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Daily Task Sheet

Daily Task Sheet

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Philippine Rehabilitation Institute Foundation Inc College Of Nursing RLE LEADERSHIP AND MANAGEMENT ( HEAD NURSING ) ACHIEVEMENT EVALUTION

REPORT (HEAD NURSE TO STAFF NURSE) Area: Children's Ward Inclusive Date: February 19, 2013 Clinical Instructor: Jerry Manlapaz RN, MAN Name of Students Grades Amoyo, Mario Jose 94.6 Alfonso, Carmina 90.8 Fernando, Haydielyn 94.6 Laxa, Raquel 96.9 Tanquintic, Michael 90 Vasquez, Khaycee 95.3 Visitacion, Von Darwin 92.3 Semester: 2nd Level: NCM 205 Sec/ Group: Remarks

Date: Submitted By: Signature Over Printed Name

Philippine Rehabilitation Institute Foundation, Inc. College Of Nursing Daily TASK SHEET Name: Gian Arlo H. Castro Section/Group: Patient’s Name: Balbuena, Ariane Room/Bed #: Diagnosis: Fx open IIIB comp. Disp. D3rd femur R Fx close inc D3rd fibula R S/P Spanning External Fixator Attending Physician: Dr. Cuevedo Vital Signs:q8 I & O: Diet: DAT Activity: Contraption: Spanning E.F. IVFs: Procedure/ Laboratory Work Up: X-ray Medication: Oxacillin 100mg IV ANST (-) q6 Paracetamol 250mg/5ml 5ml TID for pain Carbocistein drops 1.5mg q6 x 5 days Vit. C drops 1ml OD Area:Children's Ward Date: Feb. 20, 2013 >received px awake, alert & coherent sitting on wheelchair and wants to go outside asking her mom >px is bored and wants to do other things >took the V/S as follos BP: 80/40 T:35.1 P:82 R:32 >TSB given by mother and px shown signs of relief >I & O as follows Oral: 150ml Urine: 2 diapers Stool: 0 >took the patients incident history CASTRO,Gian Arlo H. SN =================================

Vital Signs: BP: 80/40 T: 35.1 P: 82 R: 32

I: Oral = 150ml Parenteral = n/a Output: Urine= 2 Drainage= n/a BM=0

Philippine Rehabilitation Institute Foundation, Inc. College Of Nursing Daily TASK SHEET Name: Gian Arlo H. Castro Section/Group: Patient’s Name: Balbuena, Ariane Room/Bed #: Cubicle I Diagnosis: Fx open IIIB comp. Disp. D3rd femur R Fx close inc D3rd fibula R S/P Spanning External Fixator Attending Physician: Dr. Cuevedo Vital Signs:q8 I & O: Diet: DAT Activity: Contraption: Spanning E.F. IVFs: Procedure/ Laboratory Work Up: X-ray Medication: Ceftazidime 250mg/IV q8 (-)ANST Paracetamol 250mg/5ml 6ml q6 PRN for pain Multivitamins + FeSO4 1 tsp OD Area:Children's Ward Date: Mar. 4, 2013 >received px awake, active and coherent lying on a different bed. >px has no IVF but has Spanning EF >on DAT >took the V/S as follos BP: 80/60 T:36.3 P:10 R:34 >arranged and groomed the bed >I & O as follows Oral: 80ml Urine: 1 diapers Stool: 0 >endorsed CASTRO,Gian Arlo H. SN =================================

Vital Signs: BP: 80/60 T: 36.3 P: 110 R: 34

I: Oral = 80ml Parenteral = n/a Output: Urine= 1 Drainage= n/a BM=0

Philippine Rehabilitation Institute Foundation, Inc. College Of Nursing Daily TASK SHEET Name: Gian Arlo H. Castro Section/Group: Patient’s Name: Cabanes. Phillip Joshua Room/Bed #: Diagnosis: Cl. Comp. Disp. Subtrochanderic Femur L Attending Physician: Dr. Cueveda Vital Signs:q4 I & O: Diet: DAT Activity: Contraption: Steinmann Pin Insertion 90-90 BST IVFs: Procedure/ Laboratory Work Up: X-ray, Ultrasound, Blood exam, Medication: Co-amoxiclav 4mg/5ml TID x 7 days Paracetamol 250mg/5ml 3ml q4 PRN for pain Area:Children's Ward Date: Mar. 5, 2013 >received pax awake, alert & coherent sitting on wheelchair and wants to go outside asking her mom >px is bored and wants to do other things >took the V/S as follos BP: 80/40 T:35.1 P:82 R:323 >TSB given by mother and px shown signs of relief >I & O as follows Oral: 150ml Urine: 2 diapers Stool: 0 >took the patients incident history CASTRO,Gian Arlo H. SN =================================

Vital Signs: BP: 90/60 T: 37.9 P: 92 R: 42

I: Oral = 100ml Parenteral = n/a Output: Urine= 1 Drainage= n/a BM=0

Philippine Rehabilitation Institute Foundation, Inc. College Of Nursing Daily TASK SHEET Name: Gian Arlo H. Castro Section/Group: Patient’s Name: Balbuena, Ariane Room/Bed #: Diagnosis: Fx open IIIB comp. Disp. D3rd femur R Fx close inc D3rd fibula R S/P Spanning External Fixator Attending Physician: Dr. Cuevedo Vital Signs: I & O: Diet: DAT Activity: Contraption: Spanning E.F. IVFs: Procedure/ Laboratory Work Up: X-ray Medication: Oxacillin 100mg IV ANST (-) q6 Multivitamins + FeSO4 1 tsp OD Vital Signs: BP: 80/60 T: 36.3 P: 110 R: 34 I: Oral = 2000ml Parenteral = n/a Output: Urine= 1 Drainage= n/a BM=0 Area:Children's Ward Date: Mar. 14, 2013 >received pax awake, alert & coherent lying on a different bed playing with her >px is playful and is stll on Spanning E.F. On >took the V/S as follos BP: 80/60 T:36.3 P:110 R:34 >TSB given by mother and px shown signs of relief >I & O as follows Oral: 200ml Urine: 1 diapers Stool: 0 >played with the px to lessen the uneasiness of the patient CASTRO,Gian Arlo H. SN =================================

19. b. 6. 5. observation. College of Nursing # 56 Banawe Street.PHILIPPINE REHABILITATION INSTITUTE FOUNDATION. INC. 1. 2013 Clinical Area: Children's Ward Direction: Rate the students on the following competencies using a 5-point scale as follows: Rating Quantitative Description 5 Outstanding Able to function independently and correctly observes principles 4 Very satisfactory Able to function with less supervision from the instructor ad observes principles theories of nursing most of the time 3 Satisfactory Able to function but requires close supervision from the instructor and observes principles at theories of nursing sometimes 2 Needs Improvement Able to function but requires close supervision from the instructor and occasionally applies principles and theories of nursing 1 Unsatisfactory Unable to function and has not applied nor observed underlying principles at theories of nursing I. d. 7. c. Quezon City RLE LEADERSHIP AND MANAGEMENT (HEAD NURSING) CLINICAL PERFORMANCE EVALUATION TOOL (Student Head Nurse to Student Staff Nurse) Name: Mario Jose Amoyo Year/ Section: Group: 3 Date of Exposure: Feb. a. Performance Assessment/ Planning Establishes rapport with patients Able to involve patients in plan of care Punctual and prompt in all activities Able to maintain stability under pressure Gathers data using interview. 3. 4. 2. records review and reports Formulates appropriate nursing care plan Wears complete prescribed RLE uniform Assessment/ Planning Carriers out assigned tasks based on the criteria of distribution of assignments Follows principles of time management Equipped with the required paraphernalia for RLE Observes proper channels of communication Rating 5 5 4 5 4 5 4 5 5 4 5 . II.

