Chapter 12
Respiratory Procedures
Procedure 81 Checking Capillary Refill
Procedure 82 Using A Pulse Oximeter
Procedure 83 Preparing Wall-Outlet Oxygen
Procedure 84 Preparing The Oxygen Cylinder
Procedure 85 Attaching The Humidifier To The Oxygen Flow Meter Or Regulator
Procedure 86 Administering Oxygen Through A Nasal Cannula
Procedure 87 Administering Oxygen Through A Mask
Procedure 88 Inserting The Oropharyngeal Airway
Procedure 89 Inserting The Nasopharyngeal Airway
Procedure 90 Oropharyngeal Suctioning
Procedure 91 Nasopharyngeal Suctioning
Procedure 92 Assisting With Postural Drainage
PERFORMANCE REVIEW CHECKLIST
Procedure 81
Checking Capillary Refill
Name of Patient Care Technician ________________________ Date of Program ______ to ______
Social Security Number or Identification Number _______________________________
Program Code Number (if any) _________________
S=Satisfactory Performance
U=Unsatisfactory Performance
Place a full signature to correspond with each set of initials appearing below.
Initials
Corresponding Signature of Instructor
Procedure Guidelines
S/U
1.
Perform your beginning procedure
actions.
2.
Inspect the nails, noting the color.
3.
Press the nail for a few seconds, until the
skin underneath blanches or turns white.
4.
Release the nail and evaluate the time it
takes for the skin to return to the normal
color. In normal oxygenation, this will
occur within 2 to 3 seconds.
5.
Perform your procedure completion
actions.
__________________________________
Instructor Signature
__________________________________
Student Signature
Title
Date
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Date
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Date
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PERFORMANCE REVIEW CHECKLIST
Procedure 82
Using A Pulse Oximeter
Name of Patient Care Technician ________________________ Date of Program ______ to ______
Social Security Number or Identification Number _______________________________
Program Code Number (if any) _________________
S=Satisfactory Performance
U=Unsatisfactory Performance
Place a full signature to correspond with each set of initials appearing below.
Initials
Corresponding Signature of Instructor
Title
Supplies needed:
•
•
•
Pulse oximeter unit
Sensor appropriate to the site
Adhesive tape, if needed, to secure the sensor
Procedure Guidelines
1.
Perform your beginning procedure
actions.
2.
Select and apply the sensor. If the sensor
has position markings, align them
opposite each other to ensure an accurate
reading. Fasten the sensor securely, or the
reading will not be accurate. Make sure
the sensor is not wrapped so tightly with
tape that it restricts blood flow.
3.
Attach the sensor to the patient cable on
the oximeter.
4.
Turn the unit on. You will hear a beep
with each pulse beat. Adjust the volume
as desired. Some units also have light
bars, indicating the strength of the pulse.
Note the percentage of oxygen
saturation. Inform the RN, or document
according to facility policy.
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5.
Note the patient’s pulse rate, if the unit
provides this reading. Compare with the
patient’s actual pulse to make sure the
unit is picking up each beat. Inform the
RN, or document according to facility
policy.
6.
Monitor the patient’s respirations and
general appearance. Inform the RN, or
document according to facility policy. If
the patient’s general condition changes at
any time, notify the RN.
7.
Perform your procedure completion
actions.
__________________________________
Instructor Signature
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Student Signature
Date
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Date
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Date
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Date
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PERFORMANCE REVIEW CHECKLIST
Procedure 83
Preparing Wall-Outlet Oxygen
Name of Patient Care Technician ________________________ Date of Program ______ to ______
Social Security Number or Identification Number _______________________________
Program Code Number (if any) _________________
S=Satisfactory Performance
U=Unsatisfactory Performance
Place a full signature to correspond with each set of initials appearing below.
Initials
Corresponding Signature of Instructor
Title
Supplies needed:
•
•
•
•
Flow meter
Sterile humidifier bottle, if used
Oxygen precautions sign(s)
Triangular adapter, if necessary (this is commonly called a Christmas tree because of its
shape and color)
Procedure Guidelines
1.
Perform your beginning procedure
actions.
2.
Select the correct flow meter. Oxygen is
color-coded green in the United States
and air is coded black. You cannot put
the flow meter in the wrong outlet
because the connectors are different sizes.
