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1. BLOOD PRESSURE MEASUREMENT
Equipments: Aneroid Sphygmomanometer, Stethoscope, Chair, Medical Record
Scenario: A Client attends Medicine O.P.D with headache, dizziness, vertigo. you as a student nurse
will check her Blood Pressure.
CONTENT
Total
mark
Marks
obtained
Remarks
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
i. Check the B.P and ensure bulb is properly attached to the tubing and
there are no cracks or leakage.
ii. Ensure patient is sitting or lying down on her left side
iii. Remove all clothing from the upper arm. Wrap the cuff around the upper
arm and secure it. The lower border of the cuff should be about 2.5 cm(2
fingers) above the hollow of the elbow.
Palpatory Method.
i. With the left hand, feel for the brachial pulse of the elbow. Alternatively,
feel for the radial pulse of the arm to which the cuff is tied.
ii. With the right hand tighten the screw of the rubber bulb and squeeze the
bulb repeatedly with the right hand to inflate the cuff until the pulse is not
felt.
iii. Note the manometer reading at the level where the pulse is not felt.
iv. Deflate the cuff gradually till you feel the pulse again.
v. Note this reading on the manometer, this is the systolic blood pressure.
vi. Deflate the cuff by loosening the screw of the rubber bulb.
Auscultatory Method.
i. Follow the first five steps of the palpatory method and note down the
client’s systolic blood pressure. Raise the pressure of the cuff to 30 mm of
Hg above the level at which brachial/ radial pressure is no longer felt.
ii. Put the stethoscope in your ears with the earpieces facing forward. Place
the flat part (diaphragm)of the stethoscope over the brachial pulse in the
hollow of the elbow(cubital fossa)and hold it in place. You should not be
able to hear any sound.
iii. Slowly release the valve to lower the pressure in the cuff and listen for the
thumping sounds.
iv. Note the reading on the instrument when first thumping sound is heard.
This is systolic blood pressure.
v. Continue lowering the pressure until the thumping sound first get muffled
and finally disappears. This is diastolic pressure.
vi. Release the valve and quickly allow all the air to go out of the cuff.
Remove the cuff
vii. Record the blood pressure reading as SBP/DBP in mmHg.
TOTAL 16

2. INTRAMUSCULAR INJECTION
Equipment: arm model, tray containing; spirit cotton swab, betadine swab, syringe, gloves, medicine
card, kidney tray, paper bag, mackintosh, towel.
Scenario: A client has come to you with a Doctor’s prescription with advice of Drotin injection to be
given stat.
CONTENT
Total
mark
Marks
obtained
Remarks
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
i. Take informed consent
ii. Assemble the necessary articles,
tray containing; spirit cotton swab, betadine swab, syringe, gloves,
Medicine card, kidney tray, paper bag, mackintosh, towel.
iii. Identify the site for IM injection
iv. Ensure 6 rights of medication administration
Right patient, Right time, Right route, Right drug/medicine, Right dose,
Right documentation.
v. Wash your hands and put on the gloves
vi. Clean the site with the spirit swab.
vii. Wait for 30 seconds again, with betadine swab the site in circular motion.
viii. Allow it to air dry for 30 seconds.
ix. Draw the prescribed dose of the medication
x. Maintain the privacy
xi. Use anatomical marks
xii. Select appropriate needle and syringe
xiii. Expel any air bubbles from the syringe
xiv. Holding the syringe between the thumb and the forefinger of the dominant hand
spread the skin tightly or pinch. Inject needle at 90O
angle
xv. Release the skin
xvi. Pull back the plunger and aspirate, if no blood appears, slowly inject the
medication.
xvii. Remove the non dominant hand and quickly remove the needle.
xviii. Apply pressure with antiseptic swab.
xix. Assist the patient in comfortable position.
xx. Safe disposal of
A. Destroy needle
B. Throw the needle in puncture proof container
C. Cut the syringe nozzle
D. Throw the syringe in the red bin bucket
TOTAL 23

3. REVERSE SPIRAL BANDAGING
Equipment: First Aid Box containing sterile dressing material, antiseptics,
bandage of size 2 -2.5 inch, pins
Scenario: In an accident a person has had a cut injury over his left forearm, apply
a reverse spiral bandage to secure his dressing.
CONTENT
Total
mark
Marks
obtained
Remarks
1
1
1
1
1
1
1
1
1
1
i. Dress the injured part
ii. Face the casualty
iii. When bandaging the left arm hold the head of
the bandage in the right hand
iv. Apply bandage from inner side to outer side
from below, take two turns of a simple spiral
on a limb to fit the limb snugly.
v. Bandage should be neither too tight nor too
loose, check it
vi. Roll bandage so that each layer covers two
third of the earlier layer
vii. After taking two turns of a simple spiral, apply
a reverse spiral downwards on the third turn
viii. Apply reverse turn on each turn taken from
below above in the left forearm and cover the
injured part
ix. At the end take a simple spiral turn
x. Fix the bandage either with pin or with the
adhesive or with the end torn into two and
making a knot.
TOTAL 10