L2 RLE - eBOOK 2021-22

UNIVERSITY OF MAKATI
COLLEGE OF ALLIED HEALTH STUDIES

CENTER OF NURSING
BACHELOR OF SCIENCE IN NURSING
LEVEL 2:
NURSING SKILLS
A.Y. _______ - _______
NAME OF STUDENT:
YEAR AND SECTION:
Compiled by: Esmeraldo C. De Las Armas IV MAN, RN, EMT-B
Disclaimer: All literary works that appears on the workbook are copyrighted by
their own owners. We claim no credits for them unless otherwise needed. If you
own the rights to any of the works and do not wish them to appear on the workbook,
please contact us and they will be promptly removed.
NAME OF STUDENT:
YEAR/SECTION:
LEVEL 2 NURSING SKILLS
TABLE OF CONTENT PAGE

NUMBER
NP 4 – Community Health Nursing 1 5

1. Bag Technique 6
A.Y. 2021-2022
1st SEMESTER,
2. Cleaning a Wound and Applying Sterile Dressings 8

3. First Aid 12
4. Intradermal Injection 14
5. Intramuscular Injection 16
6. Subcutaneous Injections 18
7. Breast Examination 20
8. Leopold’s Maneuver 22
Summary of Grades 24
NP 7 – Care of Mother, Child, Adolescent (Well Client) 25

9. Oral, Buccal, and Sublingual Medication Administration 26
10. Administering Eye and Ear Medications 29
11. Administering Vaginal and Rectal Suppositories 31
12. Oxygen Administration 33
13. EINC 34
14. Enema Administration 36
15. Surgical Handwashing 38
16. Gowning and Gloving (closed method) 40
17. Skin Preparation for Surgery 42
18. Urinary Catheterization (Male & Female) 44
19. Obtaining a urine specimen from a closed-drainage system 49
20. Removing Indwelling Catheter 51
Disclaimer: All literary works that appears on the workbook are copyrighted by their own owners. Page 2
We claim no credits for them unless otherwise needed. If you own the rights to any of the works and
do not wish them to appear on the workbook, please contact us and they will be promptly removed.
PAGE
TABLE OF CONTENT NUMBER
NP 9 – Care of Mother, Child at Risk or with Problems

54
(Acute and Chronic)
21. Setting up Intravenous Infusion 55
22. Setting the flow rate (IV infusion) 58
23. Administering of drugs through IV push and Heplock 60
24. Drug Incorporation into IV Solution 63
A.Y. 2021-2022
25. Administering medication via Piggy Back 65

1st SEMESTER,
26. Changing Intravenous Site Dressing 67

27. Blood Transfusion 69
28. BLS for Pediatric Patient 71
29. BLS for Infant with AED 73
30. Nebulization Administration 76
UNIVERSITY OF MAKATI
VISION
We envision the University of Makati as the primary instrument where
University education and Industry training programs interface to mold Makati
youth into productive citizens and IT-enabled professionals who are exposed to
the cutting edge of technology in their areas of specialization. The University
shall be the final stage of Makati City's integrated primary level to university
educational system that allows its less privileged citizens to compete for high
paying job opportunities in its business and industries.
A.Y. 2021-2022
1st SEMESTER,
MISSION
To achieve our vision, University of Makati shall mold highly competent
professionals and skilled workers from the children of poor Makati residents
while inculcating in them good moral values and desirable personality
development by offering baccalaureate degree, graduate degree, and non-
degree programs with parallel on campus social, cultural, sports and other co-
curricular activities.
COLLEGE OF ALLIED HEALTH STUDIES
VISION
The College of Allied Health Studies is dedicated to becoming the top of the
mind innovative provider of relevant and needs based-health care education.
MISSION
Development of health care industry workforce that is resilient to its dynamics;
and who are competent, creative and socially responsible.
CORE VALUES
• Resiliency
• Competence
• Creativity
• Social Responsibility
CENTER OF NURSING
VISION-MISSION
The Center supports the College’s vision in becoming the top of mind
innovative provider of relevant and needs-based education by producing
graduate nurses who are fully competent in delivering standard and quality
nursing care, as well as expanded nursing career roles, integrating theory,
practice, and values.
A.Y. 2021-2022
1st SEMESTER,
NP 4 - Community
Health Nursing 1
NAME OF STUDENT:
YEAR/SECTION: DATE: GRADE: (%) CLINICAL

INSTRUCTOR:
Correctly Needs
Not Done
SKILL: BAG TECHNIQUE RATIONALE Done Improvement
(0)
(2) (1)
ASSESSMENT
1. Assess the family health record.
2. Assess the health needs of the client and
family.
3. Assess the articles, supplies which may be
used to answer emergency needs.
4. Assess for the arrangements of the contents
of the bag.
A.Y. 2021-2022
5. Assess the environment and look for a flat