Conducts appropriate health teachings III. Demonstrates honesty at all times b. MAN Clinical Instructor . Observes the 11 Core Competency Guidelines REMARKS: 5 4 5 4 5 5 5 4 5 5 5 5 5 5 5 EVALUATED BY: CONFORME: NOTED: Actual Score x 100 Total Score Gian Arlo H. Evaluates nursing care rendered IV. Provides psychological and spiritual support to patients i. Accepts supervision and criticisms j. Accomplishes delegated tasks within prescribed time frame h. IVF ) f. Shows initiative in performing tasks g.e. Makes revision in the plan of care as necessary c. Carriers out plan of care. Castro Student Head Nurse Gian Arlo H.Evaluation a. Ethico Considerations a. Keeps confidential information d. Conducts self in a tactful manner c. Nebulization. including: Bedside care Administration of Medications Administration of treatment ( CPT. Notifies immediate supervisor about untoward situations or conditions related to patient care in the area b. Castro Student Staff Nurse Jerry Manlapaz RN. Guided by RA 9173 f. Observes the PNA Code of Ethics e.

College of Nursing # 56 Banawe Street. 7. 2. a. 5. 19. II. 6.PHILIPPINE REHABILITATION INSTITUTE FOUNDATION. c. observation. b. 3. 2013 Clinical Area: Children's Ward Direction: Rate the students on the following competencies using a 5-point scale as follows: Rating Quantitative Description 5 Outstanding Able to function independently and correctly observes principles 4 Very satisfactory Able to function with less supervision from the instructor ad observes principles theories of nursing most of the time 3 Satisfactory Able to function but requires close supervision from the instructor and observes principles at theories of nursing sometimes 2 Needs Improvement Able to function but requires close supervision from the instructor and occasionally applies principles and theories of nursing 1 Unsatisfactory Unable to function and has not applied nor observed underlying principles at theories of nursing I. Performance Assessment/ Planning Establishes rapport with patients Able to involve patients in plan of care Punctual and prompt in all activities Able to maintain stability under pressure Gathers data using interview. records review and reports Formulates appropriate nursing care plan Wears complete prescribed RLE uniform Assessment/ Planning Carriers out assigned tasks based on the criteria of distribution of assignments Follows principles of time management Equipped with the required paraphernalia for RLE Observes proper channels of communication Rating 4 4 5 4 4 5 4 5 5 4 4 . INC. Quezon City RLE LEADERSHIP AND MANAGEMENT (HEAD NURSING) CLINICAL PERFORMANCE EVALUATION TOOL (Student Head Nurse to Student Staff Nurse) Name: Michael Tanquintic Year/ Section: Group: 3 Date of Exposure: Feb. 4. d. 1.

Ethico Considerations a. Notifies immediate supervisor about untoward situations or conditions related to patient care in the area b. Makes revision in the plan of care as necessary c. Observes the PNA Code of Ethics e. Conducts self in a tactful manner c. Keeps confidential information d. Accomplishes delegated tasks within prescribed time frame h. Nebulization. Provides psychological and spiritual support to patients i.e. Guided by RA 9173 f. Shows initiative in performing tasks g. Castro Student Head Nurse Gian Arlo H. Observes the 11 Core Competency Guidelines REMARKS: 4 4 5 5 4 5 4 4 5 5 5 5 5 5 5 EVALUATED BY: CONFORME: NOTED: Actual Score x 100 Total Score Gian Arlo H. Demonstrates honesty at all times b. Castro Student Staff Nurse Jerry Manlapaz RN. IVF ) f. Carriers out plan of care. Evaluates nursing care rendered IV. including: Bedside care Administration of Medications Administration of treatment ( CPT. MAN Clinical Instructor . Accepts supervision and criticisms j.Evaluation a. Conducts appropriate health teachings III.

a. II. 6. 5. 1. b. 2013 Clinical Area: Children's Ward Direction: Rate the students on the following competencies using a 5-point scale as follows: Rating Quantitative Description 5 Outstanding Able to function independently and correctly observes principles 4 Very satisfactory Able to function with less supervision from the instructor ad observes principles theories of nursing most of the time 3 Satisfactory Able to function but requires close supervision from the instructor and observes principles at theories of nursing sometimes 2 Needs Improvement Able to function but requires close supervision from the instructor and occasionally applies principles and theories of nursing 1 Unsatisfactory Unable to function and has not applied nor observed underlying principles at theories of nursing I. observation. INC. 4. College of Nursing # 56 Banawe Street. c. 19. Performance Assessment/ Planning Establishes rapport with patients Able to involve patients in plan of care Punctual and prompt in all activities Able to maintain stability under pressure Gathers data using interview. records review and reports Formulates appropriate nursing care plan Wears complete prescribed RLE uniform Assessment/ Planning Carriers out assigned tasks based on the criteria of distribution of assignments Follows principles of time management Equipped with the required paraphernalia for RLE Observes proper channels of communication Rating 5 5 4 5 4 4 5 5 5 5 4 .PHILIPPINE REHABILITATION INSTITUTE FOUNDATION. Quezon City RLE LEADERSHIP AND MANAGEMENT (HEAD NURSING) CLINICAL PERFORMANCE EVALUATION TOOL (Student Head Nurse to Student Staff Nurse) Name: Carmina Alfonso Year/ Section: Group: 3 Date of Exposure: Feb. 2. 7. d. 3.

Conducts self in a tactful manner c. Provides psychological and spiritual support to patients i. Nebulization. Makes revision in the plan of care as necessary c. Shows initiative in performing tasks g. Keeps confidential information d. Castro Student Head Nurse Gian Arlo H. Guided by RA 9173 f.Evaluation a. Carriers out plan of care. Ethico Considerations a. IVF ) f. Observes the 11 Core Competency Guidelines REMARKS: 5 5 5 4 5 5 4 5 4 4 5 5 3 4 4 EVALUATED BY: CONFORME: NOTED: Actual Score x 100 Total Score Gian Arlo H. Evaluates nursing care rendered IV. Notifies immediate supervisor about untoward situations or conditions related to patient care in the area b. Castro Student Staff Nurse Jerry Manlapaz RN. Demonstrates honesty at all times b. including: Bedside care Administration of Medications Administration of treatment ( CPT. Conducts appropriate health teachings III. MAN Clinical Instructor .e. Accomplishes delegated tasks within prescribed time frame h. Accepts supervision and criticisms j. Observes the PNA Code of Ethics e.

