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Name: __________________________________________ Date: _____________ Score: _____________
Procedure 39–3 Steps
Start Time: End Time: Total Time:
Steps
Possible
Points
First
Attempt
Second
Attempt
Third
Attempt
1. Wash hands. Assemble the items needed for the
procedure; prepare lukewarm solution. Incorporate
critical thinking skills when performing patient
assessment and care.
15
2. Identify the patient, introduce yourself, and explain
the rationale for performance of the procedure. Show
awareness of the patient’s concerns related to the
procedure being performed.
15
3. Ask the patient which position would be more
comfortable, sitting or lying down. Drape the patient
with a towel to protect clothing.
10
4. Put on gloves. 15
5. Ask patient to tilt his or her head back and to the side.
Place the emesis basin against the head. Instruct
patient to hold the basin to catch the solution during
irrigation.
15
6. Gently wipe eye with gauze square from the inner to
outer canthus to remove any particles before
proceeding with irrigation.
15
7. Fill syringe with ordered solution. 15
8. Hold the affected eye open with the thumb and index
finger, and slowly release the solution over the eye
gently and steadily.
15
9. When irrigation is completed, use gauze squares or
tissues to blot the area dry.
10
10. Record the procedure in the patient’s chart. 15
11. Wash the items and return them to the proper storage
area.
15
12. Remove gloves and wash hands. 15
Points Awarded / Points Possible _______/
170
