SKILLS LABORATORY MODULE
BASIC NURSING SKILLS ON RESPIRATORY, CARDIO AND HEMATOLOGIC CARE MODALITY
WELCOME TO SKILLS LAB MODULE!!!
Oxygen is essential for sustaining life. The cardiovascular, blood and the respiratory systems are
responsible for supplying the body’s oxygen demands. Blood is oxygenated through the mechanisms of
ventilation, perfusion, and the transport of respiratory gases (Potter, Perry, Ross-Kerr, & Wood, 2010).
Respiration is optimal when sufficient oxygenation occurs at the cellular level and when cellular
waste and carbon dioxide are adequately removed via the bloodstream and lungs. If this system is
interrupted — for example by lung tissue damage, inflammation or excess mucus in the airways, or
impairment of ventilation — intervention is required to support the client and prevent the condition
from worsening or, potentially, to prevent death from occurring (Perry, Potter, & Ostendorf, 2014).
Oxygen is the most frequently used medication in emergency medicine, and when used
appropriately in the treatment of hypoxemia (an inadequate supply of oxygen in the arterial blood), it
potentially saves lives (Kane, Decalmer, & O’Driscoll, 2013). Clients with compromised oxygenation
status need careful assessment and thoughtful nursing care to achieve an adequate and comfortable
level of oxygenation function.
This module describes the basic principles of nursing skills on oxygenation encompassing
procedures on respiratory, cardio and hematologic care:
Lesson 1: Oxygen Therapy, Suctioning, Bronchial Hygiene
Lesson 2: Chest Physiotherapy, Incentive Spirometry, Chest Drainage
Lesson 3: Artificial Airway, Chest Surgery
Lesson 4: ECG and CVP and BLS-CPR
At the end of this module, the students will be able to:
1. Define and explain the basic nursing procedures needed to maintain client’s adequate
oxygenation.
2. Identify the purposes, reasons and materials needed for the basic nursing procedures
needed to maintain client’s adequate oxygenation
3. Enumerate the steps of the basic procedures needed to maintain client’s adequate
oxygenation
4. Demonstrate the basic procedures in maintaining client’s adequate oxygenation
5. Discuss the nursing principles in caring for clients undergoing basic procedures needed to
maintain adequate oxygenation.
Prepared by Prof. Amelia Z. Manaois for AU - College of Nursing to be used as Instructional Material only for the NCM112 – SKILLS LAB Lecture.
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I. PRE – TASK ACTIVITY – WORD GAME
WORD GAME - JUMBLE WORDS
As a starter, let's recall our Anatomy and Physiology. Students will arrange the jumbled letters
to form a correct word base from the clue given.
This is a 10-point introductory activity. Be reminded to type your answer in CAPITAL LETTERS in
the space provided on the link.
If you are ready, Click the link below:
https://forms.gle/N7VLGeASgCMD8eJeA
Prepared by Prof. Amelia Z. Manaois for AU - College of Nursing to be used as Instructional Material only for the NCM112 – SKILLS LAB Lecture.
Refrain from reproducing this material without the consent of the preparer and the AU-CON
II. WHILE TASK ACTIVITY – MODULE CONTENT: CARDIO - RESPIRATORY CARE MODALITY
LESSON 1: OXYGEN THERAPY, SUCTIONING, BRONCHIAL HYGIENE
I. OXYGEN THERAPY
Oxygen is a gas that is essential for life and relieves hypoxemia (low level of oxygen
in the blood) and hypoxia (low level of tissue oxygenation)
ABG analysis is the best measure for determining the need for oxygen therapy and
for evaluating its effects.
Hazards and Complications of O2 Therapy
1. Combustion – ignition, incineration, burning, fire
NCM: Posting a no-smoking sign on the tank and on the client’s room. Flammable
solutions (containing alcohol or oil) are not used in rooms where O2 is in use
2. O2-induced hypoventilation
When the client with low PaO2 levels and high PaCO2 levels receives O2 therapy, the
PaO2 level increases removing the stimulation for breathing and the client has
respiratory depression.
NCM: O2 therapy is prescribed at the lowest liter flow of 1 – 3 Lpm needed to treat
hypoxemia
3. O2 toxicity
An O2 level greater than 50% given continuously for more than 24 to 48hrs may
damage the lungs leading to initial symptoms similar to Acute Respiratory Distress
Syndrome (ARDS) such as non productive cough, substernal chest pain, GIT upset
and dyspnea.
