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Critical Elements of Psychomotor Skills

7. If weak, transfer towards patient’s strong Bed bath: 1. Assess patient’s ability to ambulate
side Critical Elements : 2. Correctly position self and arms to provide
Moving patient up in bed: 1. Prepare supplies using medical asepsis for assistance and safety
Critical Elements: 2. Maintain proper body positioning of the 3. Evaluate patient’s gait, distance and
tolerance of exercise
1. Assess the patient’s ability to assist patient and good body mechanics of the
2. Position a draw sheet under the patient nurse; minimizing movements of the Applying bandages
appropriate patient and nurse Critical Elements:
3. Use proper body mechanics 3. Keep patient covered to maintain modesty 1. Assess CSM
4. Properly instruct the patient how to assist and prevent chilling 2. Position body part in neutral, elevated

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4. Clean from head to toe; perineal area last position if possible
Applying restraints: 5. Change water when appropriate 3. Apply bandage using equal distance and
Critical Elements: equal pressure
1. Assess CSM or any contradictions to use Vital Signs: 4. Wrap the extremity distal to proximal
5. Secure appropriately
2. Explain rationale to patient and/or family Critical Elements:

21 Nursing Skills Zone


3. Apply restraint properly 1. Measure vital signs accurately Applying binders:
4. Secure restraint t proper location on bed or a. within +/- mmHg of systolic and diastolic Critical Elements:
wheelchair as appropriate blood pressure 1. Choose proper sized binder for the patient
5. Assess at frequency dictated by agency b. within +/- 4 bpm of pulse 2. Position the binder appropriately
policy c. within +/- 2 of respirations per minute 3. Assess for potential breathing or skin
d. within +/- 0.2 degree of temperature impairment
Applying and removing personal protective 2. Prepare and place thermometer correctly
equipment: 3. Count irregular and apical pulse for one Applying antiembolism stockings:
Critical Elements:
Critical Elements: minute
1. Measure patient for proper fit
1. Identify needed equipment 4. Count irregular respirations for one minute 2. Apply the stocking appropriately
2. Apply appropriate equipment on proper 5. Use correct size blood pressure cuff 3. Assess CSM and presence of wrinkles in
order 6. Correctly identify location of apical pulse stockings
3. After use, remove protective equipment in
proper in order to prevent contamination Positioning of a patient: Intermittent and continuous tube feeding
Critical Elements: administration:
Administering an Enema 1. Maintain use of body mechanics by the Critical Elements:
1. Position HOB at least 30° unless
Critical Elements: nurse
contradicted
1. Use warm water 2. use pillows appropriately for support 2. Check placement and patency of tube
2. Regulate flow of water to appropriate rate 3. Support body during position changes as 3. Perform residual check; hold if residual >
3. Offer and place patient on bedpan after appropriate 100mL
instillation 4. Using the correct port, administer (TF or
Ambulating a patient: water) correct type and amount at
Critical Elements: prescribed rate
Critical Elements of Psychomotor Skills
Critical Thinking Question: Standard Precautions Handwashing:
1. Demonstrates applicant of knowledge Critical Elements: Critical Elements:
obtained in current and previous courses 1. Wash hands before initiating direct contact 1. Regulate water temperature and flow
related to the skill and patient situation with patient and whenever hands are 2. Lather with soap covering all aspects of
hand and wrists for appropriate length of
contaminated by patient’s body secretions
time
Safety and security: or substance 3. Dry hands
Critical Elements: 2. Wear gloves whenever coming in contact 4. Maintain medical asepsis and does not
1. Identify assigned patient by reading ID with human secretions contaminate self
bracelet before initiating care 3. Protect patient from contamination.

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2. Protect the patient from physical harm at 4. Protect self and others from contamination Occupied bedmaking:
all times, such as the following: 5. Confine contaminated material to Critical Elements:
*Siderails are raised when indicated contaminated areas. 1. Making medical asepsis of linen
* Bed is left in low position appropriately 6. Dispose of contaminated materials in 2. Place bed at working level for height
3. Keep patient covered at all times
* Patient’s ability to ambulare safely is designated containers
4. Maintain proper positioning of patient and

