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00Rhoads(F)-FC 5/3/07 1:57 PM Page 2

STANDARD PRACTICE FOR ALL PROCEDURES

BEFORE THE PROCEDURE
✓ Check the patient’s chart both to identify the patient and to
understand why procedure was ordered.
✓ Evaluate if the patient’s condition or history will affect how the
procedure is performed.
✓ Wash your hands.
✓ Introduce yourself if the patient does not know you. Verify patient’s
identity.
✓ Explain procedure to the patient and answer any questions.
✓ Close curtains or door to ensure privacy.
✓ Obtain and arrange supplies and equipment.
✓ Raise the bed to the appropriate height, raise side rails, and obtain
assistance if necessary.
DURING THE PROCEDURE

✓ Wash your hands.

✓ Don gloves following standard precautions. Don eye protection and
gown, if necessary.
✓ Execute procedure in accordance with standard practices.
AFTER THE PROCEDURE

✓ Dispose of sharps in appropriate container.

✓ Remove protective equipment.
✓ Wash your hands.
✓ Help the patient to a comfortable position.
✓ Lower the bed height.
✓ Wash your hands again before leaving the room.
✓ Document the procedure and report significant variations or results.
00Rhoads(F)-FM 5/7/07 7:21 PM Page i

Davis’s Guide to

Clinical
Nursing
Skills
Jacqueline Rhoads, PhD, ACNP-BC, ANP-C, GNP, CCRN
Professor
Director of Primary Care in Community Health Public Health Nursing
Louisiana State University Health Sciences Center School of Nursing
New Orleans, Louisiana
Bonnie Juvé Meeker, DNS, RN
Professor of Nursing
Southeastern Louisiana University
School of Nursing—Baton Rouge Center
Baton Rouge, Louisiana
00Rhoads(F)-FM 5/7/07 7:21 PM Page ii

F. A. Davis Company
1915 Arch Street
Philadelphia, PA 19103
www.fadavis.com

Copyright © 2008 by F. A. Davis Company

Copyright ©2008 by F. A. Davis Company. All rights reserved.This book is protected by copy-
right. No part of it may be reproduced, stored in a retrieval system, or transmitted in any
form or by any means, electronic, mechanical, photocopying, recording, or otherwise, with-
out written permission from the publisher.

Printed in the United States of America

Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1

Acquisitions Editor: Robert G. Martone

Content Development Manager: Darlene D. Pedersen
Project Editor: Padraic J. Maroney

As new scientific information becomes available through basic and clinical research, rec-
ommended treatments and drug therapies undergo changes. The author(s) and publisher
have done everything possible to make this book accurate, up to date, and in accord with
accepted standards at the time of publication. The author(s), editors, and publisher are not
responsible for errors or omissions or for consequences from application of the book, and
make no warranty, expressed or implied, in regard to the contents of the book. Any practice
described in this book should be applied by the reader in accordance with professional
standards of care used in regard to the unique circumstances that may apply in each situ-
ation. The reader is advised always to check product information (package inserts) for
changes and new information regarding dose and contraindications before administering
any drug. Caution is especially urged when using new or infrequently ordered drugs.

Library of Congress Cataloging-in-Publication Data

Rhoads, Jacqueline, 1948–

Davis’s guide to clinical nursing skills / Jacqueline Rhoads, Bonnie
Juvé Meeker.
p. ; cm.
ISBN-13: 978–0–8036–1164–1
ISBN-10: 0–8036-1164–1
1. Nursing—Handbooks, manuals, etc. I. Meeker, Bonnie Juvé.
II. Title. III. Title: Guide to clinical nursing skills.
[DNLM: 1. Nursing Care—methods—Handbooks. WY 49 R474d
2007]
RT41.D3844 2007
610.73—dc22
2006034029