5. II. 6. records review and reports Formulates appropriate nursing care plan Wears complete prescribed RLE uniform Assessment/ Planning Carriers out assigned tasks based on the criteria of distribution of assignments Follows principles of time management Equipped with the required paraphernalia for RLE Observes proper channels of communication Rating 4 4 4 4 5 5 5 5 5 4 5 . INC. Quezon City RLE LEADERSHIP AND MANAGEMENT (HEAD NURSING) CLINICAL PERFORMANCE EVALUATION TOOL (Student Head Nurse to Student Staff Nurse) Name:Von Darwin Visitacion Year/ Section: Group: 3 Date of Exposure: Feb. 2. 19. observation. b. 7. 1.PHILIPPINE REHABILITATION INSTITUTE FOUNDATION. 3. Performance Assessment/ Planning Establishes rapport with patients Able to involve patients in plan of care Punctual and prompt in all activities Able to maintain stability under pressure Gathers data using interview. d. College of Nursing # 56 Banawe Street. 2013 Clinical Area: Children's Ward Direction: Rate the students on the following competencies using a 5-point scale as follows: Rating Quantitative Description 5 Outstanding Able to function independently and correctly observes principles 4 Very satisfactory Able to function with less supervision from the instructor ad observes principles theories of nursing most of the time 3 Satisfactory Able to function but requires close supervision from the instructor and observes principles at theories of nursing sometimes 2 Needs Improvement Able to function but requires close supervision from the instructor and occasionally applies principles and theories of nursing 1 Unsatisfactory Unable to function and has not applied nor observed underlying principles at theories of nursing I. 4. a. c.

Conducts self in a tactful manner c. Accomplishes delegated tasks within prescribed time frame h. Castro Student Head Nurse Gian Arlo H. including: Bedside care Administration of Medications Administration of treatment ( CPT. MAN Clinical Instructor . Carriers out plan of care. Castro Student Staff Nurse Jerry Manlapaz RN. Conducts appropriate health teachings III. Keeps confidential information d. IVF ) f. Evaluates nursing care rendered IV. Accepts supervision and criticisms j. Demonstrates honesty at all times b. Ethico Considerations a. Nebulization.Evaluation a.e. Guided by RA 9173 f. Notifies immediate supervisor about untoward situations or conditions related to patient care in the area b. Provides psychological and spiritual support to patients i. Shows initiative in performing tasks g. Makes revision in the plan of care as necessary c. Observes the PNA Code of Ethics e. Observes the 11 Core Competency Guidelines REMARKS: 5 4 4 5 5 5 5 4 4 4 5 5 5 5 5 EVALUATED BY: CONFORME: NOTED: Actual Score x 100 Total Score Gian Arlo H.

3. 19. Quezon City RLE LEADERSHIP AND MANAGEMENT (HEAD NURSING) CLINICAL PERFORMANCE EVALUATION TOOL (Student Head Nurse to Student Staff Nurse) Name: Khaycee Vasquez Year/ Section: Group: 3 Date of Exposure: Feb. Performance Assessment/ Planning Establishes rapport with patients Able to involve patients in plan of care Punctual and prompt in all activities Able to maintain stability under pressure Gathers data using interview. 2013 Clinical Area: Children's Ward Direction: Rate the students on the following competencies using a 5-point scale as follows: Rating Quantitative Description 5 Outstanding Able to function independently and correctly observes principles 4 Very satisfactory Able to function with less supervision from the instructor ad observes principles theories of nursing most of the time 3 Satisfactory Able to function but requires close supervision from the instructor and observes principles at theories of nursing sometimes 2 Needs Improvement Able to function but requires close supervision from the instructor and occasionally applies principles and theories of nursing 1 Unsatisfactory Unable to function and has not applied nor observed underlying principles at theories of nursing I. 1. II. 5. College of Nursing # 56 Banawe Street. b. c. 7. 6. a. 4. 2. observation.PHILIPPINE REHABILITATION INSTITUTE FOUNDATION. INC. d. records review and reports Formulates appropriate nursing care plan Wears complete prescribed RLE uniform Assessment/ Planning Carriers out assigned tasks based on the criteria of distribution of assignments Follows principles of time management Equipped with the required paraphernalia for RLE Observes proper channels of communication Rating 5 5 5 5 5 5 5 5 5 5 5 .

Shows initiative in performing tasks g. Castro Student Staff Nurse Jerry Manlapaz RN. Castro Student Head Nurse Gian Arlo H. Provides psychological and spiritual support to patients i. Makes revision in the plan of care as necessary c. Evaluates nursing care rendered IV. Observes the 11 Core Competency Guidelines REMARKS: 4 4 4 5 5 5 5 4 5 5 4 4 5 5 5 EVALUATED BY: CONFORME: NOTED: Actual Score x 100 Total Score Gian Arlo H. including: Bedside care Administration of Medications Administration of treatment ( CPT. Carriers out plan of care. Ethico Considerations a. MAN Clinical Instructor . Demonstrates honesty at all times b. Accomplishes delegated tasks within prescribed time frame h. Conducts appropriate health teachings III. Nebulization. Notifies immediate supervisor about untoward situations or conditions related to patient care in the area b.Evaluation a. Guided by RA 9173 f. Accepts supervision and criticisms j. Conducts self in a tactful manner c. Keeps confidential information d.e. Observes the PNA Code of Ethics e. IVF ) f.

College of Nursing # 56 Banawe Street. a. records review and reports Formulates appropriate nursing care plan Wears complete prescribed RLE uniform Assessment/ Planning Carriers out assigned tasks based on the criteria of distribution of assignments Follows principles of time management Equipped with the required paraphernalia for RLE Observes proper channels of communication Rating 5 5 5 5 5 5 4 5 5 5 5 . 2. 7. 6.PHILIPPINE REHABILITATION INSTITUTE FOUNDATION. Performance Assessment/ Planning Establishes rapport with patients Able to involve patients in plan of care Punctual and prompt in all activities Able to maintain stability under pressure Gathers data using interview. b. 19. 4. d. 1. Quezon City RLE LEADERSHIP AND MANAGEMENT (HEAD NURSING) CLINICAL PERFORMANCE EVALUATION TOOL (Student Head Nurse to Student Staff Nurse) Name:Raquel Laxa Year/ Section: Group: 3 Date of Exposure: Feb. c. 3. II. observation. 5. INC. 2013 Clinical Area: Children's Ward Direction: Rate the students on the following competencies using a 5-point scale as follows: Rating Quantitative Description 5 Outstanding Able to function independently and correctly observes principles 4 Very satisfactory Able to function with less supervision from the instructor ad observes principles theories of nursing most of the time 3 Satisfactory Able to function but requires close supervision from the instructor and observes principles at theories of nursing sometimes 2 Needs Improvement Able to function but requires close supervision from the instructor and occasionally applies principles and theories of nursing 1 Unsatisfactory Unable to function and has not applied nor observed underlying principles at theories of nursing I.

