Introduction to clinicals

Clinical Sites

Clinical Uniforms

Clinical Packet

Ethics and hospital etiquette

Privacy and confidentiality

Comply with patient privacy rights.

Respect confidentiality.

Codes, charting, and regulations

Use proper charting terms and abbreviations

Use hospital emergency codes for fire, cardiac arrest, and security as appropriate

Follow the rules and regulations of the hospital and other clinical affiliates

Care of the critical intensive care patient

Assessment of the intensive care patient

Perform patient assessment, including developing a pertinent medical history and performing a physical examination. At a minimum, the patient assessment should include a review of the patient’s chart, taking vital signs, and auscultation of chest sounds.

Recognize the signs and symptoms of increased intracranial pressure and describe the management of the patient.

Recognize the signs, symptoms, and treatment of hypoxia and hypercarbia.

Recognize the signs, symptoms, causes, and treatment of hypovolemia.

Review all cases including the patient’s chart, diagnosis, and treatment.

Management of the intensive care patient

Assist with the maintenance of a patent airway in the unconscious patient.

Administer intramuscular, subcutaneous, and IV medications utilizing a cannula.

Assist in the care of patients with endotracheal or tracheostomy tubes and patients breathing on respirators.

Assessment of the coronary care patient

Carry out a physical assessment of a patient with coronary artery disease.

Recognize cardiac arrhythmias on a monitor.

Identify rales, rhonchi, and wheezes.

Identify a gallop rhythm and systolic murmur.

Identify the signs, symptoms, and treatment of cardiogenic shock.

Identify the signs, symptoms, and treatment of congestive heart failure.

Management of the coronary care patient

Participate in the pharmacological and electrical management of complications of the acute MI.

Identify the coronary risk factors of patients in the unit.

Identify the psychological effects of coronary artery disease and of a stay in a critical care unit.

Intravenous Therapy

IV Injection

Demonstrate aseptic techniques.

Identify IV fluids using an intravenous catheter with supervision.

Perform peripheral IV insertion using both a straight needle and an over-the-needle catheter device on adults.

Initiate fluids on an elderly patient.

Review techniques with the IV therapist for the use of IV fluids in children.

Observe the techniques of the IV nurse.

Note the complications of IV therapy.

Phlebotomy

Draw blood samples.

Prepare blood samples for blood sugar, electrolytes, type and cross-match, and CBC analysis.

Airway and Ventilation Management

Assessment of airway and ventilation

Perform patient assessment including developing relevant medical history and conducting a physical examination. The assessment should include, at a minimum, taking and recording vital signs and auscultation of chest sounds.

Identify rales, rhonchi, and wheezes.

Identify and manage patients presenting the following problems, as patient census allows: asthmatic attack and chronic obstructive pulmonary disease.

Discuss the pathophysiology, assessment, and management of the following respiratory disorders: bronchiolitis, croup, and epiglottitis.

Recognize the signs, symptoms, and treatment of hypoxia and hypercarbia.

Airway management

Assist with respiratory care.

Maintain air in an unconscious patient using manipulations and positions of the head, oropharyngeal or nasopharyngeal airways, etc..

Assist with the maintenance of a patent airway in the unconscious patient.

Perform oxygen administration.

Endotracheal and tracheal tubing

Assist in the care of patients with endotracheal or tracheostomy tubes and patients breathing on respirators.

Perform endotracheal intubation.

Perform aseptic endotracheal and orotracheal suctioning.

Perform endotracheal intubation in the operating/recovery room.

Perform insertion of a combitube or alternate intubation device.

Pneumothorax

Relieve tension pneumothorax using a catheter and Heimlich valve, if appropriate.

Anesthetized patient

Maintain a patent airway in an unconscious anesthetized patient without an airway adjunct.

Maintain a patent airway utilizing an oropharyngeal airway on an anesthetized patient.

Maintain a patent airway utilizing an endotracheal tube on an anesthetized patient.

Maintain adequate ventilation with a bag-valve-mask on an anesthetized patient.

Management of normal and abnormal deliveries

Assessment of mother and neonate

Identify the three stages of labor and common complications and abnormal deliveries.

Monitor the vital signs of a patient in active labor.

Monitor fetal heard tones with the mother’s and nurse’s permission.

Observe fetal monitoring.

Feel and time uterine contractions with the mother’s permission.

Observe the signs and symptoms of eclampsia (toxemia).

Delivery of an infant

Observe a normal cephalic vaginal delivery with patient and physician permission.

Observe complicated deliveries such as a breech delivery, multiple birth, placenta previa, abruptio placenta, caesarean section, and/or prolapsed cord.

Note the Apgar score.

Assist in the management of the newborn, including severing the cord, suctioning, etc.

