expose the electrode’s outer rim and firmly press it
to the skin.
13. Prepare to pace the heart. After making sure the energy output in
½
milliamperes (mA) is on 0, connect the electrode cable to the monitor output
cable.
14. Check the waveform, looking for a tall QRS complex in lead II.
½
15. Check the selector switch to ‘Pacer on.’ Select synchronous (demand) or
½
asynchronous (fixed-rate or nondemand) mode, per medical orders. Tell the
patient he or she may feel a thumping or twitching sensation. Reassure the
patient you will provide medication if the discomfort is intolerable.
16. Set the pacing rate dial to 10 to 20 beats higher than the intrinsic rhythm. 1
Look for pacer artifact or spikes, which will appear as you increase the rate.
If the patient does not have an intrinsic rhythm, set the rate at 80
beats/minute.

17. Set the pacing current output (in milliamperes [mA]). For patients with 1
bradycardia, start with the minimal setting and slowly increase the amount
of energy delivered to the heart by adjusting the ‘Output’ mA dial. Do this
until electrical capture is achieved: you will see a pacer spike followed by a
widened QRS complex and a tall broad T wave that resembles a premature
ventricular contraction.
18. Increase output by 2 mA or 10%. Do not go higher because of the
½
increased risk of discomfort to the patient.
19. Assess for mechanical capture: Presence of a pulse and signs of
½
improved cardiac output (increased blood pressure, improved level of
consciousness, improved body temperature).
 20. For patients with asystole, start with the full output. If capture occurs,
1
slowly decrease the output until capture is lost, then add 2 mA or 10% more.
21. Secure the pacing leads and cable to the patient’s body.
½
22. Monitor the patient’s heart rate and rhythm to assess ventricular
½
response to pacing. Assess the patient’s vital signs, skin color, level of
consciousness, and peripheral pulses. Take blood pressure in both arms.
23. Assess the patient’s pain and administer analgesia/sedation, as ordered,
½
to ease the discomfort of chest wall muscle contractions
24. Perform a 12-lead ECG and additional ECG daily or with clinical
½
changes.
25. Continually monitor the ECG readings, noting capture, sensing, rate,
½
intrinsic beats, and competition of paced and intrinsic rhythms. If the
pacemaker is sensing correctly, the sense indicator on the pulse generator
should flash with each beat.
26. Remove PPE, if used. Perform hand hygiene.
½
27. Documentation:
½
Document the reason for pacemaker use, time that pacing began,
electrode locations, pacemaker settings, patient’s response to the procedure
and to temporary pacing, complications, and nursing actions taken.
Document the patient’s pain-intensity rating, analgesia or sedation
administered, and the patient’s response.

Key: 0 ≡ 0 Mark (Not done) 1 ≡ 1mark (Needs Practice) 2≡ 2marks (Satisfactory) 3≡ 3 marks (Excellent)

Comment----------------------------------------------------------------------------

Total Degree ……………………………………………………………..

Student’s Signature-………………………………………………………

Instructor’s Signature …………………………………………………….

 Central Venous Pressure MeasurementsVia Manometer Checklist [ / 15 ]

Student’s Name: …………………………………………………….