Accomplishes delegated tasks within prescribed time frame h. Castro Student Staff Nurse Jerry Manlapaz RN. Nebulization. Makes revision in the plan of care as necessary c.Evaluation a. including: Bedside care Administration of Medications Administration of treatment ( CPT. Shows initiative in performing tasks g. Conducts self in a tactful manner c. Carriers out plan of care. Evaluates nursing care rendered IV. Observes the 11 Core Competency Guidelines REMARKS: 4 5 5 5 5 4 4 5 5 5 5 5 5 5 5 EVALUATED BY: CONFORME: NOTED: Actual Score x 100 Total Score Gian Arlo H. Conducts appropriate health teachings III. Guided by RA 9173 f. Castro Student Head Nurse Gian Arlo H. Keeps confidential information d.e. Ethico Considerations a. Notifies immediate supervisor about untoward situations or conditions related to patient care in the area b. Provides psychological and spiritual support to patients i. Accepts supervision and criticisms j. MAN Clinical Instructor . Demonstrates honesty at all times b. IVF ) f. Observes the PNA Code of Ethics e.

observation. INC. 7. 5. 2013 Clinical Area: Children's Ward Direction: Rate the students on the following competencies using a 5-point scale as follows: Rating Quantitative Description 5 Outstanding Able to function independently and correctly observes principles 4 Very satisfactory Able to function with less supervision from the instructor ad observes principles theories of nursing most of the time 3 Satisfactory Able to function but requires close supervision from the instructor and observes principles at theories of nursing sometimes 2 Needs Improvement Able to function but requires close supervision from the instructor and occasionally applies principles and theories of nursing 1 Unsatisfactory Unable to function and has not applied nor observed underlying principles at theories of nursing I. II. College of Nursing # 56 Banawe Street. d. records review and reports Formulates appropriate nursing care plan Wears complete prescribed RLE uniform Assessment/ Planning Carriers out assigned tasks based on the criteria of distribution of assignments Follows principles of time management Equipped with the required paraphernalia for RLE Observes proper channels of communication Rating 5 5 5 5 5 4 4 4 4 5 5 . 2. c. Performance Assessment/ Planning Establishes rapport with patients Able to involve patients in plan of care Punctual and prompt in all activities Able to maintain stability under pressure Gathers data using interview. 3. a. 6. 19. 1.PHILIPPINE REHABILITATION INSTITUTE FOUNDATION. 4. Quezon City RLE LEADERSHIP AND MANAGEMENT (HEAD NURSING) CLINICAL PERFORMANCE EVALUATION TOOL (Student Head Nurse to Student Staff Nurse) Name:Von Darwin Visitacion Year/ Section: Group: 3 Date of Exposure: Feb. b.

Conducts self in a tactful manner c. Shows initiative in performing tasks g. IVF ) f. Observes the PNA Code of Ethics e. Keeps confidential information d. Castro Student Staff Nurse Jerry Manlapaz RN.e. Castro Student Head Nurse Gian Arlo H. MAN Clinical Instructor . Conducts appropriate health teachings III. Carriers out plan of care. Observes the 11 Core Competency Guidelines REMARKS: 4 5 5 5 5 4 5 5 5 5 4 5 5 5 5 EVALUATED BY: CONFORME: NOTED: Actual Score x 100 Total Score Gian Arlo H. Notifies immediate supervisor about untoward situations or conditions related to patient care in the area b.Evaluation a. Provides psychological and spiritual support to patients i. Accepts supervision and criticisms j. Demonstrates honesty at all times b. Makes revision in the plan of care as necessary c. Guided by RA 9173 f. Accomplishes delegated tasks within prescribed time frame h. Evaluates nursing care rendered IV. including: Bedside care Administration of Medications Administration of treatment ( CPT. Ethico Considerations a. Nebulization.

Gains trust and confidence of subordinates 3. Able to mediate between subordinates and patients 4. Able to maintain stability under pressure II. reports) 3. 2013 Clinical Area: Children's Ward Description Able to function independently and correctly Observes principles Able to function with less supervision from the instructor and observes principles theories of nursing most of the time Able to function but requires close supervision from the instructor and observes principles at theories of nursing sometimes Able to function but requires close supervision from the instructor and occasionally applies principles and theories of nursing Unable to function and has not applied nor observed underlying principles at theories of nursing Quantitative Outstanding Very Satisfactory Satisfactory Needs Improvement Unsatisfactory Performance I. College of Nursing #56 Banawe Street.PHILIPPINE REHABILITATION INSTITUTE FOUNDATION. ASSESSMENT/ PLANNING 1. Utilizes appropriate resources for ward assessment 2. records review. Utilizes different techniques in gathering data ( interview. 19. Quezon City RLE LEADERSHIP AND MANAGEMENT (HEAD NURSING) CLINICAL PERFORMANCE EVALUATION TOOL (Student Staff Nurse to Student Head Nurse) Name: Gian Arlo Castro Year/ Section: Rating 5 4 3 2 1 Group: Date of Exposure: Feb. Establishes rapport with subordinates 2. Gathers data on: Rating 5 5 5 5 5 5 5 . observation.ESTABLISHMENT OF WORKING RELATIONSHIP 1. INC.

Come up with resolutions to address constraints h. Coordinates and collaborates with other members of the health team and other administrative units in the attainment of objectives j. Analyze data gathered based on scientific concepts and principles 5. Distribute patient assignment evenly d. address questions pertaining to accomplishment of task b. Delegates tasks to student staff nurse e. materials. Generates suggestions and recommendations for the resolution of identifies problems c. LEADERSHIP a. PROBLEM SOLVING PROCESS a. Analyze the existence of the problem d. Prepares and brief subordinates on the daily plan activities f. records. Identifies specific and appropriate strategies to attain objectives e. helps subordinates. and conferences 5 5 5 5 5 5 5 5 5 4 4 4 4 4 5 5 5 5 5 . Evaluates if the objective are met g. other members of the health team and administrative units in identifying problems in the unit b. Supervise his/her staff during procedures and other assigned tasks i. Develops alternative course of action f.Nursing service history Physical set up Organization chart Ongoing appraisal evaluation Ward rules and regulation at SOP”S Channel of communication Records and Reports 4. money/ budget) III. Evaluates performance of staff and the unit as a whole through the use of reports. Conduct a pre conference with his/her staff to discuss the objectives and activities for the day. formulate strategies in accomplishing assigned tasks. Identifies and priorities problems based on data gathered according to the urgency of the availability of resources ( man power. Involves the staff. interviews. Sets criteria for evaluation using the different parameters of evaluation V. Implements plan of action g. Briefs students staff nurses on data gathered 6. observations. Prepares and brief subordinates on the learning objectives for the day c.