3.
Attach the male adapter in the flow meter
to the female adapter in the oxygen plate
in the wall by pushing it in securely. You
may need to push hard.
4.
Hold the flow meter in your hand as you
gradually release the pressure. If the flow
meter is not securely in place, it may pop
out, causing injury.
5.
Gently pull on the flow meter to make
sure it will not fall off the wall.
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6.
Attach the sterile humidifier bottle
(Procedure 85), if used.
7.
If the humidifier is not used, you must
screw the triangular adapter to the
bottom of the flow meter. Connect the
tubing to the point of the triangle.
8.
Post the oxygen precautions sign(s)
according to facility policy.
9.
Perform your procedure completion
actions.
__________________________________
Instructor Signature
__________________________________
Student Signature
Date
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Date
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Date
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Date
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PERFORMANCE REVIEW CHECKLIST
Procedure 84
Preparing The Oxygen Cylinder
Name of Patient Care Technician ________________________ Date of Program ______ to ______
Social Security Number or Identification Number _______________________________
Program Code Number (if any) _________________
S=Satisfactory Performance
U=Unsatisfactory Performance
Place a full signature to correspond with each set of initials appearing below.
Initials
Corresponding Signature of Instructor
Title
Supplies needed:
•
•
•
•
•
•
•
•
Oxygen cylinder
Wrench, depending on type of flow meter used
Handle or wrench for opening cylinder valve
Flow meter to fit cylinder
Sterile humidifier bottle, if used
Sterile distilled water for humidifier
Tubing and delivery device
Oxygen precautions sign(s)
Procedure Guidelines
1.
Perform your beginning procedure
actions.
2.
Obtain the cylinder. Check the color and
read the label to identify the contents.
3.
Transport the cylinder to the designated
area, chained to a wheeled dolly, if
necessary.
4.
Position the cylinder upright on the
dolly, upright in a base, or chained to
the wall.
5.
Stand to the side. Do not stand directly
over the cylinder. Remove the metal or
plastic cap, or wrapper protecting the
outlet.
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6.
Attach the handle to the cylinder. Crack
the main valve for one second. Close the
valve.
7.
Position the cylinder valve gasket on the
regulator port.
8.
Check the regulator. Turn the knob to
make sure the regulator port is closed.
9.
Align the two holes in the outlet with
the two pins in the regulator, or thread
the nut onto the male adapter on the
outlet. Tighten the t-screw for the pin
yolk, or use a wrench to tighten the
threaded outlet. Note: for small,
cylinder-type regulators, a Teflon “O”
ring must be in place, or the connection
will leak.
10.
Turn the cylinder on and check the
pressure gauge. Make sure the cylinder is
full. Listen for air leaks. If a leak is
present, turn the cylinder off, remove
the regulator, and reapply.
11.
Attach the humidifier filled with sterile
distilled water, tubing, and delivery
device, if ordered.
12.
Post the oxygen precautions sign(s)
according to facility policy.
13.
Perform your procedure completion
actions.
__________________________________
Instructor Signature
__________________________________
Student Signature
Date
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Date
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Date
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Date
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PERFORMANCE REVIEW CHECKLIST
Procedure 85
Attaching The Humidifier To The Oxygen Flow Meter Or Regulator
Name of Patient Care Technician ________________________ Date of Program ______ to ______
Social Security Number or Identification Number _______________________________
Program Code Number (if any) _________________
S=Satisfactory Performance
U=Unsatisfactory Performance
Place a full signature to correspond with each set of initials appearing below.
Initials
Corresponding Signature of Instructor
Title
Supplies needed:
•
•
Sterile disposable or refillable humidifier bottle
Sterile distilled water for refillable humidifier
Procedure Guidelines
1.
Perform your procedure completion
actions.
2.
Open the package for the humidifier and
remove the bottle.
3.
If a refillable humidifier is used, obtain a
fresh bottle that has been washed and
sterilized. Unscrew the lid and place it
with the clean inside up on the table. Fill
the bottle with sterile distilled water, then
replace the lid. Do not touch the inside of
the bottle or lid with your fingers.
4.
Connect the female adapter in the top of
the humidifier bottle to the male adapter
on the flow meter. Tighten the nut
securely.
5.