Authorization to photocopy items for internal or personal use, or the internal or personal
use of specific clients, is granted by F. A. Davis Company for users registered with the
Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the fee of
$.10 per copy is paid directly to CCC, 222 Rosewood Drive, Danvers, MA 01923. For those
organizations that have been granted a photocopy license by CCC, a separate system of
payment has been arranged. The fee code for users of the Transactional Reporting Service
is: 8036-1164-1/07 1 $.10.
00Rhoads(F)-FM 5/7/07 7:21 PM Page iii

Contributors

Michael Adams, RN, MN, CRNA

Louisiana State University Health Sciences Center
Lake Chartes, Louisiana

Jennifer Eileen Badeaux, MN, APRN, CRNA

Louisiana State University Health Sciences Center
New Orleans, Louisiana

Marie Billings, RN, MN

Southeastern Louisiana University
Hammond, Louisiana

Suzanne Robbins Blumer, MN, APRN, CRNA

Louisiana State University Health Sciences Center
New Orleans, Louisiana

Daniel M. Castell, MN, APRN, CRNA

Louisiana State University Health Sciences Center
New Orleans, Louisiana

Chris Davis, MN, APRN, CRNA

Louisiana State University Health Sciences Center
New Orleans, Louisiana

William Davis, MN, APRN, CRNA, CCRN

Louisiana State University Health Sciences Center
New Orleans, Louisiana

Claudine Dufrene, RN, C, APRN, BC, MSN

University of Texas Medical Branch
Galveston, Texas

Carol Foster, MN, APRN, CRNA

Louisiana State University Health Sciences Center
New Orleans, Louisiana

Deborah Delaney Garbee, PhD, APRN, BC

Louisiana State University Health Sciences Center
New Orleans, Louisiana
00Rhoads(F)-FM 5/7/07 7:21 PM Page iv

iv Contributors

Kathleen Harris, RN, CWOCN

Wound, Ostomy, Continence Society
Baton Rouge, Louisiana

Denise Hart, MSN, APRN, BC, CWOCN

Southeastern Louisana University
Baton Rouge, Louisiana

Alison Hepting, MN, APRN, CRNA

Louisiana State University Health Sciences Center
New Orleans, Louisiana

Barbara Hyde, EdD, APRN, FNP–BC

Southeastern Louisiana University
Baton Rouge, Louisiana

Scott Larson, PT, OCS

BRPT Lake Rehabilitation Centers
Baton Rouge, Louisiana

Cynthia Logan, PhD, APRN

Southeastern Louisiana University
Baton Rouge, Louisiana

Jamie May, MN, APRN, CRNA

Louisiana State University Health Sciences Center
New Orleans, Louisiana

Karen B. Moody, PhD, RNC

Southeastern Louisiana University
Baton Rouge, Louisiana

Harold S. Mustin III, MN, APRN, CRNA

Judith L. Mysing RN, APRN, CRNA

Ochsner
New Orleans, Louisiana

Lynn Pennington, FNP-C, BC-ADM, CWOCN

Stanacola Medical Center
Baton Rouge, Louisiana

Demetrius Porche, DNS, APRN

Louisiana State University Health Sciences Center
New Orleans, Louisiana
00Rhoads(F)-FM 5/7/07 7:21 PM Page v

Contributors v

Susan Pryor, DNS, RN

Southeastern Louisiana University
Baton Rouge, Louisiana

Marcy Ruello, APRN, CRNA

Louisiana State University Health Sciences Center
New Orleans, Louisiana

Ruth Rolling, RN, MSN

Southeastern Louisiana University
Baton Rouge, Louisiana

Jerilyn Schaller, MN, APRN

Louisiana State University Health Sciences Center
New Orleans, Louisiana

Karen Silady, RN, MN, CEN, APRN

Louisiana State University Health Sciences Center
New Orleans, Louisiana

Wanda Spurlock, DNS, RN, BC, CNS

Southern University and A&M College
Baton Rouge, Louisiana

Francise Thomas, MN, CCRN

Louisiana State University Health Sciences Center
New Orleans, Louisiana

Yolanda Jean Urick, MN, RN

Southeastern Louisiana University
Hammond, Louisiana

Sonja Washington, MN, CNS

Louisiana State University Health Sciences Center
New Orleans, Louisiana
00Rhoads(F)-FM 5/7/07 7:21 PM Page vi

