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HomeMy WebLinkAboutCompetency Evaluations ` . . Competency Evaluation . ' RESCUE OF ADULT CHOKING VICTIM Position: Licensed Nurse/C.N.A. ' (Please check one) 90 Day Probation [� Annual [ ] Interim [ ] � r Competency Sta.tement: Criteria Code: Demonstrates proper procedure of 1 =Criteria met treating adult choking victim 2=Did not meet criteria � � � 3 =Met criteria after instruction Results(See ' # CRITERIA Criteria Code} 1 2 3 RESPONSIVE RESIDENT ' 1 Look For Signs and Symptoms of Distress ' Mild Airway Obstruction a. Good air exchange [� [ ] [ ] b. Responsive a.nd can cough forcefully [� [ ] [ ] c. May wheeze between coughs ['� [ ] [ ] Severe Airway Obstruction a. Poor or no air exchange [�}' [ ] [ ] ' b. Weak, ineffective cough or no cough at all [C]� [ ] [ ] c. High-pitched noise while inhaling or no noise at all [� [ ] [ ] i d. Increased respiratory difficulty [/]� [ ] [ ] i e. Possible cyanosis (turning blue) [�' [ ] [ ] � f. Unable to speak [r]' [ ] [ ] ' g. CIutching the neck with the thumb and fingers, making [X [ ] [ ] universal choking sign h. Unable to move air 2 Stand or kneel behind the victim and wrap your anns around the [ [ ] [ ] victim's waist 3 Make a fist with one hand ] 4 Place the thumb side of your fist against the victim's abdomen, [ [ ) [ ] in the mid-line,slightly above th�naval and well below the ' breastbone ' 5 Grasp your fist with your other hand and press your fist into the [ [ ] [ ] victim's abdomen with a uick u ward thrust 6 Repeat thrusts until the object in expelled from the airway or the [/]' [ ] [ ] victim becomes unres onsive 7 Give each new thrust with a separate, distinct movement to [ [ ] [ ] relieve the obstruction _ _ _ - - � _ :. - _ _ .. , . _ . - - � � . % Page 2—Licensed Nurse/C.N.A. Rescue of Adult Choking Victim ui�i��ivi�.�iv�L' iLL`��lI1L'1\1-Lii1�Vi;v:��: (UNCONSCIOUS ' 1 f the adult victim is unresponsive, activate the emergency r onse system, open the airway,remove an object if you see it, [.�[ ] [ ] and in CPR 7 Rvar��f a vnii nr�Pn t}ia aittxlav tn Q1VP. hrPathc (lY1P.11 f}lP, . victim's m th wide and look for the object. If you see an [.]'�[ ] [ ] object, remov ' with your fingers. If you do not see an object, kee doin CPR 3 You can tell you have ccessfully removed an airway obstruction in the unrespo ive victim if you - Feel air move t and see the chest rise when [,-]- [ ] [ ] ' you give breaths - See and remove a forei body from the victim's '[.�]�[ ] [ ] : harynx 4 Fotlow these steps after you relieve choking in e unresponsive victim: a. Provide 2 breaths [�[ � [ � b. Check for pulse [;�}�( ] ( � Then You Should ' Pulse—No Breathing—No � Perform chest compressions an Lattach the AED [�[ ] [ ] D„1� Va. Rro�th:,,R_7�Tn I r'nntirnia racr.iia hrP.athinv anrj � a .n..�.'. ..... ,.�............ .b ..., � ....."-"'..._ -_.•--- "-'------o -'-- �.. Lcheck for pulse everv 2 minutes [ [ ] [ ] ' Pulse—Yes Breathing—Yes � Place the victim in the recovery � position and continue monitoring [�[ [ ] ', � � until EMS personnel arrive. You � will learn more about the �recovery_ .osition later 5 If you successfully relieve choking with abdominal thrusts, �' � encourage the victim to seek immediate medical attention to [� J [ ] � ensure that the victim does not have a complication from � abdominal thrusts i � ; Method Code: Return Demonstration`y� Exam ` ' Other(specify) ' ��9��� "t� a-�a^�`�� ' Plan of Action