NCM____ (SKILLS)

PROCEDURE/ACTIVITY: __OXYGEN THERAPY__ _____________Date: ________________________Name of Student: ______________________________________________Year & Section: ________________

Criteria for Scoring Scoring

Performed the procedures correctly. 5 – Done all criteria Performed the procedures in systematic & organized manner. 4 – Done at least 4 States rationales/principles correctly. 3 – Done at least 3 States the definition, purposes & special considerations 2 – Done at least 2

of the activity/procedure. 1 – Done at least 1 Finished within specified time. 0 – Not done

5 4 3 2 1 Not Done

Assessment1. Determine current vital signs, level of consciousness.2. Assess breath sounds and signs and symptoms of respiratory distress.3. Check doctor’s order.Planning4. Wash hands.5. Assemble all equipment. Place a “NO SMOKING” sign on the patient’s door.Implementation6. Identify the client. Explain the procedure.7. Position the client in a semi-fowlers.8. Attach nasal cannula to oxygen source with the humidifier.9. Turn on oxygen flow rate until bubbling is noted.10. Regulate flow meter at prescribed liters per minute.11. Place oxygen cannula or mask on client. A. Nasal Cannula a. Clean nostrils of secretion with moist cotton balls. b. Place cannula prongs upward into client’s nose. c. Slip attached tubing and around client’s nose. d. Tighten tubing to secure cannula.B. Face Mask a. Place mask over nose, mouth and chin. Adjust strap at nose bridge. b. Pull elastic band around back of head.12. Stay with the client for a time, to observe response to treatment.13. Remove cannula each shift every 4 hours to assess skin. Remove mask every 2 to 4 hours. Wipe away accumulated mist and assess underlying skin.14. Discard used equipment appropriately.15. Wash hands.Evaluation16. Evaluate client’s immediate response to oxygen administration.17. Evaluate the client’s comfort with oxygen use.18. Assess client’s vital signs.

Documentation

19. Record date and time of oxygen administration and method of delivery. Record flow rate and route in administration used in oxygen.20. Record immediate response of oxygen therapy, subjective and objective observation of client.21. Record client’s comfort with oxygen use.

Remarks: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

________________ __________________________________Rating Name & Signature of Clinical Instructor

NCM____ (SKILLS)

PROCEDURE/ACTIVITY: _STEAM INHALATION__ __________Date: ________________________Name of Student: ______________________________________________Year & Section: ________________

Criteria for Scoring Scoring

Performed the procedures correctly. 5 – Done all criteria Performed the procedures in systematic & organized manner. 4 – Done at least 4 States rationales/principles correctly. 3 – Done at least 3 States the definition, purposes & special considerations 2 – Done at least 2

of the activity/procedure. 1 – Done at least 1 Finished within specified time. 0 – Not done

PROCEDURE 5 4 3 2 1 Not Done

Assessment1. Check the client’s respiratory status.Planning2. Wash hands.3. Assemble the equipment.Implementation 4. Identify the client.5. Explain the procedure.6. Position client in a semi-fowlers.7. Place your chosen remedy in a bowl or basin of steaming water.8. Add 2-3 drops of medicated aroma in a bowl of steaming water.9. Drape a towel over your head and bowl of water10. Cover the client’s eyes with washcloth.11. Keep the face at 20 cm away from the water. Cover chest with towel.12. Instruct client to inhale deeply for around 15 minutes.13. Instruct deep breathing and coughing exercise after the treatment.

14. Provide oral hygiene.15. Do after care of equipment.16. Wash handsEvaluation17. Evaluate respiratory condition (Character of respiration, breath sounds).18. Evaluate the client’s response after the procedure.19. Evaluate the client’s tolerance to the procedure.Documentation20. Record the client’s respiratory status before and after the procedure.21. Record the client’s tolerance.

Remarks: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

________________ __________________________________Rating Name & Signature of Clinical Instructor