1. Check physician’s order for insertion of nasogastric tube.

2. Explain procedure to patient.

3. Gather equipment.
4. If nasogastric tube is rubber, place it in a basin with ice for 5 to 10
minutes or place a plastic tube in a basin of warm water if needed.
5. Assess patient’s abdomen.
6. Perform hand hygiene. Don disposable gloves.
7. Assist patient to high Fowler’s position or to 45 degrees if unable to
maintain upright position and drape his or her chest with bath towel or
disposable pad. Have emesis basin and tissues handy.
8. Check nares for patency by asking patient to occlude one nostril and
breathe normally through the other. Select nostril through which air
passes more easily.
9. Measure distance to insert the tube by placing tip of tube at patient’s
nostril and extending to tip of earlobe and then to tip of xiphoid
process. Mark tube with a piece of tape.
10. Lubricate tip of tube (at least 1-2 inches) with water-soluble lubricant.
Apply topical analgesic to nostril and oropharynx or ask patient to hold ice chips in his or her mouth for several minutes
(according to physician’s preference).
11. After having the patient lift his or her head, insert tube into nostril while directing tube downward and backward. Patient
may gag when tube reaches the pharynx.
12. Instruct patient to touch his or her chin to chest. Encourage him or her to swallow ever if no fluids are permitted. Advance
tube in a downward-and-backward direction when patient swallows. Stop when patient breathes. Provide tissues for tearing
or watering eyes. If gagging and coughing persist, check placement of tube with a tongue blade and flashlight. Keep
advancing tube until tape marking is reached. Do not use force. Rotate tube if it meets resistance.
13. Discontinue procedure and remove tube if there are signs of distress, such as gasping, coughing, cyanosis, and inability to
speak or hum.
14. Determine that tube is in patient’s stomach. Hold tube in place to keep it from withdrawing while placement is checked.

a. Attach syringe to end of tube and aspirate a small amount of stomach contents.
b. Measure pH of paper or a meter.
c. Visualize aspirated contents, checking for color and consistency.
d. Obtain radiograph of placement of tube (as ordered by physician).
15. Apply tincture of benzoin to tip of nose and allow to dry. Secure tube with tape to patient’s nose. Be careful not to pull tube
too tightly against nose.

a. Cut a 4-inch piece of tape and split bottom 2 inches or use packaged nose tape nasogastric tubes.
b. Place unsplit end over bridge of patient’s nose.
c. Warp split ends under tubing and up and over onto nose.
16. Attach tube to suction or clamp tube and cap it according to physician’s orders.
17. Secure tube to patient’s gown by using a rubber band or tape and a safety pin. If double-lumen tube is used, secure vent
above atomach level. Attach at shoulder level.
18. Assist or provide patient with oral hygiene at regular intervals.
19. Perform hand hygiene. Remove all equipment and make patient comfortable.
20. Record the insertion skill, type, and size of tube and measure tube from tip of nose to end of tube. Also document
description of gastric contents, which naris used, and patient’s response.

CATHETERIZING THE FEMALE & MALE URINARY BLADDER (Straight & Indwelling)