Connect the tubing on the cannula or
mask to the male adapter on the side of
the humidifier bottle.
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6.
Turn on the flow of oxygen. Pinch the
connecting tubing to ensure that the
safety valve pops off.
7.
Perform your procedure completion
actions.
__________________________________
Instructor Signature
__________________________________
Student Signature
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PERFORMANCE REVIEW CHECKLIST
Procedure 86
Administering Oxygen Through A Nasal Cannula
Name of Patient Care Technician ________________________ Date of Program ______ to ______
Social Security Number or Identification Number _______________________________
Program Code Number (if any) _________________
S=Satisfactory Performance
U=Unsatisfactory Performance
Place a full signature to correspond with each set of initials appearing below.
Initials
Corresponding Signature of Instructor
Title
Supplies needed:
•
Oxygen cannula
Procedure Guidelines
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1.
Perform your beginning procedure
actions.
2.
Connect the end of the cannula tubing to
the male adapter on the humidifier or flow
meter by pushing it securely in place.
3.
Turn the oxygen on to the designated flow
rate by adjusting the knob on the flow meter.
4.
Place your hand in front of the nasal
prongs to feel the flow of oxygen.
5.
Position the cannula in the patient’s
nostrils. Tighten the adjustment on the
strap so it is secure, but not too tight.
6.
Perform your procedure completion
actions.
__________________________________
Instructor Signature
__________________________________
Student Signature
Date
_______________
Date
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Date
Initials
S/U
Date
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PERFORMANCE REVIEW CHECKLIST
Procedure 87
Administering Oxygen Through A Mask
Name of Patient Care Technician ________________________ Date of Program ______ to ______
Social Security Number or Identification Number _______________________________
Program Code Number (if any) _________________
S=Satisfactory Performance
U=Unsatisfactory Performance
Place a full signature to correspond with each set of initials appearing below.
Initials
Corresponding Signature of Instructor
Title
Supplies needed:
•
Oxygen mask
Procedure Guidelines
1.
Perform your beginning procedure
actions.
2.
Connect the end of the mask tubing to
the male adapter on the humidifier or
flow meter by pushing it securely into
place.
3.
Turn the oxygen on to the designated
flow rate by adjusting the knob on the
flow meter.
4.
Place your hand in front of the inlet and
feel for the flow of oxygen.
5.
Position the mask over the patient’s nose,
mouth, and chin. Mold the metal band at
the top of the mask to the patient’s nose.
6.
Slip the elastic strap behind the patient’s
head.
7.
Tighten the adjustment on the elastic
strap so that the mask is secure, but not
too tight.
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8.
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Perform your procedure completion
actions.
__________________________________
Instructor Signature
__________________________________
Student Signature
_______________
Date
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Date
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Date
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PERFORMANCE REVIEW CHECKLIST
Procedure 88
Inserting The Oropharyngeal Airway
Name of Patient Care Technician ________________________ Date of Program ______ to ______
Social Security Number or Identification Number _______________________________
Program Code Number (if any) _________________
S=Satisfactory Performance
U=Unsatisfactory Performance
Place a full signature to correspond with each set of initials appearing below.
Initials
Corresponding Signature of Instructor
Title
Supplies needed:
•
•
•
Disposable exam gloves
Oral airways of various sizes
Tongue blade (optional)
Procedure Guidelines
1.
Perform your beginning procedure
actions.
2.
If the patient’s mouth is not open, use a
tongue blade or cross the thumb and
forefinger of one gloved hand. Position
your fingers in the corner of the mouth,
on the upper and lower teeth. Spread
your fingers apart to open the mouth.
3.
Select the airway size and position it with
the tip pointing sideways, toward the
cheek.
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4.
Insert the airway into the mouth, sliding
it along the tongue past the tissue in the
back of the throat until you meet
resistance. Check the tongue to make
sure it is not against the back of the
throat. An alternate method is to press
the tongue down and forward with the
tongue blade. Insert the airway with the
tip pointing downward. This method is
preferred in infants and children.
5.
Gently rotate the airway 90 degrees, until
the tip is pointing down.
6.
Check the tongue to make sure it is not
against the back of the throat. The flange
of the airway should be between the
patient’s lips.
7.
Check the patient’s respirations to ensure
that they are adequate.
