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Nur
sing
Ori
enta
tion
Che
cklis
t
Red—
Com
plet
e du
ring
off
ice
orie
ntat
ion
and/
or f
irst
day
of
hom
e or
ient
atio
n Y
ello
w—
Com
plet
e w
ithi
n 3
days
of
hom
e or
ient
atio
n pe
riod
G
reen
—Co
mpl
ete
wit
hin
30 d
ays
of b
eing
ass
igne
d a
case
IM
PORT
AN
T: T
he c
heck
lists
are
not
inte
nded
to
be a
sub
stit
ute
for
any
doct
or’s
inst
ruct
ion
for
any
pati
ent’
s sp
ecif
ic p
lan
of c
are.
The
y ar
e in
tend
ed t
o do
cum
ent
the
trai
ning
pro
vide
d by
the
Men
tor
RN t
o th
e N
urse
in t
he h
ome.
Pa
ge 1
of
13
The
follo
win
g ch
eckl
ist
mus
t be
com
plet
ed a
nd s
igne
d by
bot
h M
ento
r an
d Le
arne
r. T
his
will
ens
ure
that
the
Lea
rner
has
all
the
skill
s ne
cess
ary
to s
afel
y pr
ovid
e on
e-on
-one
car
e in
a h
ome
sett
ing.
Th
e Le
arne
r m
ust
give
ver
bal e
xpla
nati
on in
non
-gre
y sh
aded
are
as a
nd m
ust
retu
rn d
emon
stra
te c
ompe
tenc
e w
ithi
n th
e gr
ey
shad
ed a
reas
. R
emin
der:
The
Men
tor
and
Lear
ner
mus
t si
gn o
ff o
n th
e bo
ttom
of
the
Nur
sing
Ori
enta
tion
Che
ckli
st p
rior
to
wor
king
ind
epen
dent
ly.
Teac
hing
Che
cklis
t Re
view
for
: __
____
____
____
____
____
____
____
____
D
ate
Star
ted:
___
____
_ D
ate
Com
plet
ed:
____
___
Cl
ient
’s in
itia
ls o
r #
____
_
F
irst
Nam
e
Last
Nam
e
Men
tor
Nam
e/In
itia
ls
Dat
e of
or
ient
atio
n D
ate
of
orie
ntat
ion
Dat
e of
or
ient
atio
n D
ate
of
orie
ntat
ion
Dat
e of
or
ient
atio
n P
rogr
ess
of L
earn
er’s
ori
enta
tion
was
up
date
d to
RN
Man
ager
Ori
enta
tion
Dat
e __
__/_
____
/___
__
(Wri
te in
itia
ls b
elow
)
Ori
enta
tion
Dat
e __
__/_
____
/___
__
(Wri
te in
itia
ls b
elow
)
Des
crib
es a
nd/o
r de
mon
stra
tes
____
/___
_/__
__
(Wri
te in
itia
ls b
elow
)
Hom
e Sa
fety
N
urse
kno
ws:
M
ento
r Le
arne
r M
ento
r Le
arne
r M
ento
r Le
arne
r
How
to
secu
re p
ower
cor
ds a
nd p
atie
nt t
ubin
g to
pre
vent
tri
ppin
g
Ther
e ne
eds
to b
e w
orki
ng s
mok
e de
tect
ors,
fir
e ex
ting
uish
ers,
and
car
bon
mon
oxid
e de
tect
ors
in t
he h
ome
To k
eep
a w
orki
ng f
lash
light
at
all t
imes
and
in t
he s
ame
plac
e in
the
pat
ient
’s r
oom
How
to
use
safe
ty b
elts
, st
raps
, re
stra
ints
, ra
iling
s, c
ar s
eats
, ga
tes
Pote
ntia
l haz
ards
wit
h pe
ts,
sibl
ings
, vi
sito
rs
How
to
use
and
stor
e ha
zard
ous
chem
ical
s (h
ouse
hold
cle
anin
g, C
ontr
ol II
I®,
etc.
)
Wha
t th
e Em
erge
ncy
Acti
on P
lan
is a
nd h
ow t
o ca
rry
it o
ut
Nur
sing
Ori
enta
tion
Che
cklis
t
Red—
Com
plet
e du
ring
off
ice
orie
ntat
ion
and/
or f
irst
day
of
hom
e or
ient
atio
n Y
ello
w—
Com
plet
e w
ithi
n 3
days
of
hom
e or
ient
atio
n pe
riod
G
reen
—Co
mpl
ete
wit
hin
30 d
ays
of b
eing
ass
igne
d a
case
IM
PORT
AN
T: T
he c
heck
lists
are
not
inte
nded
to
be a
sub
stit
ute
for
any
doct
or’s
inst
ruct
ion
for
any
pati
ent’
s sp
ecif
ic p
lan
of c
are.
The
y ar
e in
tend
ed t
o do
cum
ent
the
trai
ning
pro
vide
d by
the
Men
tor
RN t
o th
e N
urse
in t
he h
ome.
Pa
ge 2
of
13
O
rien
tati
on D
ate
____
/___
__/_
____
(W
rite
init
ials
bel
ow)
Ori
enta
tion
Dat
e __
__/_
____
/___
__
(Wri
te in
itia
ls b
elow
)
Des
crib
es a
nd/o
r de
mon
stra
tes
____
/___
_/__
__
(Wri
te in
itia
ls b
elow
)
Infe
ctio
n Pr
even
tion
Pra
ctic
es
Nur
se k
now
s:
Men
tor
Lear
ner
Men
tor
Lear
ner
Men
tor
Lear
ner
Prop
er h
and
clea
nsin
g te
chni
que
Impo
rtan
ce o
f a
clea
n/ir
rita
nt-f
ree
envi
ronm
ent
Wha
t to
do
whe
n fa
mily
, gu
ests
, th
erap
ists
are
sic
k
Appr
opri
ate
visi
tor
para
met
ers
Com
mon
infe
ctio
us d
isea
ses
and
repo
rtin
g
Stan
dard
pre
caut
ions
for
infe
ctio
n ex
posu
re c
ontr
ol
How
to
prop
erly
dis
pose
of
cont
amin
ated
mat
eria
ls (
e.g.
