OUR LADY OF FATIMA UNIVERSITY

College of Nursing – Cabanatuan City

PROGRAM Bachelor of Science in Nursing STUDENT NAME

COURSE NCM-103 YEAR & SECTION

Care of Patients with Alteration in
Oxygenation, Fluids & INSTRUCTOR
Electrolytes, Metabolism and
Endocrine DATE
(SKILLS LABORATORY)

PROCEDURE : INCENTIVE SPIROMETRY

EXPECTED OUTCOME : The student should be able to perform incentive spirometry correctly.
ASSESSMENT TASK : Return Demonstration

Assessment Exceptional Good Average Poor

SCORE
Dimension (4) (3) (2) (1)
1. Verified the Verified the Verified the Failed to verify
Verify the doctor’s order doctor’s order doctor’s order doctor’s order the doctor’s
properly and with minimal improperly and order.
accurately. error. inaccurately.
2. Observed Hand washing Hand washing Hand washing
Wash hands principles of was done with was done with was not done.
medical hand minimal errors. maximal errors.
washing.

3. Gathered Gathered Gathered and Failed to gather

Gather the materials. materials and materials and performed one and identify
Identify the patient. identified patient performed the (1) way of patient.
by asking his/her two (2) ways of identifying
name and identifying patient.
checking his/her patient.
ID band politely.

4. Greeted and Greeted and Greeted and Failed to greet

Greet and explain the explained explained explained and explain the
procedure. procedure to the procedure but procedure but in procedure.
client clearly and lacks details. an unclear
completely with manner.
client’s approval.

5. Positioned the Positioned the Positioned the Failed to

Position the patient patient patient patient provide privacy
comfortably and provide comfortably and comfortably and comfortably and and position
privacy.
provided privacy provided privacy provided privacy the patient
during the entire but not in the but was observed comfortably.
procedure. entire only at times.
procedure.

Instruct client to: Held the Held the Held the Failed to hold
6. incentive incentive incentive the incentive
Hold the incentive spirometer spirometer spirometer in spirometer.
spirometer upright, with correctly with incorrectly with correctly with
both hands both hands. one hand. further
 instructions.

7. Performed the Performed the Performed the Failed to do the

Slide the indicator (located step correctly. step with little step with some step.
in the left-hand column instructions. instructions.
when you are facing the
spirometer) to the desired
level. For example, start at
1250 milliliters and slowly
increase as your treatment
progresses
8. Performed the Performed the Performed the Failed to do the
Place the mouthpiece into step correctly. step with little step with some step.
your client’s mouth and instructions. instructions.
instruct the patient to
tightly seal his/her lips
around it
9. Performed the Performed the Performed the Failed to do the
With lips tightly sealed step correctly. step with little step with some step.
around the mouthpiece, instructions. instructions.
breathe 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. Performed the Performed the Performed the Failed to do the
Hold breath for at least 3 step correctly. step with little step with some step.
seconds and allow the instructions. instructions.
piston to fall back to the
bottom of the column
11. Performed the Performed the Performed the Failed to do the
After each set of deep step correctly. step with little step with some step.
breathing, cough to help instructions. instructions.
clear the airways of mucus.
Ask client to rest for a few
seconds and repeat steps
2-8, 10 times each hour
while your patient is awake
12. Provided comfort Provided Provided comfort Documentation
Provide comfort. and documented comfort and but most of the was not done.
Document the procedure. the information some of the details of
about the details of procedure were
procedure procedure were not documented.
properly and not
completely. documented.

OVERALL SCORE: ______________

Target Raw Score: 36 out of 48. If raw score is less than 36, repeat the return demonstration.

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FACULTY SIGNATURE OVER PRINTED NAME