ABG ANALYSIS

PERFORMANCE CHECKLIST

Name: Score:
Section: Date:

Score Done Not done

1. Give the normal values
Normal Values
pH- 7.35-7.45 3
PaCO2- 35-45 mmHg 3
PaO2- 70- 100 mmHg 3
3
HCO3- 22-25 meq/ L
2. Note the pH
>7.40 alkalosis 5
<7.40 acidosis
3. Determine the primary cause of disturbance
Respiratory
PaCO2- > 40 acidosis 5
<40 alkalosis

Metabolic 5
HCO3- > 24 alkalosis
<24 acidosis
4. Determine if compensation has begun
Uncompensated- abnormal pH, 1C abnormal, OC normal 3
Partially compensated- abnormal pH, 1C abnormal, OC abnormal 3
Compensated- normal pH, 1C abnormal, OC abnormal 3
Over compensated- return to normal
5.Evaluate patient.
Clinical Manifestation 7
Management 7

Total 50
 INCENTIVE SPIROMETRY
PERFORMANCE CHECKLIST

Name: Score:
Section: Date:

Score Done Not done

1. Verify the doctor’s order. 2

2. Greet and identify the patient. 2

3. Prepare the materials needed. 2

4. Explain the procedure to the patient. 3

(Give the indications and contraindications)

5. Position the patient. 3

Instruct client to:

6. Hold the incentive spirometer upright, with both hands. 5

7. Slide the indicator (located in the left-hand column when 5

you are facing the spirometer) to the desired level. For
example, start at 1250 milliliters and slowly increase as
your treatment progresses.

8. Place the mouthpiece into your client’s mouth and 5

instruct the patient to tightly seal his/ her lips around it.

9. With lips tightly sealed around the mouthpiece, breathe 5

in slowly and as deeply as possible. The piston that is
resting below the indicator should now rise toward the top
of the column.
10. Hold breath for at least 3 seconds and allow the piston
to fall back to the bottom of the column. 4
11. After each set of deep breathing, cough to help clear
the airways of mucus. 4
12. Ask client to rest for a few seconds and repeat steps
two through eight, 10 times each hour while you patient is 5
awake.
13. Provide comfort. 2
14. Document 2
 TOTAL PARENTERAL NUTRITION ADMINISTRATION PERIPHERAL ACCESS
PERFORMANCE CHECKLIST

Name: Score:
Section: Date:

Score Done Not done

1.Verifies doctor’s order 2
2. Greet and identify the patient. Explain the procedure. 2
3. Secure consent from patient and/ or authorized 2
members of the family.
4. Prepares parenteral solution and all other devices 5
needed for the parenteral administration taking into
consideration the mode of administration
5. Assess patient and choose suitable vein, location and get 5
baseline vital sign.
6. Check the integrity and functionality of the parenteral 3
solution and IV devices.
7. Observe the 10R’s in safe drug administration 5
8. Do hand hygiene and maintain asepsis throughout the 2
procedure.
9. Prepare TPN solution 5
11. Connects the tubing to the prepared parenteral 4
solution and regulate flow rate as prescribed
12. Dress IV site as per IV standard. 4
13. Labels IV site and solution as per IV standard. 3
14. Continue to reassure patient and do pertinent health 3
education.
15. Dispose waste materials according to Health Care 3
Waste Management.
16. Document procedure. 2
Total
 TOTAL PARENTERAL NUTRITION ADMINISTRATION CENTRAL VASCULAR ACCESS
PERFORMANCE CHECKLIST

Name: Score:
Section: Date:

Score Done Not done

1.Verifies doctor’s order 2
2. Greet and identify the patient. Explain the procedure. 2
3. Secure consent from patient and/ or authorized 2
members of the family.
4. Prepares parenteral solution and all other devices 6
needed for the parenteral administration taking into
consideration the mode of administration.
6. Check the integrity and functionality of the parenteral 6
solution and IV devices.
7. Observe the 10R’s in safe drug administration 6
8. Do hand hygiene and maintain asepsis throughout the 3
procedure.
9. Prepare TPN solution 5
10. Connects the IV administration set to the central 5
vascular access catheter aseptically and regulate flow rate
as prescribed.
11. Assess dressing over central vascular access for 5
swelling, redness, pain and foul smelling discharges.
Change dressing aseptically everyday.
12. Monitor/ reassure patient. 3
13. Dispose waste materials according to Health Care 3
Waste Management.
14. Document procedure. 2
Total
 DISCONTINUING PARENTERAL SOLUTION ADMINISTRATION
PERFORMANCE CHECKLIST