1st SEMESTER,
surface.
PLANNING / EXPECTED OUTCOMES:
6. To minimize or eradicate the spread of
infection.
7. To render effective nursing care.
MATERIALS:
8. CHN/ PHN Bag
9. Paper or plastic lining
10. Plastic (waste receptacle)
11. Apron
12. Hand towel in plastic bag
13. Liquid soap or soap with soap dish
14. Thermometer
15. 2 scissors (surgical and bandage)
16. 2 forceps (curved and straight)
17. Syringes (5mL, 3mL, 1mL)
18. Hypodermic needles (g. 18, 20, 22, 23 and
25)
19. Sterile dressing
20. Sterile cord clamp
21. Sterile gloves (5 pairs)
22. Clean gloves (5 pairs)
23. Tape measure
24. Baby’s scale
25. Adhesive tape (micropore)
26. 2 test tubes
27. Test tube holder
28. Specimen bottle
MATERIALS:
29. Povidone iodine – antiseptic solution for
clean wounds
30. 70% isopropyl or ethyl alcohol
31. Alcohol lamp
32. Ophthalmic ointment
33. Zephiran solution – disinfection of materials
(forceps, scissors)
34. Hydrogen peroxide – antiseptic solution for
dirty wounds
35. Spirit of ammonia
36. Acetic acid – to test for protein in urine
37. Benedict’s solution - to test for glucose in
urine
IMPLEMENTATION:
38. Assess for presence of dogs in the area.
Knock or ring doorbell.
39. Introduce yourself and explain the purpose
of your visit.
40. Upon entering the client’s home, ask
permission to use a flat surface
41. Place your bag on the flat surface, lined with
paper lining with clean side out (folded part
touching the table). Tuck the strap beneath
the bag
42. Ask for a basin of water, if faucet is not
available. Place it outside the working area
43. Open the bag, take the plastic linen and
spread over the work field area (folded part
out of the paper lining)
44. Take out the hand towel, soap & apron,
leaving the plastic wrappers of the towel and
soap dish inside the bag. Place the towel,
soap dish and apron at the corner with the
confines of the linen.
45. Perform hand washing, pat dry with towel.
46. Put on the apron right side out and wrong
side with crease touching the body.
47. Put out the things most needed for the
specific case.
48. Place the waste bag outside the work area.
49. Close the bag
50. Proceed to the specific nursing care or
treatment
51. After completing nursing care, clean with
A.Y. 2021-2022
alcohol to cleanse materials used

1st SEMESTER,
AFTER CARE:
52. Perform hand washing again
53. Open the bag and put back all the articles in
their proper places
54. Remove apron folding away the body with
soiled side folded inwards and the clean side
out and place it in the bag.
55. Carry the bag from the table and fold the
paper and plastic lining clean side out. If it is
heavily soiled, discard. If still clean, place
between the flaps and cover the bag
DOCUMENTATION:
56. Record all relevant findings about the client
and members of the family
57. Take note of the environmental factors which
affects the client
58. Include quality of nurse-patient relationship
EVALUATION:
59. Infection and spread of microorganisms have
been minimized.
60. Nursing care has been rendered effectively.
TOTAL
/ 120
Computation: Raw Score / Total Score X 100 = FINAL GRADE
Clinical Instructor: ____________________________________ %

REMARKS:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
NAME OF STUDENT:

INSTRUCTOR:
SKILL: CLEANING A WOUND AND Correctly Needs

Not Done
RATIONALE Done Improvement
(0)
APPLYING STERILE DRESSING (2) (1)
ASSESSMENT
1. Verify the physician’s order
2. Assess the situation to determine the need
for wound cleaning and a dressing change.
3. Assess the patient’s level of comfort and the
need for analgesics before wound care.
4. Assess if the patient experienced any pain
related to prior dressing changes and the
effectiveness of interventions employed to
minimize the patient’s pain.
A.Y. 2021-2022
5. Assess the current dressing to determine if it