Contents

U N I T
1
Basic Care
C H A P T E R 1 Hygiene
1.1 Giving a Complete Bed Bath, 2
1.2 Providing Mouth Care, 5
1.3 Performing Foot Care, 10
1.4 Making an Occupied Bed, 12

C H A P T E R 2 Infection Control
2.1 Handwashing, 18
2.2 Donning Isolation Gown and Gloves, 20
2.3 Droplet Precautions, 22
2.4 Contact Precautions, 24
2.5 Airborne Precautions, 26

U N I T
2
Assessment
3
C H A P T E R Vital Signs
3.1 Assessing Body Temperature, 30
3.2 Assessing Heart Rate, 38
3.3 Assessing Respiratory Rate, 44
3.4 Assessing Blood Pressure, 47

C H A P T E R 4 Physical Assessment
4.1 Assessing the Eyes, 54
4.2 Assessing the Ears, 61
4.3 Assessing the Nose and Sinuses, 67
4.4 Assessing the Mouth and Pharynx, 71
vi
00Rhoads(F)-FM 5/7/07 7:21 PM Page vii

Contents vii

4.5 Assessing the Neck, 75

4.6 Assessing the Thorax and Lungs, 78
4.7 Assessing the Heart and Vascular System, 86
4.8 Assessing the Musculoskeletal System, 96
4.9 Assessing the Abdomen, 100
4.10 Assessing the Neurologic System, 105
4.11 Assessing the Skin, Hair and Scalp, and Nails, 115

U N I T
3
Medication Administration
5 Oral and Topical Medications
C H A P T E R

5.1 Administering Oral Medications, 120

5.2 Helping Patients with Self-Medication, 126
5.3 Applying Medications to the Skin, 130
5.4 Administering Eye Drops and Ointments, 134
5.5 Instilling Medications into the Ear, 139
5.6 Administering Medications via Metered-Dose
Inhaler, 142
5.7 Administering Medications via Rectal
Suppositories, 145

C H A P T E R 6 Parenteral Medications
6.1 Administering Subcutaneous Injections, 150
6.2 Administering Intramuscular Injections, 155
6.3 Administering Intramuscular Injections by the
Z-Track Method, 161
6.4 Administering Intradermal Injections, 164
6.5 Administering Intravenous Medications by
Intermittent Infusion Sets or Mini-Infusion Pumps, 169
6.6 Administering Medications by Intravenous Bolus, 178
6.7 Teaching Patients How to Administer
Self-Injections, 183
6.8 Mixing Two Types of Insulin, 188
6.9 Using Patient-Controlled Analgesia (PCA) Infusion
Devices, 191
00Rhoads(F)-FM 5/7/07 7:21 PM Page viii

viii Contents

U N I T
4
Respiratory
7
C H A P T E R Noninvasive Pulmonary Hygiene
7.1 Performing Postural Drainage, 198
7.2 Teaching Controlled Coughing Techniques, 203

C H A P T E R 8 Oxygen Therapy
8.1 Administering Oxygen Therapy, 208
8.2 Administering Oxygen Therapy to the Patient with an
Artificial Airway, 213

C H A P T E R 9 Ventilation Support
9.1 Managing Continuous Positive Airway
Pressure (CPAP), 220
9.2 Managing Intermittent Positive Pressure
Ventilation, 223
9.3 Managing Mechanical Ventilation (MV), 225
9.4 Using an Ambu Manual Ventilator, 229
9.5 Performing Endotracheal Tube Care, 232
9.6 Performing Tracheostomy Care, 235
9.7 Managing a Cuffed Endotracheal or Tracheostomy
Tube, 240

