ASSESSMENT 5 4 3 2 1

1. Assess for:
a. Clinical signs of fever, hypothermia
b. Site most appropriate for measurement
c. Factors that may alter core body temperature

PLANNING

2. Prepare the needed equipment:

Thermometer
Thermometer sheath or cover
Water soluble lubricant for rectal temperature
Disposable Gloves
Towel of axillary temperature
Tissue/Wipes

PROCEDURE 5 4 3 2 1

1. Wash your hands. Wear gloves and follow standard precautions if

in contact with blood or body fluids cannot be avoided.

2. Identify the person, and greet him or her by name

3. Explain the procedure and encourage the patient to participate as

appropriate.

4. Provide privacy. Close the door and the curtains

5. Place the client in the appropriate position.

6. Place thermometer. Apply a protective sheath or probe cover if

appropriate. Lubricate rectal thermometer.

7. Wait the appropriate amount of time. Electronic and tympanic

thermometers will indicate that the reading is complete through 3
light or tone.

8. Remove the thermometer and discard the cover or wipe with a

tissue if necessary.

9. Read the temperature and record it on your worksheet. If the

temperature is obviously too high, too low or inconsistent with
the client’s condition, recheck it with a thermometer known to be
functioning properly.
 10. Wash the thermometer if necessary and return it to the storage
location.
11. Document the temperature in the client record.

Remarks:

Clinical Instructor: ______________________________ Conforme: _______________________

Signature over Printed Name Student’s Signature over Printed Name
 Evaluation Tool
ASSESSING FOR THE PERIPHERAL PULSE

NAME:_______________________________________________________ DATE: _______________

INSTRUCTOR:__________________________________________________ SCORE: ______________

ASSESSMENT 5 4 3 2 1

I. Assess for:
a. Clinical signs of cardiovascular alterations such as
dyspnea, fatigue, cyanosis, etc.
b. Factors that may alter pulse rate
c. Most appropriate site for assessment

PLANNING

II. Prepare the needed equipment:

Wrist watch with second hand/indicator

PROCEDURE 5 4 3 2 1

1. Wash your hands. Wear gloves and follow standard precautions if

in contact with blood or body fluids cannot be avoided.

2. Identify the person, and greet him or her by name

3. Explain the procedure and encourage the patient to participate as

appropriate.

4. Provide privacy. Close the door and the curtains

5. Select the pulse point. Normally the radial pulse is taken, unless it
cannot be exposed or circulation to another body area is to be
assessed.

6. Assess the client to a comfortable resting position.

When the radial pulse is assessed, with the palm facing
downward, the client’s arm can rest alongside the body or the
forearm can rest along side the body or the forearm can rest
across the thigh, with the palm of hand facing downward or
inward.

7. Palpate and count the pulse. Place the two or three middle
fingertips lightly over the pulse point. Count for a full minute.
 8. Assess the pulse rhythm and volume.

9. Document the pulse rate, rhythm, volume and your actions in the
client record.

Remarks:

Clinical Instructor: ______________________________ Conforme: _______________________

Signature over Printed Name Student’s Signature over Printed Name