if Needed: , � � Employee Name: � �' '��-- Date: `� 1 i � ; Evaluator: Date: �,'(11 � 1 Ej r � , ���� : _ �r � � . . . _ -a -F �Competency Evaluation RESCUE OF ADULT CHOKING VICTIM Position: Licensed Nurse/C.N.A. (Please check one) 90 Day Probation [✓]� Annual [ ] Interim [ ] Competency Statement: Criteria Code: Demonstrates proper procedure of 1 =Criteria met treating adult choking victim 2=Did not meet criteria � 3 =Met criteria after instruction Results (See ' # CRITERIA. Criteria Code) 1 2 3 RESPONSIVE RESIDENT 1 Look For Signs and Symptoms of.Distress MiId Airway Obstruction a. Good air exchange . [. [ ] [ ] b. Responsive and can cough forcefully [ [ ] [ ) ' c. May wheeze between coughs [ ] [ ] [ ] Ssvere Airway Obstruction , a. Poor or no air exchange [� [ ) [ ] . b. Weak, ineffective cough or no cough at all [ [ ] [ ] c. High-pitched noise while inhaling or no noise at all [� [ ) [ ] d. Increased respiratory difficulty [J� [ ] [ ] ' e. Possible cyanosis (turning blue) [� [ ] [ ] f. Unable to speak [1f [ ] [ ] g. Clutching the neck with the thumb and fingers, making [/J [ ] [ ] universal choking sign i h. Unable to move air 2 Stand or kneel behind the victim and wrap your arms around the [ [ ] [ ] victim's_waist 3 Make a fist with one hand 4 Place tne thumb side of your fist against the victim's abdomen, [ [ ] [ ] in the mid-line,slightly above the naval and well below the breastbone � 5 Grasp your fist with yoar other hand and press your fist into the [ M [ ] [ ] � victim's abdomen with a uick u ward thrust � 6 Repeat thrusts until the object in expelled from the airway or the [ [ ] [ ] j victim becomes unres onsive 7 Give each new thrust with a separate, distinct movement to [ [ ] [ ] relieve the obstruction _ .: _ - -. - . . - - - ( 4 i , I i Page 2—Licensed Nurse/C.N.A. ; Rescue of Adult Choking Victim TrA7T�T,C�T}.!lh7C7�TL rT,�CTTL'hTT T V7AT!'� T!�(lUV1�T V1\i\L'JLVL\J1�L' 1tu�.7i.Li.a�t-itii�v �vv .�i• UNCONSCIOUS 1 If the aduIt victim is unresponsive, activate the emergency ' ponse system, open the airway, remove an object if you see it, [ [ ] [ ] an e in CPR ' 'l �. o �. .. tl�a o�rci»�i tn ni��a }�raat}ic h21PT1 t�'1P ��..�. victim's� outh wide and look for the object. If you see an [ ] [ ] [ ] � object,rem e it with your fingers. If you do not see an ob� t, � kee doin CP 3 You can tell you ve successfully removed an airwa ' obstruction in the unr onsive victim if you � - Feel air m vement and see the ch t rise when [ ] [ ] [ ] you give brea s i - See and remove foreign b y from the victim's '[ ] [ ] [ ] harynx ' 4 Follow these steps after you relieve 'ng in the unresponsive victim: a. Provide 2 breaths [ ] [ ) [ ] b. Check for pulse ( ] [ ] [ � I Then You Should � Pulse—No Breathing o � Perform chest compr sions and attach the AED [ ] [ � [ ] D„�CP _ V PC R.-Pat nrr_1�Tn I (`nntinnP rPcr.ne hreathin n(� ' .,..�., . .,� ._.-., - •a -... i __--------- ------ ---- -- check for ulse eve 2 min tes [ ] [ ] [ ] ' Pulse—Yes reathing—Yes � Place the victim in the recov � � position and continue monitori [ ] [ ] [ ] ; � until EMS personnel arrive. You � � will learn more about the i �recove osition later j 5 you successfizlly relieve choking with abdominal thnzsts, ' � encourage the victim to seek immediate medical attention to [ ] ] [ ] ensure that the victim does not have a complication from abdominal thrusts Method Code: Return Demonstration � Exam Other(specifY) /��. �....