Conducts post conference at the end of the shift. keeps the clinical instructor informed and updated n.k. Requires incident reports as necessary. resolves issues and concerns and conducts debriefing as necessary m. Utilizes the existing chain of command in implementing activities REMARKS: 5 5 5 5 EVALUATED BY: CONFORME: Von Darwin Visitacion Student staff Nurse Student Staff Nurse NOTED: Jerry Manlapaz RN MAN Clinical Instructor Actual Score x 100 Total Score . Troubleshoot as necessity arise l.

Utilizes different techniques in gathering data ( interview. records review. 19. 2013 Clinical Area: Children's Ward Description Able to function independently and correctly Observes principles Able to function with less supervision from the instructor and observes principles theories of nursing most of the time Able to function but requires close supervision from the instructor and observes principles at theories of nursing sometimes Able to function but requires close supervision from the instructor and occasionally applies principles and theories of nursing Unable to function and has not applied nor observed underlying principles at theories of nursing Quantitative Outstanding Very Satisfactory Satisfactory Needs Improvement Unsatisfactory Performance I. Quezon City RLE LEADERSHIP AND MANAGEMENT (HEAD NURSING) CLINICAL PERFORMANCE EVALUATION TOOL (Student Staff Nurse to Student Head Nurse) Name: Gian Arlo Castro Year/ Section: Rating 5 4 3 2 1 Group: Date of Exposure: Feb. INC. Able to maintain stability under pressure II. Establishes rapport with subordinates 2. ASSESSMENT/ PLANNING 1. Utilizes appropriate resources for ward assessment 2. Gathers data on: Rating 5 5 5 5 4 4 4 . Gains trust and confidence of subordinates 3. College of Nursing #56 Banawe Street. observation. reports) 3. Able to mediate between subordinates and patients 4.PHILIPPINE REHABILITATION INSTITUTE FOUNDATION.ESTABLISHMENT OF WORKING RELATIONSHIP 1.

interviews. other members of the health team and administrative units in identifying problems in the unit b. Analyze the existence of the problem d. Involves the staff. Prepares and brief subordinates on the learning objectives for the day c. Distribute patient assignment evenly d. Sets criteria for evaluation using the different parameters of evaluation VI. formulate strategies in accomplishing assigned tasks. helps subordinates. Develops alternative course of action f. materials. LEADERSHIP a. Analyze data gathered based on scientific concepts and principles 5. Generates suggestions and recommendations for the resolution of identifies problems c. Briefs students staff nurses on data gathered 6. Supervise his/her staff during procedures and other assigned tasks i.Nursing service history Physical set up Organization chart Ongoing appraisal evaluation Ward rules and regulation at SOP”S Channel of communication Records and Reports 4. records. money/ budget) III. Identifies and priorities problems based on data gathered according to the urgency of the availability of resources ( man power. Delegates tasks to student staff nurse e. Conduct a pre conference with his/her staff to discuss the objectives and activities for the day. observations. and conferences 4 4 4 4 4 4 4 4 5 5 5 5 5 5 5 5 5 5 4 4 . Prepares and brief subordinates on the daily plan activities f. Evaluates performance of staff and the unit as a whole through the use of reports. Identifies specific and appropriate strategies to attain objectives e. Come up with resolutions to address constraints h. Evaluates if the objective are met g. Implements plan of action g. PROBLEM SOLVING PROCESS a. address questions pertaining to accomplishment of task b. Coordinates and collaborates with other members of the health team and other administrative units in the attainment of objectives j.

k. Requires incident reports as necessary. resolves issues and concerns and conducts debriefing as necessary m. Conducts post conference at the end of the shift. keeps the clinical instructor informed and updated n. Troubleshoot as necessity arise l. Utilizes the existing chain of command in implementing activities REMARKS: 4 5 5 5 EVALUATED BY: CONFORME: Haydielyn Fernando Student staff Nurse Student Staff Nurse NOTED: Jerry Manlapaz RN MAN Clinical Instructor Actual Score x 10 Total Score .

Quezon City RLE LEADERSHIP AND MANAGEMENT (HEAD NURSING) CLINICAL PERFORMANCE EVALUATION TOOL (Student Staff Nurse to Student Head Nurse) Name: Gian Arlo Castro Year/ Section: Rating 5 4 3 2 1 Group: Date of Exposure: Feb. 19. records review.ESTABLISHMENT OF WORKING RELATIONSHIP 1. Gains trust and confidence of subordinates 3. reports) 3. Utilizes different techniques in gathering data ( interview. College of Nursing #56 Banawe Street. Gathers data on: Rating 5 5 5 5 4 4 4 . INC.PHILIPPINE REHABILITATION INSTITUTE FOUNDATION. observation. Able to mediate between subordinates and patients 4. Utilizes appropriate resources for ward assessment 2. 2013 Clinical Area: Children's Ward Description Able to function independently and correctly Observes principles Able to function with less supervision from the instructor and observes principles theories of nursing most of the time Able to function but requires close supervision from the instructor and observes principles at theories of nursing sometimes Able to function but requires close supervision from the instructor and occasionally applies principles and theories of nursing Unable to function and has not applied nor observed underlying principles at theories of nursing Quantitative Outstanding Very Satisfactory Satisfactory Needs Improvement Unsatisfactory Performance I. ASSESSMENT/ PLANNING 1. Establishes rapport with subordinates 2. Able to maintain stability under pressure II.

money/ budget) III. Prepares and brief subordinates on the daily plan activities f. Evaluates if the objective are met g. Analyze data gathered based on scientific concepts and principles 5. and conferences 4 4 4 5 4 4 5 4 5 5 5 5 5 5 5 5 5 4 4 4 . address questions pertaining to accomplishment of task b. Delegates tasks to student staff nurse e. PROBLEM SOLVING PROCESS a. Implements plan of action g. Sets criteria for evaluation using the different parameters of evaluation VII. formulate strategies in accomplishing assigned tasks. helps subordinates. Identifies specific and appropriate strategies to attain objectives e. Develops alternative course of action f. Identifies and priorities problems based on data gathered according to the urgency of the availability of resources ( man power. interviews. Come up with resolutions to address constraints h. Prepares and brief subordinates on the learning objectives for the day c. Involves the staff. Supervise his/her staff during procedures and other assigned tasks i. materials. Coordinates and collaborates with other members of the health team and other administrative units in the attainment of objectives j. Distribute patient assignment evenly d. records. Generates suggestions and recommendations for the resolution of identifies problems c. Evaluates performance of staff and the unit as a whole through the use of reports. Analyze the existence of the problem d. Conduct a pre conference with his/her staff to discuss the objectives and activities for the day. LEADERSHIP a. other members of the health team and administrative units in identifying problems in the unit b. Briefs students staff nurses on data gathered 6. observations.Nursing service history Physical set up Organization chart Ongoing appraisal evaluation Ward rules and regulation at SOP”S Channel of communication Records and Reports 4.

k. Utilizes the existing chain of command in implementing activities REMARKS: 4 5 4 5 EVALUATED BY: CONFORME: Raquel Laxa Student staff Nurse Student Staff Nurse NOTED: Jerry Manlapaz RN MAN Clinical Instructor Actual Score x 100 Total Score . Requires incident reports as necessary. resolves issues and concerns and conducts debriefing as necessary m. Troubleshoot as necessity arise l. Conducts post conference at the end of the shift. keeps the clinical instructor informed and updated n.

