OXYGENATION

ADMINISTERING OXYGEN BY NASAL CANNULA

Suggested Actions Correct Partially Not Remarks
ly Done Done
Done

1. Check physician’s orders.

2. Perform hand hygiene.

3. Prepare the materials needed.

4. Identity the client by asking for

the name or checking the
identification band.

5. Explain the procedure.

6. Assess client’s status.

7. Adjust the bed to the

appropriate height. Lower the
side rails on the working side.

8. Provide privacy.

9. Assist the client in a semi

Fowler’s position.

10. Don gloves.

11. Connect nasal cannula to a

humidifier attached to the
oxygen tank.

12. Check if the oxygen is flowing

out of prongs.

13. Adjust flow rate as ordered by

physician.

14. Place prongs in client’s nostrils

and secure the tubing behind
each ear and under the chin or
around the client’s head.

15. Place gauze pads at ear

beneath the tubing as
necessary.
 16. Encourage the client to breathe
through the tubing the nose,
with mouth close.

17. Place needed items and call

bell within the client's reach.

18. Raise side rails and lower the

bed to the lowest position.

19. Remove equipment and

dispose supplies used.

20. Perform hand hygiene.

ATTITUDE CRITERION
3 2 1 Score Remarks

Behavior

Compliance to prescribed uniform

Completion of other tasks

(assignment, reflection,
journal, etc.)

Time Efficiency

Total Score

EQUIVALENT

Score: 3 x __________ = __________ Total Weight/ __________ = __________

          2 x __________ = __________                     (no. of items)

          1 x __________ = __________ SCORE:  __________________________

K (_____%)   = _______%             EQUIVALENT: ______________

S (_____%)   = _______%

A (_____%)   = _______%

Total             = _______%
 JENNY ROSE T. ANIETE MARCH 25, 2021
Signature of Student Over Printed Name       Date

EMMA N. INTIA, RN, MAN, Ph.D.          MARCH 25, 2021

Signature of Clinical Instructor Over Printed Name          Date

ADMINISTERING OXYGEN FACIAL MASK

Suggested Actions Correct Partially Not Remarks
ly Done Done
Done
1. Check physician’s orders.

2. Perform hand hygiene.

3. Prepares materials needed.

4. Identity yourself to the client by

asking for the name or
checking the identification
band.

5. Introduce yourself to the client.

6. Explain procedure to client.

7. Assess client’s status.

8. Adjust the bed to the

appropriate height. Lower the
side rails on the working side.

9. Assist the client in a semi-

Fowler’s position.

10. Don clean gloves.

11. Connect oxygen tubing with

face mask to a humidifier
attached to an oxygen mask.

12. Adjust flow rate as ordered by

physician.

13. Position face mask over client’s

nose and mouth. Adjust it with
an elastic strap so that with an
elastic strap so that the mask
fits snugly but comfortably on
the face.

14. Use gauze pads to reduce

irritation to ears and scalp.

15. Place the client in a

comfortable position.

16. Place needed items and call

bell within the client's reach.

17. Raise side rails and lower the

 bed to the lowest position.

18. Remove equipment and

dispose supplies used.

19. Remove the mask and dry the

skin every 2 to 3 hours if the
oxygen is running continuously.

DOCUMENTATION:

Record the type of mask used,

amount of oxygen used, and
oxygen, saturation level, lung
sounds, and rate/pattern of
respirations.

ATTITUDE CRITERION
3 2 1 Score Remarks

Behavior

Compliance to prescribed uniform

Completion of other tasks

(assignment, reflection,
journal, etc.)

Time Efficiency

Total Score

EQUIVALENT

Score: 3 x __________ = __________ Total Weight/ __________ = __________

          2 x __________ = __________                     (no. of items)

          1 x __________ = __________ SCORE:  __________________________

K (_____%)   = _______%             EQUIVALENT: ______________

S (_____%)   = _______%
 A (_____%)   = _______%

Total             = _______%

JENNY ROSE T. ANIETE MARCH 25, 2021

Signature of Student Over Printed Name       Date

EMMA N. INTIA, RN, MAN, Ph.D.          MARCH 25, 2021

Signature of Clinical Instructor Over Printed Name          Date