sha
rps,
med
icat
ions
)
How
to
clea
n an
d di
sinf
ect
reus
able
med
ical
equ
ipm
ent
and
supp
lies
O
rien
tati
on D
ate
____
/___
__/_
____
(W
rite
init
ials
bel
ow)
Ori
enta
tion
Dat
e __
__/_
____
/___
__
(Wri
te in
itia
ls b
elow
)
Des
crib
es a
nd/o
r de
mon
stra
tes
____
/___
_/__
__
(Wri
te in
itia
ls b
elow
)
Apn
ea E
quip
men
t/Pr
oced
ures
N
urse
kno
ws:
M
ento
r Le
arne
r M
ento
r Le
arne
r M
ento
r Le
arne
r
Wha
t an
apn
ea m
onit
or is
and
wha
t it
is u
sed
for
How
to
turn
the
mon
itor
on/
off
How
to
prop
erly
pla
ce t
he e
lect
rode
s
How
to
resp
ond
to a
n al
arm
O
rien
tati
on D
ate
____
/___
__/_
____
(W
rite
init
ials
bel
ow)
Ori
enta
tion
Dat
e __
__/_
____
/___
__
(Wri
te in
itia
ls b
elow
)
Des
crib
es a
nd/o
r de
mon
stra
tes
____
/___
_/__
__
(Wri
te in
itia
ls b
elow
)
Oxi
met
ry E
quip
men
t/Pr
oced
ures
N
urse
kno
ws:
M
ento
r Le
arne
r M
ento
r Le
arne
r M
ento
r Le
arne
r
Wha
t an
oxi
met
er is
and
wha
t it
is u
sed
for
How
long
the
inte
rnal
bat
tery
will
last
in t
he o
xim
eter
How
to
prop
erly
pla
ce a
nd s
ecur
e th
e ox
imet
er p
robe
Nur
sing
Ori
enta
tion
Che
cklis
t
Red—
Com
plet
e du
ring
off
ice
orie
ntat
ion
and/
or f
irst
day
of
hom
e or
ient
atio
n Y
ello
w—
Com
plet
e w
ithi
n 3
days
of
hom
e or
ient
atio
n pe
riod
G
reen
—Co
mpl
ete
wit
hin
30 d
ays
of b
eing
ass
igne
d a
case
IM
PORT
AN
T: T
he c
heck
lists
are
not
inte
nded
to
be a
sub
stit
ute
for
any
doct
or’s
inst
ruct
ion
for
any
pati
ent’
s sp
ecif
ic p
lan
of c
are.
The
y ar
e in
tend
ed t
o do
cum
ent
the
trai
ning
pro
vide
d by
the
Men
tor
RN t
o th
e N
urse
in t
he h
ome.
Pa
ge 3
of
13
Whe
n to
rep
lace
the
oxi
met
er p
robe
How
to
tell
if t
he o
xim
eter
rea
ding
s ar
e ac
cura
te
How
to
resp
ond
to a
n al
arm
Impo
rtan
ce o
f re
posi
tion
ing
prob
e si
te p
er e
very
fou
r ho
urs
How
to
turn
the
oxi
met
er o
n/of
f
Ori
enta
tion
Dat
e __
__/_
____
/___
__
(Wri
te in
itia
ls b
elow
)
Ori
enta
tion
Dat
e __
__/_
____
/___
__
(Wri
te in
itia
ls b
elow
)
Des
crib
es a
nd/o
r de
mon
stra
tes
____
/___
_/__
__
(Wri
te in
itia
ls b
elow
)
Vent
ilato
r /
Trac
heos
tom
y Ca
re (
Equi
pmen
t)
Nur
se k
now
s:
Men
tor
Lear
ner
Men
tor
Lear
ner
Men
tor
Lear
ner
Wha
t a
doct
or o
rder
is f
or a
nd w
hy it
is u
sed
in h
ome
care
Use
of
a fl
ow s
heet
and
why
it is
use
d in
hom
e ca
re
Equi
pmen
t al
arm
s m
ust
be h
eard
fro
m a
ny p
lace
in t
he h
ome
How
to
prop
erly
use
the
equ
ipm
ent
and
to v
erif
y th
e eq
uipm
ent
sett
ings
(e.
g.,
vent
and
hu
mid
ifie
r se
ttin
gs)
and
how
to
turn
it o
n/of
f
How
to
test
a v
enti
lato
r BE
FORE
usi
ng it
Tubi
ng c
ircu
it s
houl
d dr
ain
dow
n an
d AW
AY f
rom
the
chi
ld
How
to
trou
bles
hoot
ven
tila
tor/
hum
idif
ier
alar
ms
(e.g
., f
irst
do
this
, th
en d
o th
is)
Purp
ose
of h
umid
ity
wit
h ve
ntila
tor
or t
rach
eost
omy
Wha
t to
do
if w
ater
has
dra
ined
into
a p
atie
nt’s
tra
cheo
stom
y
How
to
use
an H
ME
(art
ific
ial n
ose)
How
to
plug
in t
he b
atte
ry-o
pera
ted
back
up e
quip
men
t
How
to
char
ge t
he e
xter
nal b
atte
ries
for
ven
tila
tors
, bi
-lev
els
and
CPAP
s
How
to
conn
ect
an e
xter
nal b
atte
ry t
o th
e ve
ntila
tor,
bi-
leve
l or
CPAP
How
long
the
app
roxi
mat
e ba
tter
y lif
e (o
r ca
n fi
nd b
atte
ry li
fe in
form
atio
n) f
or e
ach
piec
e of
equ
ipm
ent
Prop
er s
et u
p of
the
cir
cuit
Nur
sing
Ori
enta
tion
Che
cklis
t
Red—
Com
plet
e du
ring
off
ice
orie
ntat
ion
and/
or f
irst
day
of
hom
e or
ient
atio
n Y
ello
w—
Com
plet
e w
ithi
n 3
days
of
hom
e or
ient
atio
n pe
riod
G
reen
—Co
mpl
ete
wit
hin
30 d
ays
of b
eing
ass
igne
d a
case
IM
PORT
AN
T: T
he c
heck
lists
are
not
inte
nded
to
be a
sub
stit
ute
for
any
doct
or’s
inst
ruct
ion
for
any
pati
ent’
s sp
ecif
ic p
lan
of c
are.