Group: --------------------------------- Date: ------------------------
Steps 0 1 2 3
1. Review doctor orders.
½
2. Hand washing
½
3. Prepare equipment.
½
4. Explain the procedure to the patient.
½
5. Keep patient privacy.
½
6. Raise bed to appropriate working height.
½
7. Wear sterile gloves.
½
8. Ensure that the CVC is patent by flushing the catheter.
½
9. Place the patient flat in a supine position with head flat not elevated
1
more 30 degree. The position should remain the same for each
measurement taken.
10. CVP is usually recorded at the midaxillary line. This is where the
1
fourth intercostal space and midaxillary line cross each other allowing.
11. Mark this point with felt tip to be used as zero point.
½
12. Flush IV line to assure CVP patency.
½
13. Prepare lines connections.
½
14. Turn stopcock off to the manometer.
½
15. Move the manometer scale up and down to allow to be aligned with ½
zero.
16. Turn the stopcock off to the pt. ½
17. Allow the manometer to fill up to25-cm level with IV fluid Avoid 1
letting the fluids run out the top.
18. Turn the stopcock off to the IV fluid.
½
19. The fluid level inside the manometer should fall until equal to
½
pressure in the central veins.
 20. Take CVP reading when the fluid level stabilizes. Should be taken
1
at the end of expiration.
21. If the fluid moves with the patient's breathing, read the
1
measurement from the lower number. occlusion of the catheter to
improper positioning of the stopcock will result in too slow or no
administration of iv fluids through
22. Turn the stopcock off to the manometer.
½
23. Turn the stopcock open from the IV fluids to the pt..
½
24. Run IV fluid through CVP lineas prescribed.
½
25. Document the measurement and report any changes or
abnormalities.
½

Key: 0 ≡ 0 Mark (Not done) 1 ≡ 1mark (Needs Practice) 2≡ 2marks (Satisfactory) 3≡ 3 marks (Excellent)

Comment----------------------------------------------------------------------------

Total Degree ……………………………………………………………..

Student’s Signature-………………………………………………………

Instructor’s Signature …………………………………………………….

 CVP Dressing and Care check list [ / 15 ]

Student’s Name: ………………………………………………………………

Group: --------------------------------- Date: ------------------------

Steps 0 1 2 3
1- Assess the type of central IV catheter, size and number of lumens.
½
2- Assess the patient understanding of need for care.
½
3- Assess the patient allergy to antiseptic solutions.
½
4- Explain procedure to the patient.
½
5- Position of the patient in comfortable position with head
1
slightly elevated.
6- Perform hand hygiene, wear protective measures and apply clean
½
gloves.
7- Remove old dressing in direction of catheter insertion and
1
discard in biohazard container.
8- Remove protective device if present but if use sutures and become
1
loosening using protective device
9- Inspect catheter insertion site and surround skin, for erythema,
1
warmth, tenderness, drainage.
10-Gauze dressing care provided every 48 hrs. , and as needed,
1
transparent dressing care every 7 days and as needed.
11- Remove old gloves, perform hand hygiene. ½
12- Open sterile dressing kit and wear clean gloves.
½
13- Using aseptic swab, cleanse catheter and site as the following: 1
- First swab in horizontal line
- Second swab in vertical line
- Third swab in circular outward motion
 14- Allow antiseptic to dry completely.
1
15- Apply new catheter stabilization if not sutured.
½
16- Apply sterile dressing over site.
½
17- Apply label with date, time and initial name
1
18- Dispose equipment's, remove gloves and perform hand washing.
½
19-Observe catheter connection periodically every 8 hours for leaks,
1
tear, secure and correct solution
20- Documentation. 1
- Procedure steps, type of antiseptic solution
- Date and time of procedure
- Reaction of the patient
- Signs and symptoms of inflammation, dislodgement
- Signature of the nurse

Key: 0 ≡ 0 Mark (Not done) 1 ≡ 1mark (Needs Practice) 2≡ 2marks (Satisfactory) 3≡ 3 marks (Excellent)

Comment----------------------------------------------------------------------------

Total Degree ……………………………………………………………..

Student’s Signature-………………………………………………………

Instructor’s Signature …………………………………………………….