NCM: ABG must be monitored during O2 therapy and notify physician if PaO2 level
reaches 90mmHg
Monitor the prescribed O2 level and length of therapy
4. Absorption Atelectasis
Nitrogen in the air normally helps maintain patent airways and alveoli. Nitrogen
prevents alveoli to collapse.
When high O2 levels are delivered, nitrogen is diluted, oxygen diffuses from the
alveoli into the circulation and the alveoli collapse.
Collapsed alveoli caused atelectasis.
Prepared by Prof. Amelia Z. Manaois for AU - College of Nursing to be used as Instructional Material only for the NCM112 – SKILLS LAB Lecture.
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NCM: Monitor the client closely for crackles and decreased breath sounds every 1 to
2 hours when O2 therapy is started
5. Drying of Mucous Membranes
NCM: Ensure that O2 can be seen bubbling through the water in the humidifier via a
large-volume jet nebulizer (LVN)
6. Infection
The humidifier or LVN maybe a source of bacteria, especially if it is heated.
Pseudomonas Aeruginosa is often the organism involved. O2 delivery equipment
(cannulas and masks can also harbor organisms.
NCM: Change equipment as per policy or protocol which ranges from every 24hrs to
every 7 days or whenever necessary for cannulas and masks
THE OXYGEN DELIVERY SYSTEM
Depends on the following system:
• Oxygen concentration needed by the patient
• Oxygen concentration achieved by the delivery system
• Importance of accuracy and control of oxygen concentration
• Client comfort
• Expense to the client
Prepared by Prof. Amelia Z. Manaois for AU - College of Nursing to be used as Instructional Material only for the NCM112 – SKILLS LAB Lecture.
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• Importance of humidity
• Client mobility
A. LOW FLOW OXYGEN DELIVERY SYSTEMS:
a. NASAL CANNULA / PRONG
• Used at flow rates of 1 to 6 LPM
• Oxygen concentration of 24% to 44%
• Patient can eat, drink, talk
• Used for nose and mouth breathers
• Used with chronic lung disease and any client requiring long term
oxygen therapy
• Extended use - drying. Use with humidifier
b. SIMPLE MASK
Prepared by Prof. Amelia Z. Manaois for AU - College of Nursing to be used as Instructional Material only for the NCM112 – SKILLS LAB Lecture.
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• Used at minimum flow rate of 5 LPM
• Oxygen concentration of 40% to 60%
• Used for short term or emergency oxygen therapy
c. FACE TENT
The mask covers the nose and mouth and does not create a seal around
the nose.
It can provide 28% to 100% O2 Flow meter should be set to deliver O 2 at a
minimum of 15 L/min. Face tents are used to provide a controlled
concentration of oxygen and increase moisture for patients who have
facial burn or a broken nose, or who are claustrophobic.
It is difficult to achieve high levels of oxygenation with this mask.
d. PARTIAL REBREATHER MASK
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• Used at minimum flow rate of 6 to 11 LPM
• Oxygen concentration of 60% to 75%
• A mask with a reservoir bag but no flaps
• The bag should remain slightly inflated at the end of inspiration;
otherwise, the client is not getting the desired amount of oxygen
e. NON-REBREATHER MASK
• Used at minimum flow rate of 10 to 15 LPM
• Oxygen concentration of 90%
• A mask with a one-way valve and two flaps
• Used with clients whose respiratory status is unstable and may
require intubation
• The bag should remain inflated during inhalation
COMPARISON OF PARTIAL AND NON-REBREATHER MASK
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B. HIGH FLOW OXYGEN DELIVERY SYSTEM
VENTURI MASK (VENTI MASK)
• Delivers the most accurate 02 concentration
• It works by pulling in a proportional amount of room air
for each liter flow of oxygen
• An adaptor, located between the bottom of the mask and
the oxygen source, determines the needed flow rate
• Humidification is not needed with venti mask
• Best for client with chronic lung disease
PRE-SELECTED VIDEO TO WATCH FOR THE PROCEDURE:
https://www.youtube.com/watch?v=DNx_WoNjs2U : Oxygen Therapy Nursing
Review / Nasal Cannula, Simple Mask, Venturi Mask, Non rebreather
https://www.youtube.com/watch?v=Nc2zl2SeQNo : Oxygen Therapy and
Delivery – How to Prescribe Oxygen
II. SUCTION THERAPY
• Is a required procedure of clearing out airway passage from mucus or
plugs, to improve oxygenation and ventilation.