19. ASSESSMENT/ PLANNING 1. Gathers data on: Rating 5 5 5 4 5 4 4 . Quezon City RLE LEADERSHIP AND MANAGEMENT (HEAD NURSING) CLINICAL PERFORMANCE EVALUATION TOOL (Student Staff Nurse to Student Head Nurse) Name: Gian Arlo Castro Year/ Section: Rating 5 4 3 2 1 Group: Date of Exposure: Feb. Utilizes appropriate resources for ward assessment 2. observation.PHILIPPINE REHABILITATION INSTITUTE FOUNDATION. records review. College of Nursing #56 Banawe Street. Able to mediate between subordinates and patients 4. 2013 Clinical Area: Children's Ward Description Able to function independently and correctly Observes principles Able to function with less supervision from the instructor and observes principles theories of nursing most of the time Able to function but requires close supervision from the instructor and observes principles at theories of nursing sometimes Able to function but requires close supervision from the instructor and occasionally applies principles and theories of nursing Unable to function and has not applied nor observed underlying principles at theories of nursing Quantitative Outstanding Very Satisfactory Satisfactory Needs Improvement Unsatisfactory Performance I. Establishes rapport with subordinates 2. reports) 3. Utilizes different techniques in gathering data ( interview. Able to maintain stability under pressure II. Gains trust and confidence of subordinates 3. INC.ESTABLISHMENT OF WORKING RELATIONSHIP 1.

Prepares and brief subordinates on the learning objectives for the day c.Nursing service history Physical set up Organization chart Ongoing appraisal evaluation Ward rules and regulation at SOP”S Channel of communication Records and Reports 4. interviews. Delegates tasks to student staff nurse e. Sets criteria for evaluation using the different parameters of evaluation VIII. money/ budget) III. formulate strategies in accomplishing assigned tasks. Prepares and brief subordinates on the daily plan activities f. Analyze data gathered based on scientific concepts and principles 5. Come up with resolutions to address constraints h. PROBLEM SOLVING PROCESS a. materials. Generates suggestions and recommendations for the resolution of identifies problems c. Involves the staff. Conduct a pre conference with his/her staff to discuss the objectives and activities for the day. Briefs students staff nurses on data gathered 6. other members of the health team and administrative units in identifying problems in the unit b. Evaluates performance of staff and the unit as a whole through the use of reports. Supervise his/her staff during procedures and other assigned tasks i. address questions pertaining to accomplishment of task b. helps subordinates. Distribute patient assignment evenly d. Evaluates if the objective are met g. Develops alternative course of action f. Identifies specific and appropriate strategies to attain objectives e. Analyze the existence of the problem d. records. Coordinates and collaborates with other members of the health team and other administrative units in the attainment of objectives j. Implements plan of action g. and conferences 5 4 4 4 5 5 5 5 4 4 5 5 5 4 4 4 4 4 5 5 . observations. LEADERSHIP a. Identifies and priorities problems based on data gathered according to the urgency of the availability of resources ( man power.

k. keeps the clinical instructor informed and updated n. Requires incident reports as necessary. resolves issues and concerns and conducts debriefing as necessary m. Conducts post conference at the end of the shift. Troubleshoot as necessity arise l. Utilizes the existing chain of command in implementing activities REMARKS: 5 5 5 5 EVALUATED BY: CONFORME: Mario Jose Amoyo Student staff Nurse Student Staff Nurse NOTED: Jerry Manlapaz RN MAN Clinical Instructor Actual Score x 100 Total Score .

Gains trust and confidence of subordinates 3. 19. Quezon City RLE LEADERSHIP AND MANAGEMENT (HEAD NURSING) CLINICAL PERFORMANCE EVALUATION TOOL (Student Staff Nurse to Student Head Nurse) Name: Gian Arlo Castro Year/ Section: Rating 5 4 3 2 1 Group: Date of Exposure: Feb. Utilizes different techniques in gathering data ( interview. reports) Rating 5 5 5 5 5 4 . Establishes rapport with subordinates 2. INC. Able to mediate between subordinates and patients 4. 2013 Clinical Area: Children's Ward Description Able to function independently and correctly Observes principles Able to function with less supervision from the instructor and observes principles theories of nursing most of the time Able to function but requires close supervision from the instructor and observes principles at theories of nursing sometimes Able to function but requires close supervision from the instructor and occasionally applies principles and theories of nursing Unable to function and has not applied nor observed underlying principles at theories of nursing Quantitative Outstanding Very Satisfactory Satisfactory Needs Improvement Unsatisfactory Performance I.PHILIPPINE REHABILITATION INSTITUTE FOUNDATION. records review.ESTABLISHMENT OF WORKING RELATIONSHIP 1. Utilizes appropriate resources for ward assessment 2. ASSESSMENT/ PLANNING 1. College of Nursing #56 Banawe Street. Able to maintain stability under pressure II. observation.

Identifies and priorities problems based on data gathered according to the urgency of the availability of resources ( man power. Involves the staff. Identifies specific and appropriate strategies to attain objectives e. Briefs students staff nurses on data gathered 6. Come up with resolutions to address constraints h. Develops alternative course of action f. Analyze the existence of the problem d. Prepares and brief subordinates on the learning objectives for the day c. address questions pertaining to accomplishment of task b. other members of the health team and administrative units in identifying problems in the unit b. Evaluates if the objective are met g. Evaluates performance of staff and the unit as a whole through the use of reports. Analyze data gathered based on scientific concepts and principles 5. Gathers data on: Nursing service history Physical set up Organization chart Ongoing appraisal evaluation Ward rules and regulation at SOP”S Channel of communication Records and Reports 4. Sets criteria for evaluation using the different parameters of evaluation IX.3. materials. money/ budget) III. Conduct a pre conference with his/her staff to discuss the objectives and activities for the day. interviews. observations. Delegates tasks to student staff nurse e. helps subordinates. PROBLEM SOLVING PROCESS a. 4 5 5 4 5 5 5 5 5 4 4 5 5 5 4 5 3 5 5 5 5 . Coordinates and collaborates with other members of the health team and other administrative units in the attainment of objectives j. Distribute patient assignment evenly d. LEADERSHIP a. formulate strategies in accomplishing assigned tasks. Implements plan of action g. Generates suggestions and recommendations for the resolution of identifies problems c. Prepares and brief subordinates on the daily plan activities f. records. Supervise his/her staff during procedures and other assigned tasks i.

k. and conferences Troubleshoot as necessity arise Conducts post conference at the end of the shift. resolves issues and concerns and conducts debriefing as necessary Requires incident reports as necessary. n. l. keeps the clinical instructor informed and updated Utilizes the existing chain of command in implementing activities 5 5 5 5 REMARKS: EVALUATED BY: CONFORME: Carmina Alfonso Student staff Nurse Student Staff Nurse NOTED: Jerry Manlapaz RN MAN Clinical Instructor Actual Score x 100 Total Score . m.

