Key: D= Demonstrates Skill; V=Verbalizes Skill; N=Needs reinforcement of skill on unit; L= lab time

remediation required

N223 Medical Surgical II Skills Packet

Student Name_____________________
Date____________________________

Clinical Instructor_____________________
Date____________________________

Skill/ATI Module ATI Certificate Skills Check Faculty Pass/Needs

of Completion off Date Signature Remediation
Blood
Administration
Chest Tube Care
Blood Draws from
a Central or PICC
Line
Advanced Airways Skills review
Alaris or Plum NA NA
Pumps
IV insertion NA Skills review
Foley Care NA Skills review
NG tube NA Skill review
care/insertion
Physical
Assessment
Trach Care and NA Skills Review
Suctioning

3/29/18
Key: D= Demonstrates Skill; V=Verbalizes Skill; N=Needs reinforcement of skill on unit; L= lab time
remediation required

N223/N401 Skills Fair

 The fair must be completed during the 3 hour time slot you are assigned to.
 Check in at sign in sheet at “nurses station”.
 If you are not “testing” at the station utilize the practice stations for skills review.
 You MUST have your packet with you. NO packets given out at the fair.
 Complete the post-fair evaluation survey prior to leaving for the day, find at “nurses
station”.
 Your signed packed must be turned into your clinical instructor prior to leaving the skills
fair.
 Must have ATI Completion certificates in hand as “ticket to enter” skills fair.

Starting in simulation lab in far left corner by glass wall:

Station 1: Blood Draw from central line

Station 2: Chest Tube

Station 3: Blood administration

Station 5-7: NG insertion, foley insertion male/female, trach care/suctioning

Station 8: Advanced oral airways

Station 9: in debriefing room IV pumps and IV insertion

Key: D= Demonstrates Skill; V=Verbalizes Skill; N=Needs reinforcement of skill on unit; L= lab time
remediation required

Blood Draw off Central Line

SKILL Assessment Value Notes
Gather supplies: clean
gloves, 10-mL syringes
filled with 0.9% sodium
chloride solution,
antiseptic, biohazard
container, blood tubes,
needleless connector,
patient labels
Verify client using 2
client identifiers.
Obtain blood sample:
a. Temporarily turn off
running IV solution,
disconnect tubing, cap.
b. Clean port, Flush
with 5-10mL NS.
c. Clean port, waste 5-
10mL blood.
d. Clean port, obtain
blood and transfer into
blood tubes
e. Clean port, flush
with 5-10 mL NS.
f. Clean port, reconnect
IV tubing and restart
infusion assessing
patency.

Label blood lab tubes

at bedside with
appropriate
documentation.
Dispose of equipment
appropriately.
Key: D= Demonstrates Skill; V=Verbalizes Skill; N=Needs reinforcement of skill on unit; L= lab time
remediation required

Chest Tubes
SKILL Assessment Value Notes
Identified patient using
two identifiers.
Assessed pulmonary
status for signs and
symptoms of
respiratory distress,
tachycardia,
hypotension. Assess
pain level.
Obtained baseline vital
signs, level of
cognition, and SpO2
Observed chest tube
status:
a. Chest tube dressing
and insertion site.
Applied gloves if
appropriate.
b. Tubing for kinks,
dependent loops, or
clots.
c. Checked drainage
system to ensure it was
upright and below
insertion level. Noted
amount of drainage
and description.
Ensured tube
connection was intact
and taped. Coiled
excess tubing and
secured on mattress
next to patient,
allowed patient
enough room to
reposition.
Identifies appropriate
emergency equipment
at patient bedside and
significance of each.
Demonstrates how to
identify location of
air leak with padded
clamps.
.
Key: D= Demonstrates Skill; V=Verbalizes Skill; N=Needs reinforcement of skill on unit; L= lab time
remediation required

Blood Administration
SKILL Assessment Value Notes
Verify provider order,
verify need based on
lab values. Assessed if
premedication is
required. If so what is
importance of the
medications.
Gather necessary
supplies: blood tubing,
fluids, blood,
verification sheet.
Identified patient
appropriate identifiers
for blood
administration with
another staff member.
Pre-administration
vitals and assessment
complete and
documented.
Demonstrate initiation
of unit of blood
describing rate, fluids
used, and assessments
of IV.