• A required procedure when the normal coughing mechanism is
inadequate, suppressed or disrupted
• Suctioning is a strict sterile procedure
Prepared by Prof. Amelia Z. Manaois for AU - College of Nursing to be used as Instructional Material only for the NCM112 – SKILLS LAB Lecture.
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• Carried out via a oropharynx, nasopharynx, nasotracheal, orotracheal
and tracheostomy suctioning
• Use smallest suction catheter if possible
• Conscious Client should be in semi or high-fowler's position
• Unconscious Client: Lateral position
• Hyperventilate client with 100% O2 before and after suctioning
• Insert catheter with gloved hand (3-5" length of catheter insertion)
without applying suction
• Three passes of catheter is the maximum with 10 seconds per pass
• Apply suctioning only during withdrawal of catheter
• The suction pressure should be limited to less than 120mmHg (Wall
mounted machine). 10 - 15mmHg (Portable machine)
• When withdrawing catheter, rotate while applying intermittent
suctioning
• Suctioning should only take 10 seconds (maximum of 15 seconds)
• Evaluate: clear breath sounds on auscultation of BLF
PRE-SELECTED VIDEO TO WATCH FOR THE PROCEDURE:
https://barabus.tru.ca/nursing/Oral_Suctioning.html : Oral Suctioning
https://www.youtube.com/watch?v=979jWMsF62c : Nasotracheal Suctioning
https://www.youtube.com/watch?v=fmoVnjh1WD8 : Oropharyngeal
suctioning
https://www.youtube.com/watch?v=qkCcegGqO4Y : Nasotracheal Suctioning
https://www.youtube.com/watch?v=7GobrbSC6oo : Tracheostomy Suctioning
Prepared by Prof. Amelia Z. Manaois for AU - College of Nursing to be used as Instructional Material only for the NCM112 – SKILLS LAB Lecture.
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III. BRONCHIAL HYGIENE
a. STEAM INHALATION
• Purpose/s:
• To liquify mucous secretions
• To warm and humidify air
• To relieve edema of the airways
• To soothe irritated airways
• To administer medication
• It is a dependent nursing action
• Inform client and explain purpose of procedure
• Place client in semi-fowler's position
• Cover client's eyes with washcloth to prevent irritation
• Check electric device before use
• Place inhalator in a flat, stable surface
• Place spout in 12-18' away from client's nose or adjust distance as
necessary
• CAUTION: avoid burns. Cover the chest with towel to prevent burns due
to dripping of condensate from the steam. Assess for redness on the side
of the face which may indicate first degree burns
• Render inhalation 15-20'
• Instruct client to do deep breathing and coughing exercises after the
procedure to facilitate expectoration of mucous secretions
• Provide good oral hygiene after the procedure
• Do after-care of the equipment
• PRE-SELECTED VIDEO FOR THE PROCEDURE:
• https://www.youtube.com/watch?v=5fIGBADaieY
b. AEROSOL INHALATION
• Done among pediatrics to administer bronchodilators or mucolytic-
expectorants
• PRE-SELECTED VIDEO FOR THE PROCEDURE:
• https://www.youtube.com/watch?v=V44OI-FjBCk
c. MEDIMIST INHALATION
• Done among adults to administer bronchodilators or mucolytic-
expectorants
• PRE-SELECTED VIDEO FOR THE PROCEDURE:
• https://www.youtube.com/watch?v=UZ_qmF6zL70
Prepared by Prof. Amelia Z. Manaois for AU - College of Nursing to be used as Instructional Material only for the NCM112 – SKILLS LAB Lecture.
Refrain from reproducing this material without the consent of the preparer and the AU-CON
III. POST-TASK
1. QUIZ – Link will be sent by the Clinical Instructor after the video presentation
2. VIDEO RECORDED and PRESENTATION of BASIC NURSING SKILLS and PROCEDURES on:
a. Oxygen Therapy
b. Suctioning
c. Bronchial Hygiene
INSTRUCTIONS:
1. After studying and reviewing the Lesson 1 Module, the students are tasks to demonstrate
the basic nursing skills and procedures through a graded video-recorded role playing. The
skills shall cover care modalities on oxygen therapy, suctioning and bronchial hygiene.