8.
Perform your procedure completion
actions.
__________________________________
Instructor Signature
__________________________________
Student Signature
Date
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Date
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Date
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Date
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PERFORMANCE REVIEW CHECKLIST
Procedure 89
Inserting The Nasopharyngeal Airway
Name of Patient Care Technician ________________________ Date of Program ______ to ______
Social Security Number or Identification Number _______________________________
Program Code Number (if any) _________________
S=Satisfactory Performance
U=Unsatisfactory Performance
Place a full signature to correspond with each set of initials appearing below.
Initials
Corresponding Signature of Instructor
Title
Supplies needed:
•
•
•
•
Disposable exam gloves
Water-soluble lubricant
Nasopharyngeal airways, assortment of sizes
Tongue blade
Procedure Guidelines
1.
Perform your beginning procedure
actions.
2.
Select the correct size airway: slightly
smaller than the diameter of the nostril,
and approximately 1 inch longer than
the distance from the tip of the nose to
the earlobe.
3.
Lubricate the distal half of the airway
with water-soluble lubricant.
4.
With your nondominant index finger,
push up on the tip of the patient’s nose.
5.
Hold the airway in your dominant hand.
Insert it into the nostril and gently thread
the tube until the flange is at the tip of
the nose. Avoid forcing the airway. If you
meet resistance, remove the airway and
notify the RN.
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6.
After the airway is inserted, depress the
tongue with a tongue blade. Look for the
airway behind the soft tissue at the back
of the throat. Next, close the patient’s
mouth. Place your finger in front of the
airway to feel for air movement.
7.
Perform your procedure completion
actions.
__________________________________
Instructor Signature
__________________________________
Student Signature
Date
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Date
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Date
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PERFORMANCE REVIEW CHECKLIST
Procedure 90
Oropharyngeal Suctioning
Name of Patient Care Technician ________________________ Date of Program ______ to ______
Social Security Number or Identification Number _______________________________
Program Code Number (if any) _________________
S=Satisfactory Performance
U=Unsatisfactory Performance
Place a full signature to correspond with each set of initials appearing below.
Initials
Corresponding Signature of Instructor
Title
Supplies needed:
•
•
•
•
•
•
•
Suction regulator
Sterile gloves
Other personal protective equipment as needed or according to facility policy
Yankauer suction catheter, or sterile #12 or #14 French suction catheter for an adult
Sterile water or normal saline
Small sterile basin
Plastic bag for used supplies
Procedure Guidelines
1.
Perform your beginning procedure
actions.
2.
Open the sterile water. Pour some into
the sterile basin.
3.
Attach the connecting tubing to the
suction regulator, if this has not been
done. Turn the suction on. Place your
finger over the distal end of the
connecting tubing to check the suction
while the tube is blocked.
4.
Open the suction catheter. Attach the
connecting tubing to the proximal
suction catheter. Maintain sterility by
exposing only the connecting end of the
catheter. Keep the distal (patient) end
covered inside the wrapper.
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5.
Apply sterile gloves. Consider your
dominant hand sterile and your
nondominant hand unsterile. Use your
nondominant hand to pick up objects
and to open the catheter package so you
can remove it with your sterile hand.
You can use your nondominant hand to
open and close the thumb valve while
your dominant hand controls the
position of the catheter.
6.
Pick up the catheter with your sterile
hand. Connect it to the connecting
tubing.
7.
Gently insert the catheter 3 to 4 inches
along the side of the patient’s mouth, or
until you reach the pool of secretions,
without applying suction.
8.
Cover the thumb valve, or open the
catheter and suction the secretions, and
both sides of the mouth in a continuous
rotating motion.
9.
Suction for no longer than 10 seconds,
including the time it takes you to
withdraw the catheter.
10.
Allow the patient to breathe normally
before reinserting the catheter. If you will
be reinserting the catheter, wrap it
around your dominant hand, leaving the
distal end free, to avoid contamination.
11.
If secretions are thick, insert the tip of
the catheter into the sterile water,
suctioning water into the catheter and
connecting tubing to clear it.
12.
Repeat the suctioning until gurgling or
bubbling stops and the patient’s
respirations are silent.
13.
Perform your procedure completion
actions.