 Tracheostomy Care Checklist [ / 15 ]

Student’s Name: ………………………………………………………

Group: --------------------------------- Date: ------------------------
Steps 0 1 2 3
1- Explain procedure to patient ½
2- If tracheostomy tube has just been suctioned, remove soiled 1
dressing from around tube and discard with gloves when they are
3- removed.
Perform hand hygiene and open necessary supplies. ½
4- Cleaning a Non disposable inner Cannula 1
Prepare supplies before cleaning inner cannula:
a. Open tracheostomy care kit and separate basins touching only the
edges. If kit is not available, open two sterile basins.
b. Fill one basin 4 in (1.25 cm) deep with hydrogen peroxide.
c. Fill other basin in (1.25 cm) deep with saline.
d. Open sterile brush or pipe cleaners if they are not already
available in a cleaning kit. Open additional sterile gauze pad.
5- Done disposable glove. ½
6- Remove the oxygen source if one is present. ½
7- Rotate the lock on the inner cannula in a counterclockwise motion 1
to release it
8- Gently remove the inner cannula and carefully drop it in the basin
½
with hydrogen peroxide.
9- Remove gloves and discard.
½
10- Clean the inner cannula:
1
a. Done sterile gloves.

b. Remove inner cannula from soaking solution. Moisten brush or pipe

cleaners in saline and insert into tube, using back and forth motion.
c. Agitate cannula in saline solution. Remove and tap against inner
surface of basin.
d. Place on sterile gauze pad.
11- Suction the outer cannula using sterile technique.
1
12- Secure. Reapply oxygen source if needed.
1
Replace inner cannula into outer cannula. Turn lock clockwise and cheek
that inner cannula is
 13- Disposable inner Cannula: 1
Release lock. Gently remove inner cannula and place in disposal bag.

Discard gloves and don sterile ones to insert new cannula. Replace with
appropriately sized new cannula. Engage lock on inner cannula.
14- Applying Clean Dressing and Tape: 1
Dip cotton-tipped applicator in saline and clean stoma under faceplate.
Use each applicator only once, moving from stoma site outward.
15 - Apply hydrogen peroxide to area around stoma, faceplate, 1
and counter cannula if secretions prove difficult to remove. Rinse area
with saline.
16- Pad skin gently with dry " 4x4" gauze. ½
17- Slide commercially prepared tracheostomy dressing or pre ½
folded non-cotton-filled "4x4" dressing under faceplate.
18- Change the tracheostomy tape: 1
a. Leave soiled tape in place until new one is applied.
b. Cut piece of tape that is twice the neck circumference plus in (10
cm). Trim ends of tape on the diagonal.
c. Insert one end of tape through faceplate opening alongside old tape.
Pull through until both ends are even.
d. Slide both tapes under patient's neck and insert one end through
remaining opening on other side of faceplate. Pull snugly and tie
ends in double square knot. Check that patient can flex neck
comfortably.
e. Carefully remove old tape. Reapply oxygen source if necessary. ½
19- Remove gloves and discard. Perform hand hygiene. Assess ½
the patient's respirations. Document assessments and complication
of procedure

Key: 0 ≡ 0 Mark (Not done) 1 ≡ 1mark (Needs Practice) 2≡ 2marks (Satisfactory) 3≡ 3 marks (Excellent)

Comment----------------------------------------------------------------------------

Total Degree ……………………………………………………………..

Student’s Signature-………………………………………………………

Instructor’s Signature …………………………………………………….

 Tracheostomy tube suctioning Checklist

Student’s Name: ……………………………………………….