2. The length of the video that will cover the three care modalities shall not exceed 40
minutes.
3. RUBRICS or SKILLS CHECKLIST and PEER / GROUP EVALUATION on how each student are to
be graded will be as follows:
PART I: SKILLS CHECKLIST ON CARE MODALITIES:
Oxygenation, Suctioning, Bronchial Hygiene
ASSESSMENT CRITERIA CD ID ND REMARKS
(2) (1) (0)
SKILL BASED CRITERIA
I. PRE-PROCEDURE PHASE
1. Checks Doctor’s order
2. Verifies the right client for the procedure
3. Prepares all the necessary supplies and
equipment
4. Introduces self to client
5. Explains the procedure to the client
6. Assess / re-assess client’s need for the
procedure
7. Entertains queries from the client
8. Performs hand washing
9. Dons PPEs
10. Keeps room well lighted and warm
II. PROCEDURE PHASE
1. Observes privacy by closing doors and curtains
2. Conducts procedure in chronological
sequence
3. Assists clients in assuming various positions
necessary for the procedure
4. Involves client with the procedure by giving
clear instructions or coaching
Prepared by Prof. Amelia Z. Manaois for AU - College of Nursing to be used as Instructional Material only for the NCM112 – SKILLS LAB Lecture.
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5. Observes client’s reaction / response to
procedure
6. Maintains proper posture and body
mechanics while performing procedure
7. Maintains IPR with client during the
procedure
8. Doffs PPE
III. POST PROCEDURE PHASE
1. Assists client in assuming position of comfort
after the procedure
2. Evaluates client’s response to the procedure
3. Performs after care
4. Washes hands
5. Documents procedure and significant
observations
KNOWLEDGE BASED CRITERIA
• Narrator:
1. Explains essential points in the presentation
2. States rationale as needed
3. Clear and logical structure of presentation
4. Summarizes major points of the presentation
5. Identifies indications/ contraindications of
nursing actions
6. Uses appropriate terminologies accordingly
• Members:
1. Answers questions post-video presentation
2. Offers additional information post-video
presentation
ATTITUDE BASED CRITERIA
1. Compliance
o Length of presentation within the
assigned time limits
o Observed due date
o Followed other essential instructions
2. Creativity
3. Resourcefulness
4. Cooperativeness
5. Enthusiasm and Eagerness to learn
6. Appearance (decency and appropriateness
e.g. proper uniform)
PROCEDURAL POINTS 74
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LEGEND:
CD – Correctly Done / Displayed / Demonstrated
ID – Incorrectly Done / Slightly Displayed / Slightly Demonstrated
ND – Not Done / Not Displayed / Not Demonstrated
Performed by: Evaluated by:
______________________________ ________________________________
Block and Group Clinical Instructor’s Name and Signature
Prepared by Prof. Amelia Z. Manaois for AU - College of Nursing to be used as Instructional Material only for the NCM112 – SKILLS LAB Lecture.
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PART II: PEER - GROUP EVALUATION
Instruction: Each member will rate each other including yourself according to the following rating scale:
1- Not executed
2- Poorly executed
3- Averagely executed
4- Excellently executed
Name Participation Cooperation Quality of Work TOTAL (12)
(in planning & (interest, (Value & worth of
developing enthusiasm, work output)
ideas) interest)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Note:
• Do not fill -up Part I-Skills Checklist Evaluation Form. That is for your Clinical Instructor’s guide on how
to rate you on your Video Output
o Part I – Skills Checklist Evaluation Form is presented to the students to serve as guide as to how
students will be graded
• Part II: Peer Group Evaluation Form is for you to fill up. Submission is after the video class presentation
• Clinical Instructor will add your individual overall rate for peer group evaluation to Part I Rating
• TOTAL EXPECTED PERFECT SCORE: 228 POINTS
o Part I = 216 (72 points x 3 Basic Skills / Procedures: Oxygenation, Suctioning, Bronchial Hygiene)
o Part II = 12 points
• This is Prelim Culminating Activity for the group assigned
Prepared by Prof. Amelia Z. Manaois for AU - College of Nursing to be used as Instructional Material only for the NCM112 – SKILLS LAB Lecture.
Refrain from reproducing this material without the consent of the preparer and the AU-CON
