UNIVERSITY OF SANTO TOMAS

COLLEGE OF REHABILITATION SCIENCES

DEPARTMENT OF PHYSICAL THERAPY
PHYSICAL THERAPY 1 LAB PRACTICAL EXAMINATION GRADING SHEET

INTERMITTENT PNEUMATIC COMPRESSION

NAME: ___________ ______________________________ SCORE: _________

 = Observed; X = Not Observed; NA = Not Applicable

 Criteria Mark
Knowledge --------
1 States important parameters (pressure range for treatment, inflation:deflation time; treatment
duration) for the use of IPC
2 States indications in applying IPC
3 States precautions and contraindications for the use of IPC
Skill --------
4 Introduces self
5 Establishes rapport
6 Gives a brief explanation of the rationale for treatment
7 Introduces the modality to be used and how it will function
8 Explains to patient/caregiver the procedures to be done
9 Describes what the patient is expected to feel during treatment
10 Instructs the patient as to what is expected of him during the treatment
11 Communicates to the patient using simple terms that are easy to follow
Monitors patient before treatment, includes appropriate evaluation of: --------
12 Blood pressure
13 Pressure sensation
14 Amount of swelling (girth or volumetric measurement)
15 Checks for contraindications / observes precautions
16 Prepares all necessary materials needed
17 Positions the patient appropriately (body part elevated) and comfortably
18 Exposes body part to be treated and performs proper draping
19 Applies stockinette or pillowcase properly for hygiene
20 Applies the appropriate sleeve for body part to be treated properly
21 Attaches air tubes properly
Sets machine to appropriate: --------
22 Pressure
23 Cycle
24 Duration
25 Monitors patient's initial response to IPC treatment
26 Observes proper body mechanics and posture
27 At the end of the treatment, removes all attachments
28 Checks for skin and limb condition of patient
Patient education --------
29 Educates patient regarding other interventions to be used at home to decrease swelling
30 Concludes treatment properly
31 Manages time efficiently
32 Performs aftercare of the equipments used
Attitude --------
33 Addresses patient with courtesy and respect
34 Addresses instructor with courtesy and respect
TOTAL ()

COMMENTS:

Instructor: ____________________