__________________________________
Instructor Signature
__________________________________
Student Signature
Date
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Date
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Date
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Date
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PERFORMANCE REVIEW CHECKLIST
Procedure 91
Nasopharyngeal Suctioning
Name of Patient Care Technician ________________________ Date of Program ______ to ______
Social Security Number or Identification Number _______________________________
Program Code Number (if any) _________________
S=Satisfactory Performance
U=Unsatisfactory Performance
Place a full signature to correspond with each set of initials appearing below.
Initials
Corresponding Signature of Instructor
Title
Supplies needed:
•
•
•
•
•
•
•
•
Suction regulator
Sterile gloves
Other personal protective equipment as needed or according to facility policy
Sterile #12 or #14 French suction catheter for an adult
Sterile water or normal saline
Small sterile basin
Water-soluble lubricant
Plastic bag for used supplies
Procedure Guidelines
1.
Perform your beginning procedure
actions.
2.
Open the sterile water and sterile basin.
Pour some water into the sterile basin.
3.
Attach the connecting tubing to the
suction regulator, if this has not been
done. Turn the suction on. Place your
finger over the distal end, then remove it
to check the suction.
4.
Open the suction catheter. Attach the
connecting tubing to the proximal
suction catheter. Maintain sterility by
exposing only the connecting end to the
catheter. Keep the distal (patient) end
covered inside the wrapper.
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5.
Apply sterile gloves. Consider your
dominant hand sterile and your
nondominant hand unsterile. Use your
nondominant hand to pick up objects
and to open the catheter package so you
can remove it with your sterile hand.
Use your nondominant hand to open
and close the thumb valve while your
dominant hand controls the position of
the catheter.
6.
With your nondominant hand, apply a
small amount of water-soluble lubricant
on the sterile area.
7.
Pick up the catheter with your sterile
hand. Lubricate the tip with the watersoluble lubricant.
8.
With your nondominant index finger,
push up on the tip of the patient’s nose.
If a nasopharyngeal airway is in place, omit
this step.
9.
Gently insert the catheter into the
nostril. If the patient has a
nasopharyngeal airway in place, insert
the catheter through the lumen of the
airway. Thread it carefully, 5 to 6 inches,
until you reach the pool of secretions, or
the patient begins to cough. Do not
force the catheter. Withdraw if you meet
resistance. Do not apply suction during
catheter insertion.
10.
Cover the thumb valve, or open the
catheter and suction the secretions, in a
continuous rotating motion.
11.
Suction for no longer than 10 seconds,
including the time it takes you to
withdraw the catheter.
12.
Allow the patient to breathe normally
before reinserting the catheter. If you
will be reinserting the catheter, wrap it
around your dominant hand, leaving
the distal end free, to avoid
contamination.
13.
If secretions are thick, insert the tip of
the catheter into the sterile water,
suctioning water into the catheter and
connecting tubing to clear it.
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14.
Repeat the suctioning until gurgling or
bubbling stops and the patient’s
respirations are silent.
15.
Perform your procedure completion
actions.
__________________________________
Instructor Signature
__________________________________
Student Signature
Date
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Date
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Date
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PERFORMANCE REVIEW CHECKLIST
Procedure 92
Assisting With Postural Drainage
Name of Patient Care Technician ________________________ Date of Program ______ to ______
Social Security Number or Identification Number _______________________________
Program Code Number (if any) _________________
S=Satisfactory Performance
U=Unsatisfactory Performance
Place a full signature to correspond with each set of initials appearing below.
Initials
Corresponding Signature of Instructor
Title
Supplies needed:
•
•
•
•
•
•
•
•
•
Disposable exam gloves
Emesis basin
Tissues
Mouthwash
Cup
Straw
Pillows
Props
Plastic bag for used supplies
Procedure Guidelines
1.
Perform your beginning procedure
actions.
2.
Position and support the patient as
directed, using foam wedges or pillows.
3.
Provide an emesis basin, tissues, and bag
in which to discard secretions.
4.
Remain in the room with the patient
during and after the procedure. Monitor
for signs and symptoms of respiratory
distress. Monitor vital signs as directed.
Provide comfort measures as necessary.
5.
Offer the patient mouthwash to rinse the
mouth.
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6.
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Perform your procedure completion
actions.
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Instructor Signature
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Student Signature
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