The
y ar
e in
tend
ed t
o do
cum
ent
the
trai
ning
pro
vide
d by
the
Men
tor
RN t
o th
e N
urse
in t
he h
ome.
Pa
ge 4
of
13
O
rien
tati
on D
ate
____
/___
__/_
____
(W
rite
init
ials
bel
ow)
Ori
enta
tion
Dat
e __
__/_
____
/___
__
(Wri
te in
itia
ls b
elow
)
Des
crib
es a
nd/o
r de
mon
stra
tes
____
/___
_/__
__
(Wri
te in
itia
ls b
elow
)
Vent
ilato
r /
Trac
heos
tom
y Ca
re (
Suct
ioni
ng)
Nur
se k
now
s:
Men
tor
Lear
ner
Men
tor
Lear
ner
Men
tor
Lear
ner
Corr
ect
size
cat
hete
r to
use
Corr
ect
suct
ion
pres
sure
to
use
How
to
test
for
suc
tion
pre
ssur
e
How
to
trou
bles
hoot
suc
tion
mac
hine
and
how
to
turn
it o
n/of
f
And
can
dem
onst
rate
the
ste
rile
suc
tion
tec
hniq
ue (
prop
er d
epth
)
And
can
eval
uate
suc
tion
eff
ecti
vene
ss,
desc
ribe
spu
tum
(co
lor,
con
sist
ency
, od
or,
amou
nt)
Whe
n de
ep (
pre-
mea
sure
d) s
ucti
onin
g is
nec
essa
ry
How
to
use
the
man
ual s
ucti
on c
athe
ter
in t
he e
vent
of
a su
ctio
n pu
mp
failu
re
14 F
r su
ctio
n ca
thet
ers
and
whe
n it
sho
uld
be u
sed
Ori
enta
tion
Dat
e __
__/_
____
/___
__
(Wri
te in
itia
ls b
elow
)
Ori
enta
tion
Dat
e __
__/_
____
/___
__
(Wri
te in
itia
ls b
elow
)
Des
crib
es a
nd/o
r de
mon
stra
tes
____
/___
_/__
__
(Wri
te in
itia
ls b
elow
)
Vent
ilato
r /
Trac
heos
tom
y Ca
re (
Emer
genc
y Ba
g an
d Em
erge
ncy
Beds
ide
Stoc
k)
Nur
se k
now
s:
Men
tor
Lear
ner
Men
tor
Lear
ner
Men
tor
Lear
ner
Wha
t an
em
erge
ncy
bag
is f
or a
nd w
here
it s
houl
d be
kep
t
Cont
ents
of
an e
mer
genc
y ba
g
Cont
ents
of
emer
genc
y ba
g ne
eds
to b
e ch
ecke
d at
eac
h sh
ift
chan
ge
To h
ave
a cu
rren
t si
ze t
rach
and
one
siz
e sm
alle
r tr
ach
at t
he b
edsi
de A
ND
the
pat
ient
’s
emer
genc
y ba
g
Nur
sing
Ori
enta
tion
Che
cklis
t
Red—
Com
plet
e du
ring
off
ice
orie
ntat
ion
and/
or f
irst
day
of
hom
e or
ient
atio
n Y
ello
w—
Com
plet
e w
ithi
n 3
days
of
hom
e or
ient
atio
n pe
riod
G
reen
—Co
mpl
ete
wit
hin
30 d
ays
of b
eing
ass
igne
d a
case
IM
PORT
AN
T: T
he c
heck
lists
are
not
inte
nded
to
be a
sub
stit
ute
for
any
doct
or’s
inst
ruct
ion
for
any
pati
ent’
s sp
ecif
ic p
lan
of c
are.
The
y ar
e in
tend
ed t
o do
cum
ent
the
trai
ning
pro
vide
d by
the
Men
tor
RN t
o th
e N
urse
in t
he h
ome.