C H A P T E R 10 Airway Suctioning
10.1 Inserting an Oral or Nasal Airway, 244
10.2 Performing Oropharyngeal (Yankauer)
Suctioning, 249
10.3 Performing Nasopharyngeal and Nasotracheal
Suctioning, 252
10.4 Performing Endotracheal or Tracheostomy Tube
Suctioning, 257

C H A P T E R 11 Lung Re-Expansion or Chest

Drainage
11.1 Managing Chest Tube and Drainage Systems, 264
11.2 Assisting with Chest Tube Removal, 271
00Rhoads(F)-FM 5/7/07 7:21 PM Page ix

Contents ix

U N I T
5
Cardiovascular
12 Intravenous Fluid Therapy
C H A P T E R
12.1 Inserting a Short-Term Intravenous Catheter, 276
12.2 Inserting Peripheral Midline and Central
Catheters (PICC), 285
12.3 Calculating and Regulating Intavenous Flow Rate, 293
12.4 Changing Intravenous Site Dressings
(Peripheral and Central), 296
12.5 Assisting with Percutaneous Central Line
Placement, 299

C H A P T E R 13 Circulatory Maintenance
13.1 Caring for Vascular Access Devices, 308
13.2 Applying Sequential Compression Devices, 311
13.3 Applying Antiembolic Hose, 313
13.4 Teaching Postoperative Leg Exercises, 315

C H A P T E R 14 Blood Transfusion Therapy

14.1 Transfusing Blood Products, 320
14.2 Assisting with Autotransfusion, 324

U N I T
6
Nutritional and Digestive
15 Oral and Enteric Nutrition
C H A P T E R

15.1 Administering Nasogastric, Nasoenteric, and Enteric

Tube Feedings, 330
15.2 Administering Medications Through a Feeding
Tube, 335

C H A P T E R 16 Parenteral Nutrition
16.1 Administering Total Parenteral Nutrition (TPN), 340
16.2 Administering Peripheral Partial Nutrition, 343
16.3 Administering a Fat Emulsion (Lipids), 346
00Rhoads(F)-FM 5/7/07 7:21 PM Page x

x Contents

C H A P T E R 17 Gastrointestinal Intubation
17.1 Inserting a Nasogastric Tube, 352
17.2 Advancing a Nasoenteric Decompression Tube, 356

C H A P T E R 18 Bowel Elimination
18.1 Administering an Enema, 360
18.2 Managing a Rectal Tube, 366
18.3 Managing Ostomy Care, 370

U N I T
7
Renal and Urinary
19 Urinary Elimination
C H A P T E R

19.1 Inserting a Straight or Indwelling Catheter

(Male and Female), 378
19.2 Performing Catheter Care, 385
19.3 Applying a Urinary Incontinence Collection
Device, 388
19.4 Teaching Clean Intermittent Self-Catheterization, 391

C H A P T E R 20 Bladder Irrigation and Function

20.1 Performing and Managing Bladder Irrigation
Through a Three-Way Foley Catheter, 396
20.2 Obtaining a Post-Void Residual Urine Volume, 400

U N I T
8
Musculoskeletal
21 Body Alignment and Mechanics
C H A P T E R

21.1 Maintaining Proper Body Alignment, 406

21.2 Performing Correct Lifting Techniques, 411

C H A P T E R 22 Exercise and Ambulation

22.1 Performing Passive Range-of-Motion (ROM)
Exercises, 418
22.2 Teaching Isometric Exercises, 422
00Rhoads(F)-FM 5/7/07 7:21 PM Page xi

Contents xi

22.3 Teaching the Patient to Crutch Walk or Use

a Walker, 425

C H A P T E R 23 Transfer and Positioning

23.1 Moving and Positioning the Patient in Bed, 432
23.2 Transferring a Patient from Bed to Wheelchair, 437
23.3 Teaching Hip Precautions, 439