ASSESSMENT/ PLANNING 1. Establishes rapport with subordinates 2. Able to mediate between subordinates and patients 4.PHILIPPINE REHABILITATION INSTITUTE FOUNDATION. 19. Quezon City RLE LEADERSHIP AND MANAGEMENT (HEAD NURSING) CLINICAL PERFORMANCE EVALUATION TOOL (Student Staff Nurse to Student Head Nurse) Name: Gian Arlo Castro Year/ Section: Rating 5 4 3 2 1 Group: Date of Exposure: Feb. College of Nursing #56 Banawe Street. Utilizes appropriate resources for ward assessment 2. Able to maintain stability under pressure II. INC. observation. Gains trust and confidence of subordinates 3. Utilizes different techniques in gathering data ( interview. 2013 Clinical Area: Children's Ward Description Able to function independently and correctly Observes principles Able to function with less supervision from the instructor and observes principles theories of nursing most of the time Able to function but requires close supervision from the instructor and observes principles at theories of nursing sometimes Able to function but requires close supervision from the instructor and occasionally applies principles and theories of nursing Unable to function and has not applied nor observed underlying principles at theories of nursing Quantitative Outstanding Very Satisfactory Satisfactory Needs Improvement Unsatisfactory Performance I. records review.ESTABLISHMENT OF WORKING RELATIONSHIP 1. reports) Rating 5 5 4 5 4 4 .

Involves the staff. records. other members of the health team and administrative units in identifying problems in the unit b. Analyze data gathered based on scientific concepts and principles 5. Sets criteria for evaluation using the different parameters of evaluation X. materials. Gathers data on: Nursing service history Physical set up Organization chart Ongoing appraisal evaluation Ward rules and regulation at SOP”S Channel of communication Records and Reports 4. Develops alternative course of action f. Identifies specific and appropriate strategies to attain objectives e. Identifies and priorities problems based on data gathered according to the urgency of the availability of resources ( man power. Supervise his/her staff during procedures and other assigned tasks i. Come up with resolutions to address constraints h. money/ budget) III. Implements plan of action g. interviews. address questions pertaining to accomplishment of task b. Conduct a pre conference with his/her staff to discuss the objectives and activities for the day. PROBLEM SOLVING PROCESS a. Evaluates performance of staff and the unit as a whole through the use of reports. Generates suggestions and recommendations for the resolution of identifies problems c. Briefs students staff nurses on data gathered 6. formulate strategies in accomplishing assigned tasks. Distribute patient assignment evenly d. 4 5 5 4 4 5 4 4 5 5 4 4 5 5 5 4 4 5 4 4 5 4 . Prepares and brief subordinates on the learning objectives for the day c.3. helps subordinates. observations. Evaluates if the objective are met g. LEADERSHIP a. Analyze the existence of the problem d. Prepares and brief subordinates on the daily plan activities f. Delegates tasks to student staff nurse e. Coordinates and collaborates with other members of the health team and other administrative units in the attainment of objectives j.

keeps the clinical instructor informed and updated Utilizes the existing chain of command in implementing activities 5 5 5 5 REMARKS: EVALUATED BY: CONFORME: Khaycee Vasquez Student staff Nurse Student Staff Nurse NOTED: Jerry Manlapaz RN MAN Clinical Instructor Actual Score x 100 Total Score . m. resolves issues and concerns and conducts debriefing as necessary Requires incident reports as necessary.k. n. l. and conferences Troubleshoot as necessity arise Conducts post conference at the end of the shift.

ATTENDANCE /Time of arrival II. 19. 2013 DAILY REQUIREMENT CHECKLIST CRITERIA I. College Of Nursing Name: Carmina Alfonso Section/Group: Group 3 Hospital: Philippine Orthopedic Center Date of Exposure: Feb. INC. PARAPHERNALIA PRI bag NANDA Book Drug Handbook ID/ Nameplate Complete Uniform Shoes Nursing Cap/ Undershirt Wrist Watch Notebook/ Ticklers Thermometer • Oral • Rectal • Axilla BP Apparatus Stethoscope Canister w/ • Dry cotton balls • Cotton balls with alcohol Ballpen • Red • Black • Green Pencil Eraser Ruler Micropore tape Tape measure Penlight with battery Face mask 02/19/13 06:30A M                                                                                        .PHILIPPINE REHABILITATION INSTITUTE FOUNDATION.

Bandage scissor Tourniquet Clean gloves Sterile gloves Soap Alcohol Betadine Tongue depressor Cotton buds Medicine tray Medicine cup Kidney basin Clip board Syringe • 10 cc • 5cc • 3cc Tuberculin syringe Insulin syringe PATIENTS KIT Face towel Tooth brush Toothpaste Comb Nail cutter Soap Shampoo Prepared by: Gian Arlo H. Castro Student Head Nurse                                                                                  Noted by: Jerry Manlapaz RN. MAN Clinical Instructor .

College Of Nursing Name: Mario Jose Amoyo Section/Group: Group 3 Hospital: Philippine Orthopedic Center Date of Exposure: Feb. 19. PARAPHERNALIA PRI bag NANDA Book Drug Handbook ID/ Nameplate Complete Uniform Shoes Nursing Cap/ Undershirt Wrist Watch Notebook/ Ticklers Thermometer • Oral • Rectal • Axilla BP Apparatus Stethoscope Canister w/ • Dry cotton balls • Cotton balls with alcohol Ballpen • Red • Black • Green Pencil Eraser Ruler Micropore tape 02/19/13 06:30A M                                                                               . INC.PHILIPPINE REHABILITATION INSTITUTE FOUNDATION. 2013 DAILY REQUIREMENT CHECKLIST CRITERIA I. ATTENDANCE /Time of arrival II.

Castro Student Head Nurse                                                                                           Noted by: Jerry Manlapaz RN. MAN Clinical Instructor .Tape measure Penlight with battery Face mask Bandage scissor Tourniquet Clean gloves Sterile gloves Soap Alcohol Betadine Tongue depressor Cotton buds Medicine tray Medicine cup Kidney basin Clip board Syringe • 10 cc • 5cc • 3cc Tuberculin syringe Insulin syringe PATIENTS KIT Face towel Tooth brush Toothpaste Comb Nail cutter Soap Shampoo Prepared by: Gian Arlo H.

