While there is a lot of information to know for nursing clinicals, there are a few basic tasks to master to look like a rock star… let’s discuss…
1. How to apply a 5-lead ECG
Many hospitalized patients will be on a heart monitor (telemetry monitoring). Most units utilize a 5-lead heart monitor, meaning there are 5 wires that connect to a sticker placed on a specific spot of the patient’s chest. Both nurses and nursing assistants hook patients up to these monitors, and it’s something that is really important to know!
We have a specific cheatsheet here that shows you the correct anatomical locations, lead names, and colors. We also have a smaller pocket-sized version available in our Scrubcheats pack (pictured below) as well. Check out our mnemonics podcast and book that goes over various memory devices that will help you remember which leads go where.
2. How to apply oxygen
This is a simple one that was never really explained to me… people just assumed someone, at some point, told me how these things work. Oxygen is delivered through various methods, the most common of which is through something called a nasal cannula. You can administer oxygen up to 6L/min via a nasal cannula. I always used to apply the cannula upside down… when you’re putting it on someone, make sure the little prongs are curved down. Whenever I’m about to put them on a patient, I usually joke with them and say something like, “Ok, I’m going to pick your nose now!” and that usually gets a laugh or two. You connect the other end to the wall, turn it up to the desired amount, and then apply it to the patient’s face. I find it easiest to put it on their nose first, and then trace each side back behind each ear.
If it’s a patient that will or has been on oxygen for a while, that tubing can start to cause skin breakdown on their face or behind their ears. Make sure you’re assessing those areas. You may need to add some padding.
Also, that oxygen is really dry air and can really dry out the nasal passages. Whenever I put someone on oxygen and I anticipate them needing it for more than just a few hours after surgery or something, I grab one of the humidifiers that attaches to it. This humidifies the air that goes through the tubing and it much more comfortable for the patient.
3. Incentive spirometer
Many hospitalized patients will have orders for incentive spirometry. It’s a little device that the patient breathes in and out of about 10x and hour to help expand their lungs and prevents pneumonia from developing, either after surgery or just from being in bed for an extended period of time. The device looks like something you blow into for it to work, but the goal is for the patient to inhale deeply to expand their lungs. If you’re not sure how one works, see if you can snag one from clinical to try out on your own. They’re really important, especially in the post-op patient.
Whenever I tell my patients about them, I always make sure to emphasize the focus is on breathing in. Many people see it, try to use it, and forcefully exhale and get frustrated when the little thing doesn’t move. The doctors typically order for them to be used 10x an hour, so I tell my patients that if they’re watching TV to do it 3-4 times with each commercial. Then I tell the loved one at the bedside that I’m giving them a job, and that’s to remind the patient to do it every commercial. Loved ones typically feels so helpless and burdensome that they appreciate when they’re given a task to help.
4. Bed baths
In clinicals you’ll be helping with basic patient care. A bed bath may sound like no big deal to someone who has never done it before… but giving a bed bath to a completely bedbound and unresponsive person, changing their gown, all the blankets, and cleaning them up, while they’re hooked up to a ventilator and extraventricular drain is not as simple as just a bed bath.
Hook up with the CNA’s when they’re bathing a particularly complex patient. You will learn a LOT from CNA’s.
Make sure you gather ALL supplies first, especially if it’s an isolation room. If it’s a totally unresponsive person, you most likely will need two people to complete a bed bath. You’ll turn the patient up on one side, with one person holding them up. The other person will take all of the old sheets and roll them up under the patient. Then you’ll clean everything and put the new fitted sheet and pad on your side of the bed, tucking it under the dirty. If the dirty is saturated/soiled pretty bad, then take a towel or additional pad and put it in between so you don’t get the new stuff dirty. You’ll then turn the patient the opposite way (towards you now) and the other staff member will pull out the dirty stuff, clean that side of the patient, and then pull the clean linen out and attach the fitted sheet.
You may have to provide foley care, oral care, etc. so I won’t go into all of those details, but it’s important to not only see and learn how to give a bed bath, but also to get comfortable with it. Don’t think that just because you’ve got your RN that you won’t provide basic patient care – because you will! The sooner you get comfortable with it, the better you’ll become and the faster you’ll be able to complete a quality bath.
If you take some time to focus on learning these few tasks, you’ll be able to rock them and look awesome in clinicals so you can focus on learning other more complicated things like starting IV’s, drawing blood, taking care of central lines, giving meds, and more!