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assessed before beginning ambulation 7. Implement any designated special body mechanics of nurse
* Restraints are secure, when required, precautions as required 5. Create mitered corner and foot tent
without injuring patient 6. Center top sheet and bedspread to hand
3. Protect the patient and significant other Comfort: equally on both sides
from psychological harm by following Critical Elements: 7. Place clean pillowcase on pillow
actions: 1. Assess the patient’s comfort level before,
* Refer to the patient by designated or during and after a potentially Range of Motion
preferred name uncomfortable procedure. Critical Elements:
1. Proceed systematically from head to toe
* Communicate verbally and non-verbally 2. Provide interventions to increase the
2. Support joint being exercised
in professional manner patient’s comfort level 3. Perform exercise 3-5 times
* Communicate verbally and non-verbally
in a manner that does NOT express anger, Documentation: Transfer of patient from bed to chair:
distrust, abuse, familiarity or demeaning Critical Elements Critical Elements:
behaviors to the patient and/or significant 1. Document patient care using the following 1. Assess patient’s ability to assist; presence
others methods, as designated: assessment forms, of weakness or paralysis; cognitive function
* Provide accurate information to patient flow graphs, or other standard clinical 2. Maintain use of good body mechanics by
the nurse
and/or significant others forms, narrative process recording
3. Maintain proper body alignment of the
* Keep all patient-related information 2. Document patient changed and responses patient during
professionally confidential to care in designated records 4. Position bed at working level for height
* Maintain patient’s personal privacy at all 3. Use language, terms, and abbreviations 5. Demonstrate appropriate use of gait belt
times that are consistent with professional 6. position wheelchair at appropriate angle
* Explain procedure to patient prior to standards, agency protocols, and other and locked
initiating skill specific guidelines
4. Record data so that entries are: clear,
accurate, precise, pertinent/relevant
Critical Elements of Psychomotor Skills
5. Keep HOB at least 30° for at least 1 hour 3. Utilizes “5 Rights” 5. Apply new pouch
after feeding for intermittent feedings and 4. Appropriate drug knowledge
maintain HOB always at least 30° for 5. Correct needle, syringe and site selection Trach Suctioning
continuous feedings 6. Correct administration Critical Elements
1. Assess need for suctioning
Nasogastric tube insertion +/- suction Primary IV administration: 2. Preoxygenate
Critical Elements Critical Elements: 3. Maintain asepsis
1. Measure tube for appropriate positioning 1. Maintain asepsis 4. Correct method for insertion and
2. Lubricate the tube 2. Minimal loss of fluid removal of secretions
3. Instruct the patient regarding procedure 3. Correct titration of drop rate if gravity or 5. Assess tolerance

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and patient participation correct mL/hr if using infusion pump
4. Facilitate chin tuck when appropriate Trach Care
5. Insert the tube to the appropriate place Secondary IV administration: Critical Elements
6. Check placement Critical Elements: 1. Remove inner cannula
7. Secure the tube 1. Maintain asepsis 2. Maintain asepsis
8. Attack the tube to suction appropriately 2. Correct connection to primary line 3. Clean reusable cannula or replace

21 Nursing Skills Zone


3. Backflush method with disposable cannula
Sterile Wet to moist dressing change 4. Correct titration to drop rate if gravity or 4. Clean skin and trach plate
Critical Elements correct mL/hr is using infusion pump 5. Replace ties as needed
1. Remove old dressing
2. Assess wound and drainage IV flush with Saline: CVP dressing change
3. Establish sterile field Critical Elements: Critical Elements
4. Apply sterile gloves 1. Assess for complications 1. Don mask
5. Apply dressing using sterile technique 2. Cleans injection port 2. Remove dressing without dislodging
6. Secure dressing 3. Assess for blood return catheter
4. Infuse saline while assessing for 3. Maintain asepsis throughout
Foley catheter insertion: complications procedure
Critical Elements: 4. Clean site using technique
1. Establish sterile field Colostomy Emptying: 5. Apply tegaderm dressing with sterile
2. Apply sterile gloves Critical Elements technique and no air bubbles
3. Check foley balloon 1. Assess stoma and contents of bag
4. Cleanse perineum correctly 2. Empty bag with minimal mess
5. Insert catheter maintaining sterile 3. Proper cleaning
technique 4. Reattach clamp
6. Inflate foley bulb at appropriate location
Colostomy Bag change:
Medication Administration: Critical Elements:
Critical Elements: 1. Remove bag with minimal trauma
1. Correct calculation dose 2. Assess stoma and surrounding skin
2. Medication preparation using aseptic 3. Measure for new pouch
technique 4. Prep skin