PERFORMANCE EVALUATION CHECKLIST

CARDIO – PULMONARY RESUSCITATION (AHA, 2020 GUIDELINES)

Name:________________________________ Group: ______ Date: __________ Rating:_________

Done Done Multiple

Correct but with Errors
PROCEDURE with No 1 Error Seen
Errors (2) (1)
(3)
ATTITUDE: 30% (15 points)
1. Displays readiness in performing the procedure
2. Displays conscientious efforts to correct mistakes.
3. Shows enthusiasm and interest in performing the procedure.
4. Employs professionalism, reliability and confidence in the procedure.
5. Answers rationale questions readily.

TOTAL
KNOWLEDGE AND SKILLS 70% (45 points)
1. Scene Assessment – ensure safety of the rescuer and the client
2. Position yourself by kneeling on one side of the client at the shoulder/chest
area of the client.
2. Tap on the client’s shoulders and ask “Hey, hey are you ok” Repeat this step
2 – 3 times. If a client, is unresponsive, proceed to next step.
3. Call out to the crowd for assistance and ask others to call an ambulance/call
911.
4. Position the client correctly on his/her back on a flat, hard surface.
5. Check for client’s breathing – tilt the client’s head back to open the airway,
listen for client breathing for up to 10 seconds. If there is not breathing, start
chest compressions.
6. Place the heel of the non – dominant hand at the center of the sternum,
place the heel of the dominant hand over the non – dominant hand. Center
your weight over your hands.
7. Perform chest compressions – push down on the client’s chest with the heel
of your hand up to a depth of 2 inches.
8. Ensure appropriate chest recoil of the patient by lifting your body weight off
the client in between compressions
9. Give 30 chest compressions. Push hard and fast at approximately 2
compressions per second.
10 10. After 30 chest compressions, give 2 rescue breaths – tilt the client’s head
gently and lift the chin up, pinch the client’s nose and seal your mouth over the
client’s mouth, blow air steadily and firmly for 1 second, observe for chest rise
while blowing air.
11. Repeat the cycle of 30 chest compressions and 2 rescue breaths for 4
cycles and check client’s pulse or whether client has regained consciousness.
12. If the client remains without a pulse or is still unconscious, continue CPR
until help arrives or client recovers (present pulse or regains consciousness).
13. Place the client who has regained consciousness into recovery position.
Raise the arm of the client that is nearest you with the elbow bent and the
palm facing upward.
14. Bring the other arm across the client’s chest with the back of the hand on
the client’s cheek on the rescuer side. Flex the knee on the other side with the
foot flat on the surface
15. With the your hand supporting the client’s hand on the cheek and client’s
flexed knee roll then client toward you and adjust the client’s chin to make sure
the airway is open.

TOTAL

Instructor’s Comments:
_________________________________________________________________________________________
_________________________________________________________________________________________

_____________________________ _____________________________________________
Signature of the Student Signature over Printed Name of Clinical Instructor

Prepared:
ANTHONY JOSEPH C. MERCADO, RN, MAN
MS Lecturer

Approved:

MICHELLE B. YU, DM, RN

Dean