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1. Assemble equipment. Perform hand hygiene. Explain procedure and purpose to patient. Discuss any allergies with patient,
especially iodine or latex.
2. Provide good light. Artificial light is recommended (use of flashlight requires an assistant to hold and position it).
3. Provide privacy by closing curtains or door.
4. Assist patient to the dorsal recumbent position with knees flexed and feet about 2 feet apart. Drape patient. Or, if
preferable, place patient in the side-lying position. Slide waterproof drape under patient.
5. Clean genital and perineal areas with warm soap and water. Rinse and dry. Perform hand hygiene again.
6. Prepare urine drainage setup if indwelling catheter is to be inserted and separate urine collection system is used. Secure to
bed frame according to manufacturer’s directions.
7. Open sterile catheterization tray on overbed table using sterile technique.
8. Put on sterile gloves. Grasp upper corners of drape and unfold without touching unsterile areas. Fold back cuff over gloved
hands. Ask patient to lift her buttocks. Slide sterile drape under her with gloves protected by cuff.
9. Place a fenestrated sterile drape over perineal area, exposing the labia.
10. Place sterile tray on drape between patient’s thighs.
11. Open all supplies.
a. If catheter is to be indwelling, test catheter balloon. Remove protective cap on tip of syringe and attach syringe
prefilled with sterile water to injection port. Inject appropriate amount of fluid. If balloon inflates properly,
withdraw fluid and leave syringe attached to port.
b. Pour antiseptic solution over cotton balls or gauze. Open specimen container if specimen is to be obtained.
c. Lubricate 1 to 2 inches of catheter tip.
12. With thumb and one finger of your nondominant hand, spread labia and identify meatus. Be prepared to maintain
separation of labia with one hand until urine is flowing well and continuously.
13. Using cotton balls held with forceps, clean both labial folds and then directly over meatus. Move cotton ball from above
the meatus down toward the rectum. Discard each cotton ball after one downward stroke.
14. With uncontaminated gloved hand, place drainage end of the catheter in receptacle. For insertion of an indwelling catheter
that is preattached to sterile tubing and drainage container (closed drainage system), position catheter and setup within easy
reach on the sterile field.
 15. Insert catheter tip into the meatus 5 to 7.5 cm (2-3 inches) or until urine flows. Do not use force to push catheter through
the urethra into the bladder. Ask patient to breathe deeply. Rotate catheter gently if slight resistance is met as catheter
reaches the external sphincter. For an indwelling catheter, once urine drains advance catheter another 2.5 to 5.0 cm (1-2
inches).
16. Hold catheter securely with the nondominant hand while bladder empties. Collect specimen if required. Continue drainage
according to agency policy.
17. Remove catheter smoothly and slowly if a straight catheterization was ordered.
18. If the catheter is to be indwelling:

a. Inflate balloon according to manufacturer’s recommendations.

b. Tug gently on catheter after balloon is inflated to feel resistance.
c. Attach catheter to drainage system if necessary.
d. Secure to upper thigh with a Velcro leg strap or tape. Leave some slack in catheter to allow for leg movement.
e. Check that drainage tubing is not kinked and that movement of side rails does not interfere with catheter or
drainage bag.

19. Remove equipment and make patient comfortable in bed. Clean and dry perineal area, if necessary. Care for equipment
according to agency policy. Send urine specimen to laboratory promptly or refrigerate it.
20. Perform hand hygiene.
21. Record time of catheterization, amount of urine removed, description of urine, patient’s reaction to procedure, and your
name.

Skills Lab 43-3

Catheterizing the Male Urinary Bladder
(Straight and Indwelling)

1. Assemble equipment and follows Actions 1 to 3 for female catheterization in Skill 43-2.
2. Position patient on his back with thighs slightly apart, Drape patient so that only area around penis is exposed.
3. Follow Actions 5 through 7 for female catheterization in skill 43-2.
4. Put on sterile gloves. Open sterile drape and place on patient’s thighs. Place the fenestrated drape with the opening over
penis.
5. Place catheter set on or next to patient’s legs on the sterile drape.
6. Open all supplies.
a. If catheter is to be indwelling, test catheter balloon. Remove protective cap on tip of syringe and attach syringe
prefilled with sterile water to the injection port. Inject appropriate amount of fluid. If balloon inflates properly,
withdraw fluid and leave syringe attached to port.
b. Pour antiseptic solution over cotton balls or gauze. Open specimen container if specimen is to be obtained.
c. Remove cap from syringe prefilled with lubricant.
7. Lift penis with your nondominant hand, which is then considered contaminated. Retract foreskin in the uncircumcised male
patient. Clean area at meatus with cotton ball held with forceps. Use circular motion, moving from the meatus toward base
of the penis for three cleansings.
8. Hold the penis with slight upward tension and perpendicular to patient’s body. Gently insert tip of syringe with lubricant
into urethra and instill 10 ml. of lubricant.
9. Ask patient to bear down as if voiding. With your dominant hand, place drainage end of catheter in the receptacle. For
insertion of indwelling catheter that is preattached to sterile tubing and drainage container (closed drainage system),
position the catheter and setup within easy reach on the sterile field.
10. Insert the tip into the meatus. Advance intermittent catheter 15 to 20 cm (6-8 inches) or until urine flows. Do not use force
to introduce the catheter. Once balloon is inflated, catheter may be gently pulled back into place. Replace the foreskin in
uncircumcised patient. Lower the penis.
11. Follow Actions 16 through 21 for female catheterization in Skill 43-2 except that the catheter may be secured to the upper
thigh or lower abdomen with the penis directed toward the patient’s chest. Slack should be left in the catheter to prevent
tension.