Pa
ge 5
of
13
Ori
enta
tion
Dat
e __
__/_
____
/___
__
(Wri
te in
itia
ls b
elow
)
Ori
enta
tion
Dat
e __
__/_
____
/___
__
(Wri
te in
itia
ls b
elow
)
Des
crib
es a
nd/o
r de
mon
stra
tes
____
/___
_/__
__
(Wri
te in
itia
ls b
elow
)
Vent
ilato
r /
Trac
heos
tom
y Ca
re (
Resu
scit
atio
n Ba
g)
Nur
se k
now
s:
Men
tor
Lear
ner
Men
tor
Lear
ner
Men
tor
Lear
ner
How
and
whe
n to
use
the
res
usci
tati
on b
ag
That
a r
esus
cita
tion
bag
nee
ds t
o be
kep
t at
the
bed
side
AN
D in
the
em
erge
ncy
bag
How
to
test
a r
esus
cita
tion
bag
to
ensu
re it
s pr
oper
fun
ctio
n
How
to
conn
ect
the
oxyg
en t
o th
e re
susc
itat
or b
ag a
nd c
heck
it t
o en
sure
it is
wor
king
as
it
shou
ld
Oxy
gen
liter
flo
w s
etti
ng t
o us
e w
ith
the
resu
scit
ator
How
to
asse
ss p
atie
nt f
or t
he c
orre
ct s
ize
resu
scit
ator
bag
, an
d if
app
licab
le,
mas
k
Ori
enta
tion
Dat
e __
__/_
____
/___
__
(Wri
te in
itia
ls b
elow
)
Ori
enta
tion
Dat
e __
__/_
____
/___
__
(Wri
te in
itia
ls b
elow
)
Des
crib
es a
nd/o
r de
mon
stra
tes
____
/___
_/__
__
(Wri
te in
itia
ls b
elow
)
Vent
ilato
r /
Trac
heos
tom
y Ca
re (
Trac
heos
tom
y Ca
re)
Nur
se k
now
s:
Men
tor
Lear
ner
Men
tor
Lear
ner
Men
tor
Lear
ner
Trac
h tu
be t
ype,
siz
e, a
nd d
owns
ize
back
up
Freq
uenc
y an
d ho
w t
o pe
rfor
m t
rach
sit
e (s
tom
a) c
ares
Freq
uenc
y an
d ho
w t
o pe
rfor
m t
rach
tie
cha
nges
Min
imal
leak
tec
hniq
ue (
MLT
) fo
r cu
ffed
tra
ch t
ubes
Purp
ose
and
how
to
use
a Pa
ssy-
Mui
r sp
eaki
ng v
alve
(sa
fety
pre
caut
ions
)
Sign
s of
air
way
blo
ckag
e
How
to
perf
orm
a t
rach
cha
nge—
rout
ine
freq
uenc
y ve
rsus
unp
lann
ed/e
mer
genc
y (l
ive
or
wit
h m
anne
quin
)
How
to
dete
rmin
e w
hen
911
shou
ld b
e ca
lled
How
to
insp
ect
the
neck
and
sto
ma
area
for
sig
ns o
f in
fect
ion
How
to
prop
erly
pos
itio
n or
rep
osit
ion
wit
h in
crea
se m
ovem
ent
of c
lient
Nur
sing
Ori
enta
tion
Che
cklis
t
Red—
Com
plet
e du
ring
off
ice
orie
ntat
ion
and/
or f
irst
day
of
hom
e or
ient
atio
n Y
ello
w—
Com
plet
e w
ithi
n 3
days
of
hom
e or
ient
atio
n pe
riod
G
reen
—Co
mpl
ete
wit
hin
30 d
ays
of b
eing
ass
igne
d a
case
IM
PORT
AN
T: T
he c
heck
lists
are
not
inte
nded
to
be a
sub
stit
ute
for
any
doct
or’s
inst
ruct
ion
for
any
pati
ent’
s sp
ecif
ic p
lan
of c
are.
The
y ar
e in
tend
ed t
o do
cum
ent
the
trai
ning
pro
vide
d by
the
Men
tor
RN t
o th
e N
urse
in t
he h
ome.
Pa
ge 6
of
13
Ori
enta
tion
Dat
e __
__/_
____
/___
__
(Wri
te in
itia
ls b
elow
)
Ori
enta
tion
Dat
e __
__/_
____
/___
__
(Wri
te in
itia
ls b
elow
)
Des
crib
es a
nd/o
r de
mon
stra
tes
____
/___
_/__
__
(Wri
te in
itia
ls b
elow
)
Vent
ilato
r /
Trac
heos
tom
y Ca
re (
Oxy
gen)
N
urse
kno
ws:
M
ento
r Le
arne
r M
ento
r Le
arne
r M
ento
r Le
arne
r
Prop
er w
ay t
o ch
ange
an
oxyg
en t
ank
Whe
re t
he f
low
cha
rts
are
loca
ted
How
to
dete
rmin
e ho
w m
uch
oxyg
en is
in t
he o
xyge
n ta
nk
Whe
re t
he O
xyge
n Sa
fety
sig
n ne
eds
to b
e po
sted
Safe
ty is
sues
rel
ated
to
oxyg
en
Whe
re a
nd h
ow o
xyge
n sh
ould
be
stor
ed
How
to
dete
rmin
e ho
w m
uch
oxyg
en s
houl
d be
use
d an
d w
hen
Ori
enta
tion
Dat
e __
__/_
____
/___
__
(Wri
te in
itia
ls b
elow
)
Ori
enta
tion
Dat
e __
__/_
____
/___
__
(Wri
te in
itia
ls b
elow
)
Des
crib
es a
nd/o
r de
mon
stra
tes
____
/___
_/__
__
(Wri
te in
itia
ls b
elow
)
Neb
uliz
er/I
nhal
er
Nur
se k
now
s:
Men
tor
Lear
ner
Men
tor
Lear
ner
Men
tor
Lear
ner
Whe
n ne
buliz
er/i
nhal
er t
hera
py is
indi
cate
d (o
rder
ed a
nd p
rn)
How
to
asse
mbl
e ne
b ki
t, c
onne
ct in
-lin
e
How
and
whe
n to
add
/rem
ove
a fi
lter
to
exha
lati
on t
ubin
g
Whi
ch m
edic
atio
ns c
an b
e m
ixed
ver
sus
othe
rs t
hat
requ
ire
desi
gnat
ed n
eb k
its
O
rien
tati
on D
ate
____
/___
__/_
____
(W
rite
init
ials
bel
ow)
Ori
enta
tion
Dat
e __
__/_
____
/___
__
(Wri
te in
itia
ls b
elow
)
Des
crib
es a
nd/o
r de
mon
stra
tes
____
/___
_/__
__
(Wri
te in
itia
ls b
elow
)
Resp
irat
ory
Syst
em M
anag
emen
t N
urse
kno
ws:
M
ento
r Le
arne
r M
ento
r Le
arne
r M
ento
r Le
arne
r
Com
pone
nts
of t
he r
espi
rato
ry t
ract
Thei
r cl
ient
’s d
iagn
oses
and
the
impa
ct o
n th
e ai
rway
(tr
ache
osto
my)
and
bre
athi
ng
(ven
tila
tor,
hum
idif
icat
ion
syst
ems)
Sign
s of
res
pira
tory
dis
tres
s (i
ncre
ased
WO
B: n
asal
fla
ring
, re
trac
tion
s, a
bd.