Name: Score:
Section: Date:

Score Done Not done

1.Verifies doctor’s order 2
2. Greet and identify the patient. Explain the procedure. 2
3. Secure consent from patient and/ or authorized 2
members of the family.
4. Prepare materials 2
5. Observe 10 R’s 5
6. Follow doctor’s prescription e.g. electrolyte; weight, 5
blood laboratory monitoring.
7. Monitor patient closely and document 10
8. Refer to M.D. for any unusual observations. 4
9. Discard waste materials according to Health Care Waste 3
Management.
Total 35
 PULSE OXIMETRY
PERFORMANCE CHECKLIST

Name: Score:
Section: Date:

Score Done Not done

1.Verifies doctor’s order 2
2. Make sure the pulse oximeter has enough power 2
source.
3. Place the pulse oximeter on a steady and flat surface. 5
The stand or table should not be shaky as any unnecessary
movements might alter the readings. Digital oximeters are
particularly sensitive even with just a slight shake.
4.Greet and identify the patient. Explain the procedures. 2
5. Set up the unit by connecting and clipping all the wires 3
and gauge meters..
6. Determine the spot where you will make the
exploration.
- If you choose the earlobe, push away the hair so it will 3
not intervene with the calibration.
- On the other hand if the finger is used for probing, make 3
sure the nails are clean and polish-free so there is closer
connection with the skin.
Wipe the skin on the earlobe or finger with alcohol before 4
placing the clamps of the pulse oximeters.
7. Clamp on the instrument on the earlobe or finger. Do 4
not press the diodes too much so as not to hamper free
flow of blood. Switch the pulse oximeter and wait while it
takes the readings.
8. Note down the readings as well as the date and time 4
they are taken. If the pulse oximeter recorded an oxygen
level that is below ninety five percent, more laboratory
examinations must be recommended. But if the reading
indicates ninety and above, the oxygen level is normal
9. Consider other factors that may have caused the
present oxygen level shown in the monitor.
-When the person had an intense physical activity before 4
the probe was done, oxygen content is higher.
- When in rest mode prior to the examination, the oxygen 4
level of blood will most likely be lower.
10. Record the heart and pulse rate for reference. 5
11. Evaluate the overall physical condition of the person 3
such as color of the eyes, skin and other symptoms that
may cause his present condition
12. Document. 2
 NEBULIZATION
PERFORMANCE CHECKLIST

Name: Score:
Section: Date:
Score Done Not done
1.Verifies doctor’s order 2
2. Place the air compressor on a sturdy surface that will 2
support its weight. Plug the cord from the compressor into
a properly grounded (three prong) electrical outlet.
3. Carefully measure the medicine exactly as you have 5
been instructed. Use a separate, clean measuring device
(eyedropper or syringe) for each medicine. 
4. Wash your hands with soap and warm water, and dry 2
completely with a clean towel.
5. Remove the top part of the nebulizer cup 2
6. Place your medicine in the bottom of the nebulizer cup. 2
7. Attach the top portion of the nebulizer cup and connect 2
the mouthpiece or face mask to the cup.
8. Connect the tubing to both the aerosol compressor and 2
nebulizer cup.
9. Turn on the compressor with the on/off switch. Once 2
you turn on the compressor, you should see a light mist
coming from the back of the tube opposite the
mouthpiece as shown to the left.
10. Sit up straight on a comfortable chair. 2
11. If you are using a mask, position it comfortably and securely 3
on your face
12. If you are using a mouth piece, place it between your teeth 3
and seal your lips around it.
13. Take slow, deep breaths through your mouth. If possible, 4
hold each breath for two to three seconds before breathing out.
This allows the medication to settle into the airways.
14. Continue the treatment until the medication is gone (about 4
seven to 10 minutes).
15. If you become dizzy or feel "jittery," stop the treatment and 3
rest for about five minutes. Then continue the treatment, but try
to breathe more slowly. If these symptoms continue with future
treatments, inform your health care provider.
16. Turn the compressor off. 2
17. Take several deep breaths and cough. Continue coughing and 4
try to clear any secretions you might have in your lungs. Cough
the secretions into a tissue and dispose of it properly.
18. Wash your hands with warm water and soap, and dry them 2
with a clean towel.
19. Document 2
Total 50