Group: --------------------------------- Date: -----------------------
Action 0 1 2 3
1. Explain procedure to patient and reassure him or her that you
will interrupt procedure if the patient indicates respiratory
1
difficulty. Administer pain medication before suctioning to
postoperative patient.
2. Gather equipment and provide privacy for patient.
½
3. Perform hand hygiene.
½
4. Assist the patient to a semi-fowler's or fowler's position if
conscious. An unconscious patient should be placed in the lateral
1
position facing you.
5. Turn suction to appropriate pressure:
Wall unit
1
a) Adult: 100 to 120 mm Hg
b) Child: 95 to 110 mm Hg
c) Infant: 50 mm Hg
Portable unit
a) Adult: 10 to 15 mm Hg
b) Child: 5 to 10 mm Hg
c) Infant 2 to 5 mm, fie
6. Place clean towel, if being used, across patient's chest. Don
mask, and gown, if necessary.
1
7. Open sterile kit or set up equipment, and prepare to suction.
2
a. Place sterile drape, if available, across patient's chest.
b. Open sterile container and placed on bedside table or over bed
table without contaminating inner surface.
c. Hyper oxygenate patient using manual resuscitation bag or
sigh mechanism on mechanical ventilator.
d. Done sterile gloves or one sterile glove on dominant hand and
clean glove on non dominant hand. Connect sterile suction
catheter to suction tube that is held with un sterile gloved
hand.
e. Moisten the catheter by, dipping it into the container of sterile
c saline unless it is one of the newer silicone catheters that do
not require lubrication.
8. Remove oxygen delivery setup with un sterile gloved hand if it
is still in place.
1
 9. Using sterile gloved hand, gently and quickly insert catheter 1
into the trachea (cc photo), advance about 10 to 12.5 cm (4 to 5
inches) to until patient coughs. Do not occlude Y port when
inserting catheter.
10. Apply intermittent suction by occluding Y port with thumb of 1
un sterile gloved hand. Gently rotate catheter with thumb and index
finger of sterile gloved hand as catheter is being withdrawn. Do not
allow suctioning to continue for more than 10 seconds.
Hyperventilate 3 to 5 times between suctioning or encourage patient
to cough and deep breathe between suctioning.
11. Flush the catheter with saline and repeat suctioning as needed 1
and according to patient's toleration of procedure. Allow patient
toleration of procedure. Allow patient to rest at least one minute
between suctioning, and replace oxygen delivery setup if necessary.
Limit suctioning events to three times.
12. When procedure is completed, turn off suction and disconnect 1
catheter from suction tubing. Remove gloves inside out and dispose
of glove, catheter, and container with solution in proper receptacle.
Perform hand hygiene.
13. Adjust patient's position and auscultated chest to evaluate 1
breath sounds.
14. Record the time of suctioning and the nature and amount of 1
secretions. Also note the character of patient's respirations before
and after suctioning.
15. Offer oral hygiene. 1

Key: 0 ≡ 0 Mark (Not done) 1 ≡ 1mark (Needs Practice) 2≡ 2marks (Satisfactory) 3≡ 3 marks (Excellent)

Comment----------------------------------------------------------------------------

Total Degree ……………………………………………………………..

Student’s Signature-………………………………………………………

Instructor’s Signature …………………………………………………….

 Defibrillation Checklist

Student’s Name: ……………………………………………….

Group: --------------------------------- Date: ------------------------
Steps 0 1 2 3
Before the procedure : ¼
1. Check doctor order
2. prepare the equipment ¼
3. Hand wash ¼
4. Identify pt & Explain procedure ¼
5. Maintain patient's privacy. ¼
6. Remove all metallic objects from the patient anddentures ¼
7. Place a back board under the patient. ¼
8. Verify V-fib or V-tach by ECG and correlate withclinical ½
state.
9. Assess to determine absence of pulse. Call for helpand perform ½
CPR until defibrillator and crash cart arrives..
10. Prepare for defibrillation ½
- Turn power "ON". Defaults to 200 joules
11. Select correct paddles- adult, pediatric or internal. ½
12. Prepare patient and/or paddles with proper conductive ¼
agent.