Postdelivery care

Assist in the resuscitation of the newborn

Observe/assist with the immediate post-delivery care of the mother.

Nursery

Observe/assist with the care of the neonate.

Management of the pediatric patient in the emergency department

Assessment of the pediatric patient

Interact with the children and parents.

Identify strategies for calming children and their parents used by the nurses and physicians.

Observe the psychological impact of illness or injury upon children and their parents.

Perform assessment of pediatric patients including, at a minimum, a review of the patient’s chart, taking vital signs, and auscultation of chest sounds.

Observe a neonate for normal expected behaviors and responses to stimuli.

Identify the needs of a neonate and how those needs can be met.

Pediatric patient care

Prepare and administer intramuscular and IV medications for pediatric patients, if allowed by the facility.

Monitor intravenous infusions for pediatric patients.

Assist in the management of febrile and seizure pediatric patients.

Assist in the resuscitation management of pediatric patients, as allowed.

Management of the adult patient in the emergency department

Assessment of the patient in the emergency department

Perform patient assessment including developing relevant medical history and conducting a physical examination. The assessment should include at a minimum, taking and recording vital signs, and auscultation of chest sounds.

Relate the prehospital care given to a patient to his/her presenting signs and symptoms in the emergency department.

Assist and review the treatment of trauma cases and medical emergencies.

Management of the patient in the emergency department

Assist in triaging patients.

Assist in trauma cases requiring hemorrhage control, suturing, and splinting.

Assist with CPR as requested by the nurse in charge.

Assist with respiratory care.

Monitor signs and relate them to the patient’s condition.

Apply wound dressings.

Monitor heart and breath sounds.

Observe for arrhythmias.

Observe the patients’ emotional response to illness and/or injury.

Observe for the signs and symptoms of specific trauma states such as hypovolemia, increased intracranial pressure, and hypoxia.

Observe for response to treatment rendered.

Assist in cases of cardiac arrest, including the performance of cardiopulmonary resuscitation, airway management, intubation, and defibrillation.

Demonstrate the use of a transthoracic pacemaker.

Operating/Recovery Room/Emergency Room/Throughout the hospital

Perform endotracheal intubation .

Perform peripheral IV insertion .

Administer IV medications and observe their effects on the patient

Patient care in an advanced ambulance

Patient assessment

Perform a patient assessment, including developing a relevant medical history, making pertinent observations of the environment, and doing a pertinent physical examination.

Patient management

Maintain an airway in an unconscious patient using manipulations and positions of the head, oropharyngeal airway, etc.

Perform oxygen administration.

Perform one-person and two-person cardiopulmonary resuscitation.

Perform peripheral IV insertion.

Draw blood samples.

Record and interpret EKG’s.

Prepare and administer intramuscular, subcutaneous, and IV medications.

Identify and manage patients presenting the following problems, as patient census allows:

major trauma to the head/neck, chest, abdomen, spine, and extremities

possible myocardial infarction

congestive heart failure

chronic obstructive pulmonary disease

obstructed airway

diabetic emergencies

asthmatic attack

seizure

coma

obstetric problems

psychiatric problems

overdose

intoxication

GI problems

Neurological problems to include stroke

Perform endotracheal intubation.

Perform aseptic endotracheal and orotracheal suctioning.

Perform monitored defibrillation.

Apply the MAST in cases of massive lower extremity trauma or shock.

Immobilize extremities in cases of fractures or dislocation.

Monitor vital signs and patient status during transport.

Perform spinal immobilization using short and long spine board.

Relieve tension pneumothorax using a catheter and Heimlich valve, if appropriate.

Perform a cricothyroidotomy, if appropriate.

Demonstrate the use of a transthoracic pacemaker, if appropriate.

Communication

Relay patient information to the physician in the correct sequence.

Assist in the receiving calls and dispatching emergency vehicles.

Morgue

Observe basic topographic anatomy; identification, pathogenesis, and causes of death.

Observe the assessment of the anatomical basis of endotracheal intubation and cardiopulmonary resuscitation.

Observe the assessment of injuries resulting from trauma; specifically, injuries to soft tissues, the musculoskeletal system, and the internal structure.

Psychological intervention

Assessment of psychiatric patients

Assist in the interview of patients with suicidal feelings, hostility and violent behavior, acute grief and depression, paranoia, hysterical conversion, and alcohol and drug addiction.

Management of psychiatric patients

Observe/assist with the management of patients with suicidal feelings, hostility and violent behavior, acute grief and depression, paranoia, hysterical conversion, and alcohol and drug addiction.

Assist in the restraint of combative patients.

Record the use of drugs used for the treatment of suicidal feelings, hostility and violent behavior, acute grief and depression, paranoia, hysterical conversion, and alcohol and drug addiction.