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1) When you take a patient's Blood Pressure you must PALPATE the Brachial Artery first before taking the Blood Pressure. (Treas, Leslie S; Wilkinson, Judith M. Basic Nursing Concepts, Skills & Reasoning (Page 457).

 

2) You must gel / wash your hands every time when you:

- Enter and/or leave the room

- Before you chart (if you touched ANYTHING)

- Take off your gloves at any time (even while in the room)

- Wait 15 seconds after gelling up to allow hands to dry If not you will FAIL !

 

3) You do NOT have to assess the patients MOUTH before giving medications (yay!)

 

4) Your 2 1/2 hour time limit will start AFTER you receive report in the PLANNING phase (yay!)

 

5) In the video I state to assess skin turgor by checking the arm. NOWHERE in the Excelsior guidebook does it state that you MUST palpate the clavicle OR that the clavicle is the ONLY place you can palpate a patients skin to determine dehydration due to decreased skin elasticity. According to the fundamentals of nursing book that Excelsior is referencing (Treas, Leslie S; Wilkinson, Judith M. Basic Nursing Concepts, Skills & Reasoning (Page 520)  it states:  

 "Palpate skin for turgor. Test an unexposed area, such as the area below the clavicle, inner thigh, sternum, or forehead, by gently pinching up the skin, noting its return when you release it."
As you can see, this book references to test an unexposed area. No tribe member has failed for assessing the arm, but to be safe you may want to assess BELOW THE CLAVICLE as the fundamentals of nursing book recommends. 

 

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