Indicate length RN
must stay with client
and what education
and assessments
provided.
Indicate length of
assessments during
procedure.
Post-procedure:
assessments,
documentation on
completion of unit.
Discuss how unit and
tubing is disposed of.
Key: D= Demonstrates Skill; V=Verbalizes Skill; N=Needs reinforcement of skill on unit; L= lab time
remediation required

Blood Transfusion Documentation:

Patient ID Date
Patient Name Age
Diagnosis Sex
Client Blood Pre-Transfusion
Type/Group Hgb

Bag Unit Number

Type Component
Amount of Blood
Transfusion Start
Time

Parameters Pre- 15 30 1 hour Completion

Transfusion minutes minutes
Pulse
Blood
Pressure
Temperature
Respiration
Infusion
Rate

Time Transfusion
Complete:
Evidence of Transfusion
Reaction:

Signature of Date/Time:
Infusing RN:
Signature of Date/Time
Verifying RN:
Key: D= Demonstrates Skill; V=Verbalizes Skill; N=Needs reinforcement of skill on unit; L= lab time
remediation required

Advanced Oral Airway

SKILL Assessment Value Notes
Identified patient using
two identifiers.
Assessed pulmonary
status for signs and
symptoms of
respiratory distress.
Obtained baseline vital
signs, level of
cognition, and SpO2
Opens airway by using
head tilt–chin lift
maneuver while
keeping mouth open
(jaw thrust for trauma
victim)
Verbalizes different
indications for OPA and
NPA • OPA only for
unconscious victim
without a gag reflex •
NPA for conscious or
semiconscious victim.
Selects correctly sized
airway by measuring •
OPA from corner of
mouth to angle of
mandible
Insert OPA:
a. open the patient's
mouth using the
cross-finger method,
placing your thumb
on the patient's
bottom teeth and your
index finger on the
upper teeth, then
gently pushing them
apart.
b. Begin inserting the
airway upside down,
with the curvature
toward the tongue to
prevent pushing the
tongue back into the
pharynx.
Key: D= Demonstrates Skill; V=Verbalizes Skill; N=Needs reinforcement of skill on unit; L= lab time
remediation required

c. When the airway

reaches the back of
the tongue, rotate the
device 180 degrees.
The tip should point
down as it
approaches the
posterior wall of the
pharynx, and the
curvature should
follow the contour of
the roof of the mouth.
d. Assess for
gagging, coughing.
e. Start ventilations.
Reassess respiratory
status with OPA in
place.
Key: D= Demonstrates Skill; V=Verbalizes Skill; N=Needs reinforcement of skill on unit; L= lab time
remediation required

Adult Physical Assessment

SKILL Assessment Value Notes
Identified patient using
two identifiers.
Obtain vitals and
compare to baseline.
NeuroMuscular: level
of consciousness,
orientation, PERRL,
posture, affect/mood,
mobility via ROM in all
extremities, strength in
all extremities
Integumentary:
Texture, turgor,
moisture, temperature,
edema, blanching of
reddened areas,
capillary refill, oral
mucosa
Respiratory:
Posture, use of oxygen,
use of accessory
muscles,
shape/symmetry,
auscultate anterior and
posterior lung sounds,
presence of
cough/sputum
Cardiac:
Visulization of JVD,
palpate/compare
bilateral radial pulses
and dorsalis pedis,
auscultate heart
sounds at 5 locations
with bell and
diaphragm
Abdomen:
Observe countour,
auscultate in 4
quadrants starting in
RLQ, palpate in 4
quadrants starting in
RLQ, assess last void
and BM, passing flatus
Key: D= Demonstrates Skill; V=Verbalizes Skill; N=Needs reinforcement of skill on unit; L= lab time
remediation required

Document progress
note.
Date and Time PROGRESS NOTES