C H A P T E R 24 Orthopedic Interventions
24.1 Providing Cast Care, 444
24.2 Applying Skin Traction, 448
24.3 Managing Skeletal Traction, 453
24.4 Applying a Moist Compress, 456
24.5 Applying an Ice Bag, Ice Pack, or Collar, 459

C H A P T E R 25 Beds, Frames, and Mattresses

25.1 Placing the Patient on a Specialty Surface, 464
25.2 Placing the Patient on an Air-Suspension or
Air-Fluidized Bed, 467

U N I T
9
Integumentary System and Wound Care
26 Pressure Ulcers
C H A P T E R

26.1 Assessing Pressure Ulcer Risk, 472

26.2 Implementing Pressure-Ulcer Prevention
Strategies, 477
26.3 Assessing Wounds and Staging Pressure Ulcers, 480

C H A P T E R 27 Wound Care
27.1 Applying a Pressure Bandage, 488
27.2 Administering a Sitz Bath, 490
27.3 Performing Wound Irrigation, 493
27.4 Managing Wound Drainage, 495
27.5 Teaching Self-Management of Wound-Drainage
Devices, 498
27.6 Applying Wound Dressings, 501
27.7 Applying and Managing a V.A.C. ATS™ System, 506
00Rhoads(F)-FM 5/15/07 1:29 AM Page xii

xii Contents

U N I T
10
Specimen Collection
28 Collecting Blood Samples
C H A P T E R
28.1 Performing Venipuncture, 512
28.2 Obtaining a Blood Glucose Level by Finger Stick, 517
28.3 Obtaining a Specimen for Arterial Blood Gas
Analysis, 520

C H A P T E R 29 Collecting Urine Samples

29.1 Collecting a Midstream Urine Specimen, 526
29.2 Collecting a Timed (24-Hour) Urine Specimen, 528
29.3 Collecting a Sterile Urine Specimen from an
Indwelling Catheter, 531
29.4 Measuring Specific Gravity of Urine, 533

C H A P T E R 30 Collecting Other Specimens

30.1 Collecting a Nose or Throat Specimen for Culture, 538
30.2 Collecting a Sputum Specimen, 541
30.3 Obtaining a Wound Drainage Specimen, 545

References, 549

Illustration Credits, 552

Index, 555
01Rhoads(F)-01 5/3/07 1:22 PM Page 1

Basic Care
U N I T

1
1
C H A P T E R

Hygiene
1.1 Giving a Complete Bed Bath, 2
1.2 Providing Mouth Care, 5
1.3 Performing Foot Care, 10
1.4 Making an Occupied Bed, 12
01Rhoads(F)-01 5/3/07 1:22 PM Page 2

2 C h a p t e r 1 Hygiene

PROCEDURE 1.1
Giving a Complete Bed Bath
OVERVIEW
● Ensures cleanliness of patients who cannot bathe themselves.
● Promotes circulation.
● Provides comfort.

● Maintains muscle tone and joint mobility through active and passive

movement.
● Provides an opportunity for thorough assessment.

P R E PA R AT I O N
● Assess patient’s ability to perform his or her own care.
● Discuss patient preferences for bathing.
● Provide privacy.

● Avoid chilling the patient.

● Wash your hands; wear gloves if you will come in contact with body

fluids or handle a bedpan.

● Gather all supplies in room before you begin.

● Ask patient if he or she needs to use the bedpan

● Check to see if patient is allergic or sensitive to soap.

Special Considerations
• Patients who need a complete bed bath are usually dependent in
other ways also. They may need to be fed, be incontinent, or have
devices such as IVs, feeding tubes, or multiple dressings in place.
The nurse needs to be comfortable manipulating these devices
when giving the bath and ensuring patency and cleanliness of
these devices.
• It is always preferable to have the patient assist with the bath as
much as possible, particularly with perineal care.
• The bed bath is a good time to establish rapport and expand the
nurse–patient relationship.
• During and after the bath, the bed linen is changed, and the two
activities are usually combined.