brea
thin
g,
incr
ease
/dec
reas
e in
RR
and/
or H
R, d
ecre
ase
in S
pO2,
ski
n co
lor,
sec
reti
on c
hang
es)
Nur
sing
Ori
enta
tion
Che
cklis
t
Red—
Com
plet
e du
ring
off
ice
orie
ntat
ion
and/
or f
irst
day
of
hom
e or
ient
atio
n Y
ello
w—
Com
plet
e w
ithi
n 3
days
of
hom
e or
ient
atio
n pe
riod
G
reen
—Co
mpl
ete
wit
hin
30 d
ays
of b
eing
ass
igne
d a
case
IM
PORT
AN
T: T
he c
heck
lists
are
not
inte
nded
to
be a
sub
stit
ute
for
any
doct
or’s
inst
ruct
ion
for
any
pati
ent’
s sp
ecif
ic p
lan
of c
are.
The
y ar
e in
tend
ed t
o do
cum
ent
the
trai
ning
pro
vide
d by
the
Men
tor
RN t
o th
e N
urse
in t
he h
ome.
Pa
ge 7
of
13
Appr
opri
ate
airw
ay m
anag
emen
t, in
terv
enti
ons
for
resp
irat
ory
dist
ress
(e.
g.,
suct
ioni
ng,
nebu
lizer
the
rapy
, hu
mid
ity,
tra
ch c
hang
e, v
enti
ng G
T)
How
to
ausc
ulta
te f
or b
reat
h so
unds
, ho
w t
o de
scri
be
How
to
perf
orm
bro
nchi
al d
rain
age
(BD
), in
clud
ing
man
ual B
Ds
Ori
enta
tion
Dat
e __
__/_
____
/___
__
(Wri
te in
itia
ls b
elow
)
Ori
enta
tion
Dat
e __
__/_
____
/___
__
(Wri
te in
itia
ls b
elow
)
Des
crib
es a
nd/o
r de
mon
stra
tes
____
/___
_/__
__
(Wri
te in
itia
ls b
elow
)
Gas
troi
ntes
tina
l/G
enit
ouri
nary
Sys
tem
Man
agem
ent
Nur
se k
now
s:
Men
tor
Lear
ner
Men
tor
Lear
ner
Men
tor
Lear
ner
Com
pone
nts
of a
GI t
rack
Type
s an
d pl
acem
ent
of G
I tub
e (a
ppro
pria
te t
o th
eir
clie
nt)
GI t
ube
site
car
es
GER
/asp
irat
ion/
emes
is p
reca
utio
ns (
body
pos
itio
ning
, el
evat
ing
HO
B, D
anny
Slin
g)
How
to
chec
k re
sidu
als,
whe
n to
hol
d fe
edin
gs
Die
t/hy
drat
ion
need
s –
appr
opri
ate
feed
ing
sche
dule
, Pe
dial
yte®
use
, im
pact
of
oral
inta
ke,
impa
ct o
f hy
drat
ion
in r
elat
ion
to c
ardi
ac/r
espi
rato
ry s
yste
ms
Proc
edur
e to
cor
rect
ly m
ix a
nd s
tore
for
mul
as
How
to
calc
ulat
e fo
rmul
a am
ount
s
Proc
edur
e to
unc
log
a ga
stri
c tu
be
How
to
vent
the
GI t
ube,
wha
t th
e Fa
rrel
l bag
is u
sed
for,
if a
pplic
able
Aver
age
hang
tim
e fo
r fo
rmul
as
How
to
ausc
ulta
te f
or b
owel
sou
nds
How
to
mea
sure
abd
omin
al g
irth
Nor
mal
I/O
’s –
fee
ding
sch
edul
e, u
rine
out
put
(dia
per
coun
ts/w
eigh
ts,
cath
eter
izat
ion
sche
dule
/mea
sure
men
ts,
BM n
orm
s [f
requ
ency
/con
sist
ency
/mea
sure
men
ts])
Nur
sing
Ori
enta
tion
Che
cklis
t
Red—
Com
plet
e du
ring
off
ice
orie
ntat
ion
and/
or f
irst
day
of
hom
e or
ient
atio
n Y
ello
w—
Com
plet
e w
ithi
n 3
days
of
hom
e or
ient
atio
n pe
riod
G
reen
—Co
mpl
ete
wit
hin
30 d
ays
of b
eing
ass
igne
d a
case
IM
PORT
AN
T: T
he c
heck
lists
are
not
inte
nded
to
be a
sub
stit
ute
for
any
doct
or’s
inst
ruct
ion
for
any
pati
ent’
s sp
ecif
ic p
lan
of c
are.
The
y ar
e in
tend
ed t
o do
cum
ent
the
trai
ning
pro
vide
d by
the
Men
tor
RN t
o th
e N
urse
in t
he h
ome.
Pa
ge 8
of
13
Ori
enta
tion
Dat
e __
__/_
____
/___
__
(Wri
te in
itia
ls b
elow
)
Ori
enta
tion
Dat
e __
__/_
____
/___
__
(Wri
te in
itia
ls b
elow
)
Des
crib
es a
nd/o
r de
mon
stra
tes
____
/___
_/__
__
(Wri
te in
itia
ls b
elow
)
Card
iac
Syst
em M
anag
emen
t N
urse
kno
ws:
M
ento
r Le
arne
r M
ento
r Le
arne
r M
ento
r Le
arne
r
Thei
r cl
ient
’s c
ardi
ac d
isea
se a
nd im
pact
on
othe
r sy
stem
s
Nor
mal
HR,
sig
nifi
canc
e of
incr
ease
d/de
crea
sed
HR
in t
heir
clie
nt
Nor
mal
ski
n co
lor
How
to
obta
in m
anua
l pul
ses
– ap
ical
and
per
iphe
ral
Rela
tion
of
acti
vity
leve
l for
the
ir c
lient
How
to
iden
tify
ede
ma/
inte
rven
tion
How
to
iden
tify
dia
phor
esis
/int
erve
ntio
n
How
to
chec
k ca
pilla
ry r
efill
– n
orm
al,
sign
ific
ance
of
incr
ease
d ti
me
Med
icat
ions
(i.
