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RD TOOL Cleaning-A-Wound

The document provides instructions for cleaning a wound and applying a dry sterile dressing in 17 steps. It includes legends to rate performance on a scale of 1 to 4. The steps include preparing supplies, positioning the patient, inspecting the wound, cleaning the wound with sterile gauze from the center outwards, drying the area, applying ointment if prescribed, placing sterile dressings, securing with tape, and documenting. Performance is then rated and any remarks are noted.

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Maria Es
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49 views

RD TOOL Cleaning-A-Wound

The document provides instructions for cleaning a wound and applying a dry sterile dressing in 17 steps. It includes legends to rate performance on a scale of 1 to 4. The steps include preparing supplies, positioning the patient, inspecting the wound, cleaning the wound with sterile gauze from the center outwards, drying the area, applying ointment if prescribed, placing sterile dressings, securing with tape, and documenting. Performance is then rated and any remarks are noted.

Uploaded by

Maria Es
Copyright
© © All Rights Reserved
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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COLLEGE OF NURSING

Cleaning a Wound and Applying a dry sterile Dressing


Instruction: check on the column of your choice as to what level is the performance of the student in the following procedure. Be
guided in the scoring with the legend below:
Legend: Level of performance
4 Very satisfactory (Performed all the procedures correctly)
3 Satisfactory (Needs minimal assistance in performing the procedure)
2 Good (Needs more practice in performing the procedure)
1 Fair (inappropriate in the performance of the procedure)
STE PROCEDURE 4 3 2 1
P
1 Reviews the physician’s order for wound care
2 Gathers necessary equipment
3 Identifies patient and explains importance of the procedure
4 Adjusts bed to a comfortable working height and provides privacy to the patient
5 Performs hand hygiene
6 Places waste receptacle at a convenient location for use during the procedure
7 Assists patient to a comfortable position that provides easy access to the wound area
 Uses bath blanket/towel to drape the patient appropriately
 Places waterproof pad/rubber sheet under wound site
8 Checks for the position of drains, tubes, or other adjuncts before removing the dressing
 Puts on clean, disposable gloves
9 Loosens tape on the old dressing starting with the corners
 Uses cotton balls dampened with alcohol to aid in removing adhesives as necessary
10 Carefully removes soiled dressings
 Notes the presence, amount, type, color, and odor of any drainage on the dressings
 Places soiled dressings in the appropriate receptacles
 Removes and dispose gloves
11 Inspects the wound site for size, appearance, and drainage
 Checks sutures, staples, or drains
 Notes any problems to include in documentation such as delayed wound healing and beginning
manifestations of infection
12 Prepares a sterile work area and opens needed supplies
 Opens sterile cleaning solution
 Opens sterile gauze packs
13 Puts on sterile gloves
14 Cleans the wound using sterile forceps
 Cleans the wound from top to bottom and from the center to the outside
 Uses a new gauze for each swipe
 Disposes used gauze in appropriate receptacle
 Cleans around the area of the drain using circular motions

Subtotal:
Total Score:

UC-VPAA-CON-FORM-80 Page 1of 2


JUNE 2012 REV. 00
Perfect Score:
Remarks:

Name / Signature of Student Name / Signature of RD Instructor

15 Dries area using gauze sponge in the same manner that the wound was cleaned
 Applies ointment or topical antibiotic as prescribed
16 Applies a layer of dry sterile dressing over the wound utilizing forceps
 Places a second layer of gauze on the wound site
17 Secures the dressing with adhesive tape
 Ensures that all corners of the dressing are sealed
Removes all remaining equipment from the bedside and positions patient comfortably
Removes gloves and performs hand hygiene
Documents pertinent information and updates the patient’s chart

UC-VPAA-CON-FORM-80 Page 2of 2


JUNE 2012 REV. 00

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