�y �- ��� ,,,�e�:�,n Plan of Action if Needed: � � i� � Employee Name: �� � �?� Date: � � `�`� � ! Evaluator: �',��-�,,���,;zl ��� Date: :�c i .. _ . . _..___. ... . . . __-__ .,_ . Competency Evaluation '. RESCUE OF ADULT CHOKING VICTIM Position: Licensed Nurse/C.N.A. / . (Please check one) 90 Day Probation [�]� � Annual [ ] � Interim [ ] � � Competency Statement: Criteria Code: ' Demonstrates proper procedure of 1 =Criteria met treating adult choking victim 2=Did not meet criteria � 3 =Met criteria after instruction Results(See # CRITERIA Criteria Code) 1 2 3 RESPONSIVE RESIDENT 1 Look For Signs and Symptoms of Distress Mi(d Airway Obstruction ' a. Good air exchange [�[ ] [ ] , b. Responsive and can cough forcefully [ � [ ] [ ] : c. May wheeze between coughs [ �[ ] [ ] Severe Airway Obstruction a. Poor or no air exchange [ ,]� [ ] [ ] b. Weak, ineffective cough or no cough at all [,� [ ] [ ] c. High-pitched noise while inhaling or no noise at all [ t� ] [ ] d. Increased respiratory di�culty [ �] [ ] e. Possible cyanosis (turning blue) [•� [ ] [ ] f. Unable to speak [� [ ] [ ] g. Clutching the neck with the thumb and fingers, making [ �[ ] [ ] universal choking sign h. Unable to move air 2 Stand or kneel behind the victim and wrap your arms around the [�[ ] [ ] - victim's waist '' 3 Make a fist with one hand i 4 Place the thumb side of your fist against the victim's abdomen, [�]'[ ] [ ] in the mid-line, slightly above the naval and-well below the breastbone � 5 Grasp your fist with your other hand and press your fist into the [� [ ] [ ] ! victim's abdomen with a uick u ward thrust ' 6 Repeat thrusts until the object in expelled from the airway or the [ [ � [ ] victim becomes unres onsive 7 Give each new thrust with a separate, distinct movement to [�[ ] [ ] relieve the obstruction ' I i I 4 Page 2–Licensed Nurse/C.N.A. Rescue of Adult Choking Victim UNRESPOleTSIVE RESIDEN'I'-L�C�Il`vG DO�fii ; (UNCONSCIOUS 1 If the adult victim is unresponsive, activate the emergency esponse system, open the airway, remove an object if you see it, [,�]�[ ] [ ] an be in CPR ' ,. ,-. .• ,, . _• ..--- -�- -�--- �-----��-- ------ �,__ f � �' �, i.v va y a .v)v�,.vt..... �.....,...,...> ..., b.... .,..,........� .,j..,.. �._ I victim's outh wide and look for the object. If you see an [�[ ] [ ] ! object, remo it with your fingers. If you do not see an object, �; kee doin CP 3 You can tell you ha e successfully removed an airway ' obstruction in the unre onsive victim if you - Feel air m ement and see the chest rise when �'[ ] [ ] you give bre s - See and remove foreign body from the victim's '['�[ ] [ ] harynx 4 Follow these steps after you relieve oking in the unresponsive victim: a. Provide 2 breaths [� [ ] [ ] b. Check for pulse [ ] [ ] [ � ' Then You Sho Pulse–No Breathing–No � Perform chest co ressions and ' attach the AED [ ] [ ] [ ] ' Pulse-Yes Breathing-No � Continue rescue breathi and , check for ulse eve 2 min tes [ ] [ ] [ ] , Pulse–Yes Breathing–Yes � Place the victim in the recove ' � position and con�inue monitorin [ ] [ ] [ ] � � until EMS personnel arrive. You � � will learn more about the �ee�very €ss�t�or�la�er � 5 If you successfully relieve choking with abdominal thrusts, " encourage the victim to seek immediate medical attention to [ ] [ ] ] ensure that the victim does not have a complication froxn abdominal thrusts Method Code: Return Demonstration � � Exam Other(specify) a�;� � `�– �,c�5.n Plan of Action if Needed: Employee Name: � Date: �_!'