e. d
iure
tics
) an
d th
e im
pact
on
card
iova
scul
ar a
nd G
I sys
tem
s
How
to
chec
k BP
- n
orm
al B
P, v
ersu
s hy
pert
ensi
on/h
ypot
ensi
on c
ause
s in
the
ir c
lient
Ori
enta
tion
Dat
e __
__/_
____
/___
__
(Wri
te in
itia
ls b
elow
)
Ori
enta
tion
Dat
e __
__/_
____
/___
__
(Wri
te in
itia
ls b
elow
)
Des
crib
es a
nd/o
r de
mon
stra
tes
____
/___
_/__
__
(Wri
te in
itia
ls b
elow
)
Neu
rolo
gic
Syst
em M
anag
emen
t N
urse
kno
ws:
M
ento
r Le
arne
r M
ento
r Le
arne
r M
ento
r Le
arne
r
Neu
rolo
gic
dise
ase
and
impa
ct o
n ot
her
syst
ems
(i.e
. ce
ntra
l apn
ea,
auto
nom
ic d
ysre
flex
ia)
Nor
mal
men
tal s
tatu
s/le
vel o
f co
nsci
ousn
ess,
sig
nifi
canc
e of
incr
ease
d/de
crea
sed
leve
l of
cons
ciou
snes
s
Nor
mal
neu
rom
uscu
lar
mov
emen
t/m
obili
ty
How
to
iden
tify
sei
zure
s/in
terv
enti
ons
Shun
t ty
pe,
sign
s of
mal
func
tion
How
to
iden
tify
ede
ma/
inte
rven
tion
rel
ated
to
shun
t m
alfu
ncti
on
Nur
sing
Ori
enta
tion
Che
cklis
t
Red—
Com
plet
e du
ring
off
ice
orie
ntat
ion
and/
or f
irst
day
of
hom
e or
ient
atio
n Y
ello
w—
Com
plet
e w
ithi
n 3
days
of
hom
e or
ient
atio
n pe
riod
G
reen
—Co
mpl
ete
wit
hin
30 d
ays
of b
eing
ass
igne
d a
case
IM
PORT
AN
T: T
he c
heck
lists
are
not
inte
nded
to
be a
sub
stit
ute
for
any
doct
or’s
inst
ruct
ion
for
any
pati
ent’
s sp
ecif
ic p
lan
of c
are.
The
y ar
e in
tend
ed t
o do
cum
ent
the
trai
ning
pro
vide
d by
the
Men
tor
RN t
o th
e N
urse
in t
he h
ome.
Pa
ge 9
of
13
Ori
enta
tion
Dat
e __
__/_
____
/___
__
(Wri
te in
itia
ls b
elow
)
Ori
enta
tion
Dat
e __
__/_
____
/___
__
(Wri
te in
itia
ls b
elow
)
Des
crib
es a
nd/o
r de
mon
stra
tes
____
/___
_/__
__
(Wri
te in
itia
ls b
elow
)
Vasc
ular
Sys
tem
(In
fusi
on)
Man
agem
ent
Nur
se k
now
s:
Men
tor
Lear
ner
Men
tor
Lear
ner
Men
tor
Lear
ner
Type
of
IV t
hera
py b
eing
use
d an
d w
hy
How
to
prep
are
a sa
fe w
ork
area
for
the
IV li
ne m
anag
emen
t/m
eds
How
to
scru
b th
e hu
b of
the
IV c
athe
ter
Wha
t to
do
if a
n un
capp
ed t
ip,
IV t
ubin
g, o
r hu
b is
tou
ched
How
to
insp
ect
the
IV c
athe
ter
site
and
cat
hete
r –
wha
t to
look
for
How
to
secu
re t
he IV
cat
hete
r
Sign
s of
a b
lood
stre
am in
fect
ion
Who
/whe
n to
rep
ort
sign
s of
a b
lood
stre
am in
fect
ion
Prop
er p
roto
col f
or f
lush
ing
the
IV li
ne
And
can
dem
onst
rate
the
pro
per
infe
ctio
n pr
even
tion
met
hod
of c
hang
ing
the
dres
sing
and
m
anag
ing
the
site
O
rien
tati
on D
ate
____
/___
__/_
____
(W
rite
init
ials
bel
ow)
Ori
enta
tion
Dat
e __
__/_
____
/___
__
(Wri
te in
itia
ls b
elow
)
Des
crib
es a
nd/o
r de
mon
stra
tes
____
/___
_/__
__
(Wri
te in
itia
ls b
elow
)
Com
mun
icat
ion
/ Re
sour
ces
M
ento
r Le
arne
r M
ento
r Le
arne
r M
ento
r Le
arne
r
Com
mun
icat
ing
wit
h of
fice
sta
ff,
doct
ors,
the
rapi
sts,
nur
ses
Com
mun
icat
ion
book
Com
pone
nts
of r
epor
ts a
nd w
hy t
hey
are
impo
rtan
t
Giv
e re
port
to
prec
epto
r fo
r pr
acti
ce
Giv
e re
port
to
next
nur
se
Init
iate
cal
l to
PDN
to
com
mun
icat
e vi
a af
ter
hour
s on
-cal
l sys
tem
s
Repo
rt c
once
rns
to n
urse
, nu
rse
supe
rvis
or,
or c
ase
man
ager
DM
E, e
quip
men
t m
anua
ls
Nur
se s
uper
viso
r/le
ad n
urse
/pre
cept
or
Clin
ical
man
ager
or
on-c
all c
linic
al n
urse
and
sta
ffer
Nur
sing
Ori
enta
tion
Che
cklis
t
Red—
Com
plet
e du
ring
off
ice
orie
ntat
ion
and/
or f
irst
day
of
hom
e or
ient
atio
n Y
ello
w—
Com
plet
e w
ithi
n 3
days
of
hom
e or
ient
atio
n pe
riod
G
reen
—Co
mpl
ete
wit
hin
30 d
ays
of b
eing
ass
igne
d a
case
IM
PORT
AN
T: T
he c
heck
lists
are
not
inte
nded
to
be a
sub
stit
ute
for
any
doct
or’s
inst
ruct
ion
for
any
pati
ent’
s sp
ecif
ic p
lan
of c
are.