13. Checks that defibrillator is in asynchronous mode. ½

If other than 200 joules desired, press "ENERGY SELECT"
and select desired amount
- Turn on ECG recorder for continuous printout.
During Cardioversion and Defibrillation: ½
14- Place the client in a flat, firm surface.
15 - Apply interface material (gel, paste, saline pads) to the ½
paddles.
16- Grasp the paddles only by the asulated handles. To
½
prevent electrocution.
17. Give command for personnel to STAND CLEAR ofthe
½
client and the bed.
18. Apply the chest paddle as follows: one at the right ofthe
½
sternum, third ICS, and the other one on the left mid
axillary, fifth ICS.
19. Press "CHARGE" on defibrillator front panel or on the
½
Apex paddle. Wait until indicator stops flashing toindicate
fully charged..
20. For defibrillation, release 200 to 360 watts/s. (Joules).
½
21. State "ALL CLEAR" and visually check that all
½
personnel are clear of contact with bed, patient and
equipment.
22. Checks rhythm immediately before discharge.
½
23. Depress both buttons simultaneously and maintain
½
pressure until electrical current delivered.
24. Assess conversion of dysrhythmia. ½
25. If first defibrillation unsuccessful, immediatelycharge ½
paddles to 300 joules and repeat steps 12 through 23.
24. If second defibrillation unsuccessful, immediately
½
charge paddles to 360 joules and repeat steps 12
through 23.

25. If third attempt is unsuccessful, continue CPR, initiate

ACLS protocols, intubate and obtain IV access.
½
 26. Assess patient status and precipitating factors to ½
prevent further decompensation of patient.
Post Cardioversion and Defibrillation: ½
27. Assess pt for:
- Neurologic status: Reorient to person, place, and time
- Respiratory status: Auscultate lung sounds, Monitor
rate, depth, & quality of breathing. Oxygen as ordered.
- Cardiovascular status: Get 12-lead ECG and continue to
monitor rhythm and blood pressure, pulseand respirations
frequently until stable.

28. Initiate IV antidysrhythmic therapy.

½
29. Monitor for burns. Treat if indicated.
½
30. Wash hands.
½
31. Clean defibrillator and paddles, Discard supplies
½
32. Documentation include: ½
Neurologic, respiratory and cardiovascularassessment
before and after defibrillation.

Key: 0 ≡ 0 Mark (Not done) 1 ≡ 1mark (Needs Practice) 2≡ 2marks (Satisfactory) 3≡ 3 marks (Excellent)

Comment----------------------------------------------------------------------------

Total Degree ……………………………………………………………..

Student’s Signature-………………………………………………………

Instructor’s Signature …………………………………………………….

1. Seminars, presentation or case study given by the intern [ / 5 marks ]

Topic Name Date

1.
2.
3.

2. Seminars, presentation or lectures attended by the intern

Topic Name Date

1.
2.
3.

Internship preceptor/Director Signature:

Date:

Stamp:
Technical, analytical and management [ / 5 marks ]

No Content Pass Fail

1 Applies theoretical knowledge and principles to clinical setting
½
2 Applies nursing process to related conditions
½
3 Is able to solve problem and make appropriate decision
½
4 Participates in provision of safe patient care
¼
5 Carries out the assigned task/patient load independently
¼
6 Maintains accurate, complete and current nursing documentation
½
7 Follows aseptic technique
½
8 Demonstrate supportive attitude towards patient and family
¼
9 Shows motivation to learn and seeking new learning opportunity
¼
10 Co-operates with other members on multidisciplinary team
½
11 Follows hospital rules and regulation
½
12 Demonstrate accountability and professional conduct
½
REFERENCES

A. Course Notes

B. Essential Books

1. Altman G . Delmar’s fundamental and advanced nursing skills,2 nd edition

,Delmer learning, a division of Thomson learning, Inc, Canada 2004.
2. Comer S. Delmar’s Critical care nursing care plans,2 nd edition, Thomson –
Delmar Learning, Australia ,2005
3. Schilling j. Critical Care Challenges : disorders, treatment and procedures
,Lippincott Williams and Wilkins- A Wolters Kluwer company, Philadelphia,
2003.
4. AACN Procedure Manual for Critical Care 5 th Edition
B. Recommended Books

 Gehart, B., & Nazareno, A. (2002). 2002 Intravenous medications (17th

ed.). Louis: Mosby.
 Kidd & Wagner. (2001). High acuity nursing (2nd ed.). Prentice Hall.

C. Web Sites
With my best wishes