R E L E VA N T N U R S I N G D I A G N O S E S
● Impaired bed mobility
● Bathing/hygiene self-care deficit
● Risk for disuse syndrome
01Rhoads(F)-01 5/3/07 1:22 PM Page 3

P r o c e d u r e 1 . 1 Giving a Complete Bed Bath 3

EXPECTED OUTCOMES
● Patient expresses comfort and relaxation
● Skin is clean and dry
● Patient participates in the procedure as much as possible

E Q U I P M E N T/S U P P L I E S
● Basin of warm water
● Soap and soap dish
● Towels and washcloths (two or three of each, if possible)

● Laundry bag or hamper

● Clean gown

● Clean gloves

I M P L E M E N TAT I O N
➧ Discuss procedure with patient and ensure privacy.
Promotes cooperation and decreases anxiety.

➧ Place all supplies within reach.

Organizes task and prevents unnecessary steps.

➧ Wash hands.
Reduces transmission of microorganisms.

➧ Position bed at comfortable height.

Reduces nurse’s back strain.

➧ Fill basin with warm water, and test temperature on wrist.

Testing temperature helps prevent accidental scalding.

➧ Help patient to side of bed closest to you, and lower side rail.
Provides access to patient, and reduces back strain of nurse.

➧ Remove patient’s clothes while providing warmth and privacy with

a covering such as a bed blanket.
Provides access to body parts; provides modesty and warmth.
➧ Take washcloth and wrap the cloth around your hand tightly, form-
ing a mitt.
Prevents splashing water on patient and bedclothes.

➧ Be careful of the patient’s eyes. Use clear water to clean them, start-
ing from the inner canthus to the outer canthus. If patient is not sen-
sitive to soap, lather washcloth and gently wash the patient’s face,
starting from the forehead down.
Some patients are sensitive to soap or have very dry skin, and soap could
increase dryness and lead to irritation and skin breakdown. Bathe from
01Rhoads(F)-01 5/3/07 1:22 PM Page 4

4 C h a p t e r 1 Hygiene

cleanest area and work downward toward feet, going from areas of cleanest
to dirtiest.
Attention to the eyes prevents eye irritation and infection.

➧ Bathe ears and front and back of neck.

Perspiration accumulates on the back of the neck when patients lie in bed for
long periods.

➧ Bathe upper body and extremities, stroking arms from wrist to

shoulder. Include axillary area.
Stimulates circulation.

➧ Soak hands in basin if indicated.

Dirt accumulates under fingernails, especially in incontinent patients.

➧ Keep chest covered with towel and wash under breasts on female
patients. Apply powder if patient desires.
This area stays moist on many females and can lead to skin excoriation.

➧ Bathe abdomen using side-to-side strokes on skin folds.

Moisture and debris can accumulate in skin folds leading to irritation.

➧ Bathe legs and feet, being sure perineal area is draped.

Prevents unnecessary exposure.

➧ Soak feet in basin if indicated, and if patient is able to hold leg in

position.
Soaking will soften rough skin and facilitate cleaning toenails.

➧ Change bath water if necessary.

Bath water may be cool or dirty.

➧ Assist patient to side-lying position and wash back. Give backrub.

Side-lying position gives access to patients back for backrub.

➧ Put on clean gloves and bathe perineal area. Dry thoroughly.

Prevents cross contamination of organisms. Excess moisture contributes to
skin breakdown.

➧ Remove gloves and assist patient to put on clean gown.

Promotes dignity and reduces exposure.

➧ Conduct other personal hygiene activities as needed.

Promotes patient’s body image.

➧ Lower bed, raise side rails, put call bell in reach, and dispose of used
equipment and linen.
Provides safety.

➧ Wash your hands.

Reduces transmission of microorganisms.
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