The
y ar
e in
tend
ed t
o do
cum
ent
the
trai
ning
pro
vide
d by
the
Men
tor
RN t
o th
e N
urse
in t
he h
ome.
Pa
ge 1
0 of
13
Prim
ary
diag
nosi
s
Prim
ary
doct
or
Phar
mac
y
Hom
e m
edic
al e
quip
men
t co
mpa
ny
Resp
irat
ory
ther
apis
t
Hom
e in
fusi
on c
ompa
ny/s
peci
alty
pha
rmac
y
Infu
sion
nur
se
Tran
spor
tati
on (
e.g.
, Li
fe L
ink,
Med
ivan
)
Pois
on c
ontr
ol c
ente
r
Boun
dari
es in
the
hom
e/co
mm
unic
atio
n/co
nfid
enti
alit
y
How
to
invo
lve
the
fam
ily in
the
Pla
n of
Car
e
Clie
nt c
hart
How
to
com
mun
icat
e in
an
age-
appr
opri
ate
man
ner
wit
h th
e cl
ient
O
rien
tati
on D
ate
____
/___
__/_
____
(W
rite
init
ials
bel
ow)
Ori
enta
tion
Dat
e __
__/_
____
/___
__
(Wri
te in
itia
ls b
elow
)
Des
crib
es a
nd/o
r de
mon
stra
tes
____
/___
_/__
__
(Wri
te in
itia
ls b
elow
) In
tegu
men
tary
Men
tor
Lear
ner
Men
tor
Lear
ner
Men
tor
Lear
ner
Inci
sion
/sca
r ca
res
Oth
er o
stom
y ca
res
Brea
kdow
n
Gra
nulo
mas
S/S
infe
ctio
n/ir
rita
tion
s/al
lerg
ies
Tem
pera
ture
Chan
ge d
iape
r
Nur
sing
Ori
enta
tion
Che
cklis
t
Red—
Com
plet
e du
ring
off
ice
orie
ntat
ion
and/
or f
irst
day
of
hom
e or
ient
atio
n Y
ello
w—
Com
plet
e w
ithi
n 3
days
of
hom
e or
ient
atio
n pe
riod
G
reen
—Co
mpl
ete
wit
hin
30 d
ays
of b
eing
ass
igne
d a
case
IM
PORT
AN
T: T
he c
heck
lists
are
not
inte
nded
to
be a
sub
stit
ute
for
any
doct
or’s
inst
ruct
ion
for
any
pati
ent’
s sp
ecif
ic p
lan
of c
are.
The
y ar
e in
tend
ed t
o do
cum
ent
the
trai
ning
pro
vide
d by
the
Men
tor
RN t
o th
e N
urse
in t
he h
ome.
Pa
ge 1
1 of
13
Nor
mal
ski
n ap
pear
ance
Soap
s/oi
ntm
ents
/lot
ions
Peri
car
e
Dre
ss
Envi
ronm
enta
l tem
pera
ture
par
amet
ers
(in
and
outs
ide)
Bath
e
O
rien
tati
on D
ate
____
/___
__/_
____
(W
rite
init
ials
bel
ow)
Ori
enta
tion
Dat
e __
__/_
____
/___
__
(Wri
te in
itia
ls b
elow
)
Des
crib
es a
nd/o
r de
mon
stra
tes
____
/___
_/__
__
(Wri
te in
itia
ls b
elow
) M
edic
atio
ns
Men
tor
Lear
ner
Men
tor
Lear
ner
Men
tor
Lear
ner
Revi
ew d
rug
info
rmat
ion
(i.e
., n
ames
, do
ses,
tim
es,
side
eff
ects
, st
orag
e, a
nd d
esir
ed
effe
cts)
. S
ee M
edic
atio
n Pr
ofile
s.
Rout
e (P
O,
GT,
top
ical
, SQ
, IM
, IV
, PR
, in
hale
rs,
puff
s)
Chec
k ph
arm
acy
labe
ls/e
xpir
atio
n da
tes
Prep
are
and
adm
inis
ter
all m
edic
atio
ns
Revi
ew s
ched
uled
vs
PRN
med
icat
ions
O
rien
tati
on D
ate
____
/___
__/_
____
(W
rite
init
ials
bel
ow)
Ori
enta
tion
Dat
e __
__/_
____
/___
__
(Wri
te in
itia
ls b
elow
)
Des
crib
es a
nd/o
r de
mon
stra
tes
____
/___
_/__
__
(Wri
te in
itia
ls b
elow
) Ve
ntila
tor
/ Tr
ache
osto
my
Care
Men
tor
Lear
ner
Men
tor
Lear
ner
Men
tor
Lear
ner
Equi
pmen
t: K
now
s ho
w t
o m
aint
ain
the
equi
pmen
t (e
.g.,
filt
er a
nd t
ubin
g ch
ange
s,
reus
able
sup
plie
s)
Suct
ioni
ng:
Know
s th
e cl
eani
ng o
f co
llect
ion
bott
le/t
ubin
g, f
ilter
cha
nges
Trac
heos
tom
y ca
re:
Know
s ho
w t
o cl
ean,
dis
infe
ct,
proc
ess
trac
h tu
bes
and
inne
r ca
nnul
as,
per
Plan
of
Care
Oxy
gen:
Kno
ws
how
to
ensu
re t
here
is a
thr
ee-d
ay s
uppl
y fo
r cl
ient
s th
at li
ve w
ithi
n a
40-
mile
rad
ius
of t
he e
quip
men
t su
pply
com
pany
and
a o
ne-w
eek
supp
ly if
are
a is
far
ther
tha
n 40
mile
s
Nur
sing
Ori
enta
tion
Che
cklis
t
Red—
Com
plet
e du
ring
off
ice
orie
ntat
ion
and/
or f
irst
day
of
hom
e or
ient
atio
n Y
ello
w—
Com
plet
e w
ithi
n 3
days
of
hom
e or
ient
atio
n pe
riod
G
reen
—Co
mpl
ete
wit
hin
30 d
ays
of b
eing
ass
igne
d a
case
IM
PORT
AN
T: T
he c
heck
lists
are
not
inte
nded
to
be a
sub
stit
ute
for
any
doct
or’s
inst
ruct
ion
for
any
pati
ent’
s sp
ecif
ic p
lan
of c
are.