PHILIPPINE REHABILITATION INSTITUTE FOUNDATION. ATTENDANCE /Time of arrival II. College Of Nursing Name: Hydielyn Fernando Section/Group: Group 3 Hospital: Philippine Orthopedic Center Date of Exposure: Feb. 19. INC. 2013 DAILY REQUIREMENT CHECKLIST CRITERIA I. PARAPHERNALIA PRI bag NANDA Book Drug Handbook ID/ Nameplate Complete Uniform Shoes Nursing Cap/ Undershirt Wrist Watch Notebook/ Ticklers Thermometer • Oral • Rectal • Axilla BP Apparatus Stethoscope Canister w/ • Dry cotton balls • Cotton balls with alcohol Ballpen • Red • Black • Green Pencil 02/19/13 06:30A M                                                                      .

Eraser Ruler Micropore tape Tape measure Penlight with battery Face mask Bandage scissor Tourniquet Clean gloves Sterile gloves Soap Alcohol Betadine Tongue depressor Cotton buds Medicine tray Medicine cup Kidney basin Clip board Syringe • 10 cc • 5cc • 3cc Tuberculin syringe Insulin syringe PATIENTS KIT Face towel Tooth brush Toothpaste Comb Nail cutter Soap Shampoo Prepared by: Gian Arlo H. Castro Student Head Nurse                                                                                                    Noted by: Jerry Manlapaz RN. MAN Clinical Instructor .

PARAPHERNALIA PRI bag NANDA Book Drug Handbook ID/ Nameplate Complete Uniform Shoes Nursing Cap/ Undershirt Wrist Watch Notebook/ Ticklers Thermometer • Oral • Rectal • Axilla BP Apparatus Stethoscope Canister w/ • Dry cotton balls • Cotton balls with alcohol Ballpen • Red 02/19/13 06:30A M                                                             .PHILIPPINE REHABILITATION INSTITUTE FOUNDATION. 2013 DAILY REQUIREMENT CHECKLIST CRITERIA I. INC. College Of Nursing Name: Khaycee Vasquez Section/Group: Group 3 Hospital: Philippine Orthopedic Center Date of Exposure: Feb. 19. ATTENDANCE /Time of arrival II.

MAN Clinical Instructor .• Black • Green Pencil Eraser Ruler Micropore tape Tape measure Penlight with battery Face mask Bandage scissor Tourniquet Clean gloves Sterile gloves Soap Alcohol Betadine Tongue depressor Cotton buds Medicine tray Medicine cup Kidney basin Clip board Syringe • 10 cc • 5cc • 3cc Tuberculin syringe Insulin syringe PATIENTS KIT Face towel Tooth brush Toothpaste Comb Nail cutter Soap Shampoo Prepared by: Gian Arlo H. Castro Student Head Nurse                                                                                                             Noted by: Jerry Manlapaz RN.

19. ATTENDANCE /Time of arrival II. INC. PARAPHERNALIA PRI bag NANDA Book Drug Handbook ID/ Nameplate Complete Uniform Shoes Nursing Cap/ Undershirt Wrist Watch Notebook/ Ticklers Thermometer • Oral • Rectal • Axilla BP Apparatus Stethoscope Canister w/ • Dry cotton balls • Cotton balls with 02/19/13 06:30A M                                                       .PHILIPPINE REHABILITATION INSTITUTE FOUNDATION. 2013 DAILY REQUIREMENT CHECKLIST CRITERIA I. College Of Nursing Name: Michael Tanquintic Section/Group: Group 3 Hospital: Philippine Orthopedic Center Date of Exposure: Feb.

MAN .alcohol Ballpen • Red • Black • Green Pencil Eraser Ruler Micropore tape Tape measure Penlight with battery Face mask Bandage scissor Tourniquet Clean gloves Sterile gloves Soap Alcohol Betadine Tongue depressor Cotton buds Medicine tray Medicine cup Kidney basin Clip board Syringe • 10 cc • 5cc • 3cc Tuberculin syringe Insulin syringe PATIENTS KIT Face towel Tooth brush Toothpaste Comb Nail cutter Soap Shampoo Prepared by: Gian Arlo H. Castro                                                                                                                   Noted by: Jerry Manlapaz RN.

Student Head Nurse Clinical Instructor PHILIPPINE REHABILITATION INSTITUTE FOUNDATION. 19. INC. College Of Nursing Name: Raquel Laxa Section/Group: Group 3 Hospital: Philippine Orthopedic Center Date of Exposure: Feb. ATTENDANCE /Time of arrival II. PARAPHERNALIA PRI bag NANDA Book Drug Handbook ID/ Nameplate Complete Uniform Shoes Nursing Cap/ Undershirt Wrist Watch Notebook/ Ticklers Thermometer • Oral • Rectal • Axilla BP Apparatus Stethoscope 02/19/13 06:30A M                                              . 2013 DAILY REQUIREMENT CHECKLIST CRITERIA I.

Canister w/ • Dry cotton balls • Cotton balls with alcohol Ballpen • Red • Black • Green Pencil Eraser Ruler Micropore tape Tape measure Penlight with battery Face mask Bandage scissor Tourniquet Clean gloves Sterile gloves Soap Alcohol Betadine Tongue depressor Cotton buds Medicine tray Medicine cup Kidney basin Clip board Syringe • 10 cc • 5cc • 3cc Tuberculin syringe Insulin syringe PATIENTS KIT Face towel Tooth brush Toothpaste Comb Nail cutter Soap Shampoo                                                                                                                            .

Castro Student Head Nurse Noted by: Jerry Manlapaz RN. MAN Clinical Instructor PHILIPPINE REHABILITATION INSTITUTE FOUNDATION. ATTENDANCE /Time of arrival II. PARAPHERNALIA PRI bag NANDA Book Drug Handbook ID/ Nameplate Complete Uniform Shoes Nursing Cap/ Undershirt Wrist Watch Notebook/ Ticklers Thermometer • Oral • Rectal 02/19/13 06:30A M                                     . 19. College Of Nursing Name: Von Darwin Visitacion Section/Group: Group 3 Hospital: Philippine Orthopedic Center Date of Exposure: Feb. 2013 DAILY REQUIREMENT CHECKLIST CRITERIA I.Prepared by: Gian Arlo H. INC.

• Axilla BP Apparatus Stethoscope Canister w/ • Dry cotton balls • Cotton balls with alcohol Ballpen • Red • Black • Green Pencil Eraser Ruler Micropore tape Tape measure Penlight with battery Face mask Bandage scissor Tourniquet Clean gloves Sterile gloves Soap Alcohol Betadine Tongue depressor Cotton buds Medicine tray Medicine cup Kidney basin Clip board Syringe • 10 cc • 5cc • 3cc Tuberculin syringe Insulin syringe PATIENTS KIT Face towel Tooth brush Toothpaste Comb                                                                                                                            .

MAN Clinical Instructor . Castro Student Head Nurse          Noted by: Jerry Manlapaz RN.Nail cutter Soap Shampoo Prepared by: Gian Arlo H.

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