1st SEMESTER,
is intact.
6. Assess for excess drainage, bleeding, or
saturation of the dressing.
7. Inspect the wound and the surrounding
tissue.
8. Assess the appearance of the wound for the
approximation of wound edges, the color of
the wound and surrounding area, and signs
of dehiscence.
9. Assess for the presence of sutures, staples,
or adhesive closure strips.
10. Note the stage of the healing process and
characteristics of any drainage.
11. Assess the surrounding skin for color,
temperature, and edema, ecchymosis, or
maceration.
12. The expected outcome to achieve when
cleaning a wound and applying a dry, sterile
dressing is that the wound is cleaned and
protected with a dressing without
contaminating the wound area, without
causing trauma to the wound, and without
causing the patient to experience pain or
discomfort.
13. Other outcomes that are appropriate include:
the wound continues to show signs of
progression of healing, and the patient
demonstrates understanding of the need for
wound care and dressing change.
MATERIALS:
14. Sterile gloves
15. Clean disposable gloves
16. Additional PPE, as indicated
17. Sterile gauze dressing
18. Surgical or abdominal pads
19. Sterile dressing set or suture set (for the
sterile scissors and forceps)
20. Sterile cleaning solution (0.9% normal saline
solution)
21. Sterile basin (optional)
22. Sterile drape (optional)
23. Plastic bag or other appropriate waste
container for soiled dressings
24. Waterproof pad and bath blanket
25. Adhesive tape or Ties
26. Other linen for draping patient
27. Additional dressings and supplies, as
needed or physician’s order
IMPLEMENTATION:
28. Review the medical orders for wound care or Reviewing the order and plan of
the nursing plan of care related to wound care validates the correct patient
care. and correct procedure.
29. Gather the necessary supplies and bring to Preparation promotes efficient time
the bedside stand or overbed table. management and organized
approach to the task. Bringing
everything to the bedside
conserves time and energy.
30. Perform hand hygiene and put on PPE, if Hand hygiene and PPE prevent
indicated. the spread of microorganisms.
PPE is required based on
transmission precautions.
31. Identify the patient. Identifying the patient ensures the
right patient receives the
intervention and helps prevent
errors.
32. Close curtains around bed and close door to This ensures the patient’s privacy.
room if possible. Explain what you are going Explanation relieves anxiety and
to do and why you are going to do it to the facilitates cooperation.
patient.
33. Assess the patient for possible need for Pain is a subjective experience
nonpharmacologic pain reducing influenced by past experience.
interventions or analgesic medication before Wound care and dressing changes
A.Y. 2021-2022
1st SEMESTER,
wound care dressing change. Administer may cause pain for some patients.
appropriate prescribed analgesic. Allow
enough time for analgesic to achieve its
effectiveness.
34. Place a waste receptacle or bag at a Having a waste container handy
convenient location for use during the means the soiled dressing may be
procedure. discarded easily, without the
spread of microorganisms.
35. Adjust bed to comfortable working height, Having the bed at the proper
usually elbow height of the caregiver. height prevents back and muscle
strain.
36. Assist the patient to a comfortable position Patient positioning and use of a
that provides easy access to the wound bath blanket provide for comfort
area. Use the bath blanket to cover any and warmth. Waterproof pad
exposed area other than the wound. Place a protects underlying surfaces.
waterproof pad under the wound site.
37. Check the position of drains, tubes, or other Checking ensures that a drain is
adjuncts before removing the dressing. Put not removed accidentally if one is
on clean, disposable gloves and loosen tape present. Gloves protect the nurse
on the old dressings. If necessary, use an from contaminated dressings and
adhesive remover to help get the tape off. prevent the spread of
microorganisms. Adhesive-tape
remover helps reduce patient
discomfort during removal of
dressing.
38. Carefully remove the soiled dressings. If Cautious removal of the dressing is
there is resistance, use a silicone-based more comfortable for the patient
adhesive remover to help remove the tape. If and ensures that any drain present
any part of the dressing sticks to the is not removed. A silicone-based
underlying skin, use small amounts of sterile adhesive remover allows for the
saline to help loosen and remove. easy, rapid, and painless removal
without the associated problems of
skin stripping. Sterile saline
moistens the dressing for easier
removal and minimizes damage
and pain.
39. After removing the dressing, note the The presence of drainage should
presence, amount, type, color, and odor of be documented. Proper disposal of
any drainage on the dressings. Place soiled soiled dressings and used gloves
dressings in the appropriate waste prevents spread of
receptacle. Remove your gloves and dispose microorganisms.
of them in an appropriate waste receptacle.
40. Inspect the wound site for size, appearance, Wound healing or the presence of
and drainage. Assess if any pain is present. irritation or infection should be
Check the status of sutures, adhesive documented.
closure strips, staples, and drains or tubes, if
present. Note any problems to include in
your documentation.
41. Using sterile technique, prepare a sterile Supplies are within easy reach and
work area and open the needed supplies sterility is maintained.
42. Open the sterile cleaning solution. Sterility of dressings and solution is
Depending on the amount of cleaning maintained.
needed, the solution might be poured directly
over gauze sponges over a container for
small cleaning jobs, or into a basin for more
complex or larger cleaning.
43. Put on sterile gloves Use of sterile gloves maintains
surgical asepsis and sterile
technique and reduces the risk for
spreading microorganisms.
44. