Skill Checklists for Taylor's Clinical Nursing Skills: A Nursing Process Approach

349

Skill Checklists for Taylor's Clinical Nursing Skills:
A Nursing Process Approach, 3rd edition

Name Date

Unit Position

Instructor/Evaluator: Position

SKILL 16-5

Performing Cardiopulmonary Resuscitation (CPR)

Goal:CPR is performed effectively without adverse effect

to the patient. Comments

1. Assess responsiveness. If the patient is not responsive,
   call for help, pull call bell, and call the facility emergency
   response number. Call for the automated external defibril-
   lator (AED).


2. Put on gloves, if available. Position the patient supine on
   his or her back on a firm, flat surface, with arms alongside
   the body. If the patient is in bed, place a backboard or
   other rigid surface under the patient (often the footboard
   of the patient’s bed).


3. Use the head tilt–chin lift maneuver to open the airway.
   Place one hand on the victim’s forehead and apply firm,
   backward pressure with the palm to tilt the head back.
   Place the fingers of the other hand under the bony part
   of the lower jaw near the chin and lift the jaw upward to
   bring the chin forward and the teeth almost to occlusion.
   If trauma to the head or neck is present or suspected, use
   the jaw-thrust maneuver to open the airway. Place one
   hand on each side of the patient’s head. Rest elbows on
   the flat surface under the patient, grasp the angle of the
   patient’s lower jaw, and lift with both hands.


4. Look, listen, and feel for air exchange. Take at least
   5 seconds and no more than 10 seconds (AHA, 2006).


5. If the patient resumes breathing or adequate respirations
   and signs of circulation are noted, place the patient in the
   recovery position.


6. If no spontaneous breathing is noted, seal the patient’s
   mouth and nose with the face shield, one-way valve mask,
   or Ambu-bag (handheld resuscitation bag), if available.
   If not available, seal the patient’s mouth with rescuer’s
   mouth.


7. Instill two breaths, each lasting 1 second, making the chest
   rise.

Copyright © 2011 by Wolters Kluwer Health | Lippincott Williams & Wilkins. Skill Checklists for Taylor's Clinical Nursing Skills:

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