�-- �.�"�/ Evaluator: ' ate: �-a�T�—�_ Competency Evaluation RESCUE OF ADULT CHOKING VICTIM , Position: Licensed Nurse/C.N.A. i (Please check one) 90 Day Probation [ � ' Annual [ ] ' Interim [ ] Competency Statement: Criteria Code: Demonstrates proper procedure of 1 =Criteria met ' treating adult choking victim 2=Did not meet criteria � 3 =Met criteria after instruction Results (See # CRITERIA Criteria Code) 1 2 3 ' RESPONSIVE RESIDENT 1 Look For Signs and Symptoms of Distress Mild Airway Obstruction a. Good air exchange [�'' [ ] [ ] b. Responsive and can cough forcefully [,� [ ] [ ] c. May wheeze between coughs [�[ ] [ ] Severe Airway Obstruction a. Poor or no air exchange [� [ ] [ ] b. Weak, ineffective cough or no cough at all [� [ ] [ ] c. High-pitched noise while inhaling or no noise at all [� [ ] [ ] d. Increased respiratory difficulty [�]' [ ] [ ] e. Possible cyanosis(turning blue) [/]� [ ] [ ] f. Unable to speak [� [ ] [ ] g. Clutching the neck with the thumb and fingers, making [� [ ] [ J universal choking sign ' h. Unable to move air 2 Stand or kneel behind the victim and wrap your anns around the [,�'' [ ] [ ] victim's waist -- 3 Make a fist with one hand 4 Place the thumb side of your fist against the victim's abdomen, [� [ ] [ ] in the mid-line,slightly above the naval and well below the breastbone i 5 Gra.sp your fist with your other hand and press your fist into the [ [ ] [ ] j victim's abdomen with a uick u ward thrust 6 Repeat thrusts until the object in expelled from the airway or the [� [ ] [ ] � victim becomes unres onsive 7 Give each new thrust with a separate, distinct movement to [ [ ) [ ] relieve the obstruction ' � _ - - - - - _- . _ , � _ :_-. - . _ - . f i Page 2—Licensed Nurse/CN.A. � Rescue of Adult Choking Victim , -- --_ .. _-- -—-: - : U1Vll1;�l'V1VSIVL K�;�1llL1V 1'-LY11V(.T 1JV W1V � � , NCONSCIOUS � l If the adult victim is unresponsive, activate the emergency esponse system, open the airway, remove an object if you see it, [ ] [ ] [ ] a be in CPR ,. ., - . . _ - �- ---�-- ----- ��-- G LVlil «....,y�u �r„a. u.., �..�..�, �., b..., .,..,.�.--�, �r--- �--- �, victim' mouth wide and look for the object. If you see an [ ] [ ] [ ] i object, re ove it with your fingers. If you do not see an object, � kee doin PR ' � 3 You can teil y u have successfully removed an airway obstruction in th unresponsive victim if you - Fee air movement and see the chest rise when [ ) [ ] [ ] you g e breaths - See an emove a foreign body from the victim's '[ ] [ ] [ ] harynx � Follow these steps after yo relieve choking in the unresponsive victim: a. Provide 2 breaths ( � [ ] [ � b. Check for pulse [ ] [ ] [ ] � Then ou Should ; Pulse—No Breathing—No � Perfo chest compressions and ', attach the ED [ ] [ ] [ ] � ^ - �-----�,_-__ __� , YU1Se -T�eS rsreainin� -ivv � l.,ut1i11iuc ic -iic vicauuu�aiiu check for uls ve 2 minutes [ ) [ ] [ ] ; Pulse—Yes Breathing—Yes � Place the victim the recovery ' � pasition and contin monitoring [ ] [ ] [ ] ' � until EMS personnel ive. You : � will learn more about the � reeoder-� i��r�at€r 5 If you successfully relieve choking with abdominal thrusts, � encourage the victim to seek immediate medical attention to [ ] [ ] j ensure that the victim does not have a complication from abdominal thrusts Method Code: Return Demor.stration '� Exam Other(specify) ,� � ��..�.�(T� Plan of Action if Needed: . Employee Na Date: ��_ Evaluator: -.� ` �} Date: