Name: _________________________________________________ Date: ______________

Evaluator/Signature: ______________________________________ Grade: _____________

BAG TECHNIQUE

DEFINITION:
The bag technique is a tool by which the nurse, during her visit will enable her to perform a nursing procedure
with ease and deftness, to save time and effort with the end view of rendering effective nursing care to clients.
The public health bag is an essential and indispensable equipment of a public health nurse which she has to
carry along during her home visits. It contains basic medication and articles which are necessary for giving care.
Principles

 Performing the bag technique will minimize, if not, prevent the spread of any infection.
 It saves time and effort in the performance of nursing procedures.
 The bag technique can be performed in a variety of ways depending on the agency’s policy, the
home situation, or as long as principles of avoiding transfer of infection is always observed.
Contents
The following are the contents of a Public Health Nurse bag:

 Paper lining
 Extra paper for making waste bag
 Plastic/linen lining
 Apron
 Hand towel
 Soap in a soap dish
 Thermometers (oral and rectal)
 2 pairs of scissors (surgical and bandage)
 2 pairs of forceps (curved and straight)
 Disposable syringes with needles (g. 23 & 25)
 Hypodermic needles (g. 19, 22, 23, 25)
 Sterile dressing
 Cotton balls
 Cord clamp
 Micropore plaster
 Tape measure
 1 pair of sterile gloves
 Baby’s scale
 Alcohol lamp
 2 test tubes
 Test tube holders
 Solutions of:
o Betadine
o 70% alcohol
o Zephiran solution
o Hydrogen peroxide
o Spirit of ammnonia
o Ophthalmic ointment
o Acetic acid
o Benedict’s solution
*BP apparatus and stethoscope are carried separately and are never placed in the bag.
Points to consider
 1. The bag should contain all the necessary articles, supplies and equipment that will be used to
answer the emergency needs
2. The bag and its contents should be cleaned very often, the supplies replaced and ready for use
anytime.
3. The bag and its contents should be well protected from contact with any article in the patient’s
home.
4. Consider the bag and its contents clean and sterile, while articles that belong to the patients as
dirty and contaminated.
5. The arrangement of the contents of the bag should be the one most convenient to the user, to
facilitate efficiency and avoid confusion.

STEPS RATIONALE IDEAL SCORE

SCORE

Upon arrival at the patient’s home, place 5

the bag on the table lined with a clean
paper. The clean side must be out and the
folder part, touching the table

Ask for a basing of water or a glass of 5

drinking water if tap water is not
available.

Open the bag and take out the towel and 5

soap.

Wash hands using soap and water, wipe 5

to dry.

Take out the apron from the bag and put 5

it on with the right side

Put out all the necessary articles needed 5

for the specific care.

Close the bag and put it in one corner of 5

the working area.

Proceed in performing the necessary 5

nursing care treatment.

After giving the treatment, clean all 5

things that were used and perform hand
washing.

Open the bag and return all things that 5

were used in their proper places after
cleaning them.
Remove apron, folding it away from the 5
person, the soiled side in and the clean
side out.

Fold the lining, place it inside the bag and 5

close the bag

Take the record and have a talk with the mother. Write down all the necessary data that 5
were gathered, observations, nursing care and treatment rendered. Give instructions for
care of patients in the absence of the nurse.

Make appointment for the next visit 5

(either home or clinic) taking note of the
date and time.

TOTAL SCORE 70

Administering a Intramuscular Injection

STEPS RATIONALE IDEAL SCORE

SCORE

1. Check accuracy and completeness of the MAR or 5

computer printout with the prescriber’s written
medication order. Check patient’s name,
medication name and dosage, route of
administration, and time of administration.
Recopy or reprint any portion of the MAR that is
difficult to read.

2. Prepare medications for one patient at a time using 5

aseptic technique. Keep all pages of MARs or computer
printouts for one patient together, or look at only one
patient’s electronic MAR at a time. Check label of
medication carefully with MAR or computer printout 2
times when preparing medication.

3. Take medication to patient at right time. 5

4. Identify the patient using two identifiers (e.g., 5

name and birthday

5. Compare identifiers with information on patient’s 5

MAR or medical record.

6. At patient’s bedside again compare MAR or 5

computer printout with names of medications on
medication labels and patient name. Ask patient if he or
she has allergies.
7. Discuss purpose of each medication, action, and 5
possible adverse effects. Allow patient to ask any
questions. Tell patient that injection will cause a slight
burning or sting.

8. Perform hand hygiene and apply clean gloves. 5

Keep sheet or gown draped over body parts not requiring
exposure.

9. Select appropriate site. Note integrity and size of 5

muscle. Palpate for tenderness or hardness. Avoid these
areas. If patient receives frequent injections, rotate sites.
Use ventrogluteal if possible.

10. Help patient to comfortable position. Position 5

patient depending on chosen site (e.g., sit, lie flat, on side,
or prone).

11. Relocate site using anatomical landmarks 5

12. Cleanse site with antiseptic swab. Apply swab at 5

center of site, and rotate outward in circular direction for
about 5cm (2 inches).
Option: Apply EMLA cream on injection site at
least 1 hour before IM injection, or use
vapocoolant spray (e.g., ethyl chloride) just before
injection.

13. Hold swab or gauze between third and fourth 5

fingers of nondominant hand.

14. Remove needle cap by pulling it straight off. 5

15. Hold syringe between thumb and forefinger of 5

dominant hand; hold as dart, palm down

16. Administer injection. 5

▪ a Position ulnar side of nondominant hand just
below site, and pull skin laterally approximately
2.5 to 3.5cm (1 to 112 inches). Hold position until
medication is injected. With dominant hand, inject
needle quickly at 90-degree angle into muscle.
▪ Option: If patient’s muscle mass is small, grasp
body of muscle between thumb and forefingers.
▪ After needle pierces skin, still pulling on skin
with nondominant hand, grasp lower end of
syringe barrel with fingers of nondominant hand
to stabilize it. Move dominant hand to end of
plunger. Avoid moving syringe.
 ▪ Pull back on plunger 5 to 10 seconds. If no blood
appears, inject medication slowly at a rate of 10
sec/mL
▪ Wait 10 seconds, then smoothly and steadily
withdraw needle, release skin, and apply alcohol
swab or gauze gently over site.

17. Apply gentle pressure to site. Do not massage site. 5

Apply bandage if needed.

18. Discard uncapped needle or needle enclosed in 5

safety shield and attached syringe into a puncture-proof
and leak-proof receptacle.

19. Complete post procedure protocol 5

20. Return to room in 15 to 30 minutes, and ask if 5

patient feels any acute pain, burning, numbness, or
tingling at injection site.

21. Document procedure 5

TOTAL SCORE 105

Administering a Subcutaneous Injection

STEPS RATIONALE IDEAL SCORE

SCORE

1. Check accuracy and completeness of 5

each MAR or computer printout with
prescriber’s written medication order.

2. Check patient’s name, medication 5

name and dosage, route of administration, and
time of administration. Recopy or reprint any
portion of MAR that is difficult to read.

3. Perform hand hygiene and prepare 5

medication using aseptic technique. Check
label of the medication carefully with the
MAR or computer printout two times when
preparing medication.

4. Identify patient using two patient 5

identifiers (e.g., name and birthday )
according to agency policy. Compare
identifiers with information on patient’s MAR
or medical record.

5. At patient’s bedside, again compare 5

MAR or computer printout with names of
medications on medication labels and patient
name. Ask patient if he or she has allergies.

6. Perform hand hygiene and apply clean 5

gloves. Keep sheet or gown draped over body
parts not requiring exposure.

7. Select appropriate injection site. 5

Inspect skin surface over sites for bruises,
inflammation, or edema. Do not use an area
thatis bruised or has signs associated with
infection.

8. Palpate sites; avoid those with masses 5

or tenderness. Be sure that needle is correct
size by grasping skinfold at site with thumb
and forefinger. Measure fold from top to
bottom. Make sure needle is one-half length
of fold.
• When administering insulin or
heparin subcutaneously, use
abdominal injection sites first,
followed by thigh injection site.
• When administering low molecular-
weight heparin (LMWH)
subcutaneously, choose a site on the
right or left side of the abdomen, at
least 5cm (2 inches) away from the
umbilicus.
• Rotate insulin site within an
anatomical area (e.g., the abdomen),
and systematically rotate sites within
that area.

9. Help patient into comfortable position. 5

Have him or her relax arm, leg, or abdomen,
depending on site selection.

10. Cleanse site with antiseptic swab. 5

Apply swab at center of site and rotate
outward in circular direction for about 5cm (2
inches)

11. Hold swab or gauze between third and 5

fourth fingers of nondominant hand.
12. Remove needle cap or protective 5
sheath by pulling it straight off.

13. Hold syringe between thumb and 5

forefinger of dominant hand; hold as dart

14. Administer injection: 5

• For average-size patient, hold skin
across injection site or pinch skin with
nondominant hand.
• Inject needle quickly and firmly at
45- to 90-degree angle. Release skin, if
pinched. Option: When using injection
pen or giving heparin, continue to
pinch skin while injecting medicine.
• For obese patient, pinch skin at site
and inject needle at 90-degree angle
below tissue fold.
After needle enters site, grasp lower
end of syringe barrel with
nondominant hand to stabilize it.
Move dominant hand to end of
plunger, and slowly inject medication
over several seconds. Avoid moving
syringe
• Withdraw needle quickly while
placing antiseptic swab or gauze
gently over site.

15. Apply gentle pressure to site. Do not 5

massage site. (If heparin is given, hold alcohol
swab or gauze to site for 30 to 60 seconds.)

16. Help patient to comfortable position. 5

17. Discard uncapped needle or needle 5

enclosed in safety shield and attached syringe
into puncture- and leakproof receptacle.

18. Document procedure 5

TOTAL SCORE: 90
 VITAL SIGNS TAKING

Taking the TEMPERATURE

1. Explain the procedure to the patient.
2. Get the thermometer, disinfect from bulb to stem.
3. Read the thermometer if in the level of 35ºC, if not shake the thermometer until it reaches to 35ºC.
4. Instruct the patient to open mouth and place thermometer under the patients tongue then instruct patient to
closemouth.
Taking the PULSE Rate
1. While waiting for the appropriate time, palpate radial artery and count pulse for 1 minute in the proper.
Taking the RESPIRATORY Rate
1. Proceed to counting the pulse rate for 1 minute. Observing the proper technique, 1 hand still holding unto
the radial artery. Record both RR & PR.
Taking the BLOOD PRESSURE
1. Apply the BP cuff with arm hyper extended.
2. Palpate brachial artery with left hand, put the stethoscope unto the ear with the earpiece the patient
3. Inflate cuff till pulsation disappears and add 30 mmHg
4. Place diaphragm bell of stethoscope over brachial artery
5. Release valve slowly, take systole, then diastole.
6. Remove cuff and record BP.
7. Remove Oral thermometer from the mouth
8. Wipe thermometer from stem to bulb.
9. Read the temperature and record.
10. Disinfect thermometer properly.
11. Record TRP and Graph properly.
Be familiar first with the Normal Vital Signs by Age:
VARIATIONS IN NORMAL VITAL SIGNS BY AGE

Oral
TemperatureIn Respirations
Degrees Celsius Pulse (Average (Average and Blood Pressure
Age (Fahrenheit) and Ranges) Ranges) (mm Hg)

36.8 (98.2)
Newborns axillary 130 (80 to 180) 35 (30 to 80) 73/55

36.8 (98.2)
1 year axillary 120 (80 to 140) 30 (20 to 40) 90/55

5 to 8 years 37 (98.6) 100 (75 to 120) 20 (15 to 25) 95/57

10 years 37 (98.6) 70 (50 to 90) 19 (15 to 25) 102/62

Teen 37 (98.6) 75 (50 to 90) 18 (15 to 25) 120/80

Adult 37 (98.6) 80 (60 to 100) 16 (12 to 20) 120/80

Older adult (more Possible increase

than 70 years) 37 (98.6) 70 (60 to 100) 16 (15 to 20) diastolic
VITALS SIGNS
Procedures Checklist
NAME:_____________________________YEAR & SECTION:____________DATE:___________

Performed

Preparation Correctly Incorrectly Not Remarks

Assess:
A.) Temperature
– Clinical signs of fever
– Clinical signs of hypothermia
– Client’s readiness for the procedure
– Site most appropriate for measurement
– Factors that may alter core body
temperature
B.) Pulse
– Clinical signs of cardiovascular
alteration, other than pulse rate, rhythm,
or volume
– Factor that may alter pulse rate
C.) Respiration
– Skin and mucus membrane color
– Position assumed for breathing
– Signs of cerebral anoxia
– Chest movement
– Activity tolerance
– Chest pain
– Dyspnea
Medications affecting respiratory rate.
D.) Blood Pressure
– Signs and symptoms of hypertension
– Signs and symptoms of hypotension
1. – Factors affecting blood pressure.

Assemble equipment and Supply:

– Thermometer
– Cotton balls with alcohol or alcohol
wipes
– Tissue /wipes
– Watch with a second hand or indicator.
– Stethoscope
– Blood pressure cuff of the appropriate
size
2. – Sphygmomanometer

Procedure

Identify the client properly and explain

what you are going to do, why it is
1. necessary, and how he can cooperate.

Wash hand and observe other appropriate

2. infection control procedure
3. Provide for client privacy.

Place the client in the appropriate

4. position

ASSESSING BODY TEMPERATURE (AXILLARY TEMPERATURE)

Wipe the armpit with tissue paper or ask

1. the client to do it if able

Wipe the thermometer from bulb to stem

2. with alcoholized cotton ball.

Place the thermometer on the client’s

3. opposite side.

Wait for appropriate amount of time.

(While waiting for the time, the nurse can
4. now assess the other vital signs.)

Remove the thermometer and wipe with

5. the tissue if necessary.

6. Read the temperature.

Wipe the thermometer with alcoholized

cotton ball from stem to bulb. Return to
7. container.

ASSESSING A PERIPHERAL PULSE (RADIAL PULSE)

Palpate and count the pulse. Place two or

three middle fingers lightly and squarely
1. over the pulse point.

Count for one full minute and note the

2. pulse rhythm and volume.

ASSESSING RESPIRATION

Place the client’s arm across the chest

and observe the chest movements while
1. supposedly taking radial pulse.

Count the respiratory rate for 1 full

minute. An inhalation and an exhalation
is counted as one respiration. Observe the
depth, rhythm, and character or
2. respiration.

ASSESSING BLOOD PRESSURE

 The elbow should be slightly fixed with
the palm of the hand facing up and the
1. forearm supported at heart level.

2. Expose the upper arm

Wrap the deflated cuff evenly around the

upper arm. Locate the brachial artery.
Apply the center of the bladder directly
3. over the artery.

For an adult, place the lower border of

the cuff appropriately 2.5 cm (1 inch)
4. above the antecubital space.

If this is the client’s initial examination,

perform a preliminary palpatory
5. determination of systolic pressure.

Palpate the brachial artery with

6. fingertips.

Close the valve on the pump by turning

7. the knob clockwise.

Pump the cuff until you no longer feel

the brachial pulse. At that pressure, the
blood cannot flow through the artery.
Note the pressure on the
sphygmomanometer at which pulse is no
8. longer felt.

Release the pressure completely in the

cuff, and wait for one to two minutes
9. before making further measurements.

10. Position the stethoscope appropriately

Clean the earpieces of the stethoscope

11. with alcohol.

Warm the amplifier by rubbing it with

12. the palm of your hand.

Insert the ear attachments of the

stethoscope in your ears so that they tilt
13. slightly forward.

Ensure that the stethoscope hands freely

14. from the ears to the diaphragm.

Place the bell of the amplifier of the

15. stethoscope over the brachial pulse. Hold
 the diaphragm with thumb and index
finger.

16. Auscultate the client’s blood pressure.

Pump the cuff until the

sphygmomanometer reads 30 mm Hg
above the point where the brachial pulse
17. disappeared.

Release the valve of the cuff carefully so

that the pressure decreases at the rate of
18. 2-3 mm Hg per second.

As the pressure falls, identify the

mamometer reading at each of five
19. phases, if possible.

20. Deflate the cuff rapidly.

Wait one or two minutes before making

21. further determinations.

Repeat the above steps once or twice as

necessary to confirm the accuracy of the
22. reading.

If this is the client initially examination,

repeat the procedure on the client’s other
23. arm.

24. Remove the cuff.

Wipe the cuff with an approved

25. disinfectant.

Document in the client’s record (TPR

Sheet):
A.) The temperature in the client record.
B.) The pulse rate and rhythm
C.) The respiratory rate, depth, and
rhythm
Report pertinent assessment date
26. according to agency policy.