PROCEDURE FOR CARDIO-PULMONARY RESUSCITATION (CPR)

1. If the patient is not breathing, make certain there is no airway obstruction. Feel his wrist for a pulse.
2. Administer CPR

a. Stretch the victim flat on his back on the ground or floor.

b. Kneel at his side and with your fist, strike his breast bone sharply. This may start the heart beating.
c. If it does not feel the victim’s chest, locate the lower tip of his breastbone.
d. Put one finger of your left hand on the cartilage.
e. Move the heel of the right hand (never use the palm against the finger)
f. Place the left hand a top the right.
g. With a quick firm thrust, push down.
h. Use sufficient force to press the lower one third of the breastbone down 1 ½ inches, letting your back and body do
the work. Lift your weight, repeat the procedure.
i. If you are alone with the victim, stop after each 15 compressions and give him two deep breathes mouth to mouth,
continuing this 15 to 2 rhythm.

until help comes.

j. If someone can assist you, have him kneel at the victim’s head and give mouth to mouth respiration at the rate of
12 times a minute – one breath for each five compressions of the heart that you can perform.
k. Continue complete CPR for an hour until the victim revives. Pupils constrict, color improves, breathing begins
and pulse returns.
Assessment:

1. Check vital functions and pronounce patient dead if permitted to do so, notify physician and record time of
death and time pronounced dead.

2. Notify the following:

A. Attending Physician

B. Nursing Supervisor

C. Admitting or Census Department

D. Appropriate Agency for Organ Procedures

E. Medical Examiner

F. Designated Mortician

Planning:

1. Plan for any special religious/cultural practices desired by family.

2. Offer to transfer any other patients in room to another location temporarily.

3. Wash hands.

4. Gather equipments.

Implementation:

1. Place “No visitor - Check at Nurses’ Station” sign to door.

2. Place body in supine position with bed flat.

3. Place pillow under head.

4. Close patient’s eyes.

5. Remove watch, jewelry and all possessions, give it to the nearest relative.

6. Put on clean gloves.

7. Place small towel under chin.

8. Remove IV and other tubes unless autopsy is to take place.

9. Remove soiled dressings, ostomy bags and replace them.

10. Wash soiled areas of body.

11. Place ABD’s (disposable pads) to the perineal area to absorb any stool or urine released as the sphincter
muscle relaxes.

12. Remove and discard gloves.

13. Put a clean gown on the patient.

14. Leave the wrist identifications band in place

15. Attach a second identification tag to the ankle or great toe.

16. If the body is to be viewed, replace top linens and tidy the unit.

17. Care for dentures and eye glasses, after viewing leave dentures in patients mount or place them in a
denture container. Dentures and eyeglasses are sent to the morticians with the body.
18. Gather personal effects and give to the family or provide for safekeeping.

19. Wrap body and attach identification tag on outside, if facility policy indicates.

20. Transport body to facility morgue or wait for the arrival of the mortician.

21. Put away or dispose equipment and supplies used.

22. Wash your hands.

Evaluation:

1. Evaluate using the following criteria:

A. Body cared for and transported appropriately.

B. All necessary notifications carried out.

C. Family able to carry out rituals, viewing, and spend time with patient as desired. Possessions were
carefully handled.

Documentation:

1. Document Post Mortem activities including:

A. Time of cessation of Vital Signs.

B. Persons notified and time of notification.

C. List and documentation of valuable and personal effects.

D. Time body removed from unit, destination and by whom removed.

E. Other information required by faculty.