The
y ar
e in
tend
ed t
o do
cum
ent
the
trai
ning
pro
vide
d by
the
Men
tor
RN t
o th
e N
urse
in t
he h
ome.
Pa
ge 1
2 of
13
Ori
enta
tion
Dat
e __
__/_
____
/___
__
(Wri
te in
itia
ls b
elow
)
Ori
enta
tion
Dat
e __
__/_
____
/___
__
(Wri
te in
itia
ls b
elow
)
Des
crib
es a
nd/o
r de
mon
stra
tes
____
/___
_/__
__
(Wri
te in
itia
ls b
elow
) Co
mm
unic
atio
n /
Reso
urce
s
Men
tor
Lear
ner
Men
tor
Lear
ner
Men
tor
Lear
ner
Pedi
atri
cian
Pulm
onol
ogis
t
ENT
Gas
troe
nter
olog
ist
Card
iolo
gist
Neu
rolo
gist
Ort
hope
dist
Oth
er d
octo
r
Infu
sion
pha
rmac
ist
Die
titi
an
O
rien
tati
on D
ate
____
/___
__/_
____
(W
rite
init
ials
bel
ow)
Ori
enta
tion
Dat
e __
__/_
____
/___
__
(Wri
te in
itia
ls b
elow
)
Des
crib
es a
nd/o
r de
mon
stra
tes
____
/___
_/__
__
(Wri
te in
itia
ls b
elow
) In
tegu
men
tary
Men
tor
Lear
ner
Men
tor
Lear
ner
Men
tor
Lear
ner
Ear
wax
Crad
le c
ap
Nai
l tri
mm
ing
Nur
sing
Ori
enta
tion
Che
cklis
t
Red—
Com
plet
e du
ring
off
ice
orie
ntat
ion
and/
or f
irst
day
of
hom
e or
ient
atio
n Y
ello
w—
Com
plet
e w
ithi
n 3
days
of
hom
e or
ient
atio
n pe
riod
G
reen
—Co
mpl
ete
wit
hin
30 d
ays
of b
eing
ass
igne
d a
case
IM
PORT
AN
T: T
he c
heck
lists
are
not
inte
nded
to
be a
sub
stit
ute
for
any
doct
or’s
inst
ruct
ion
for
any
pati
ent’
s sp
ecif
ic p
lan
of c
are.
The
y ar
e in
tend
ed t
o do
cum
ent
the
trai
ning
pro
vide
d by
the
Men
tor
RN t
o th
e N
urse
in t
he h
ome.
Pa
ge 1
3 of
13
Ori
enta
tion
Dat
e __
__/_
____
/___
__
(Wri
te in
itia
ls b
elow
)
Ori
enta
tion
Dat
e __
__/_
____
/___
__
(Wri
te in
itia
ls b
elow
)
Des
crib
es a
nd/o
r de
mon
stra
tes
____
/___
_/__
__
(Wri
te in
itia
ls b
elow
) M
uscu
losk
elet
al S
yste
m M
anag
emen
t
Men
tor
Lear
ner
Men
tor
Lear
ner
Men
tor
Lear
ner
Acti
viti
es d
eter
min
ed b
y th
erap
ists
/Den
ver
II/IE
P Sc
reen
ing/
PED
I
Adap
tive
equ
ipm
ent
Ther
apy
book
O
rien
tati
on D
ate
____
/___
__/_
____
(W
rite
init
ials
bel
ow)
Ori
enta
tion
Dat
e __
__/_
____
/___
__
(Wri
te in
itia
ls b
elow
)
Des
crib
es a
nd/o
r de
mon
stra
tes
____
/___
_/__
__
(Wri
te in
itia
ls b
elow
) Co
mm
unic
atio
n /
Reso
urce
s
Men
tor
Lear
ner
Men
tor
Lear
ner
Men
tor
Lear
ner
Del
iver
/mai
l app
ropr
iate
doc
umen
ts t
o th
e of
fice
Coor
dina
ting
app
oint
men
ts
Imm
uniz
atio
ns/d
ocum
enta
tion
Soci
al w
orke
r
Occ
upat
iona
l the
rapi
st
Phys
ical
the
rapi
st
Spee
ch p
atho
logi
st
Scho
ol d
istr
ict
ECFE
Ort
ho/r
ehab
Resp
ite
care
All
info
rmat
ion
has b
een
revi
ewed
with
RN
Men
tor:
M
ento
r Si
gnat
ure/
Initi
als:
___
____
____
____
____
____
____
____
____
_ R
espo
nsib
ility
for c
are
of c
hild
, inc
ludi
ng e
mer
genc
ies i
s acc
epte
d by
: L
earn
er S
igna
ture
/Ini
tials
___
____
____
____
____
____
____
____
____
__
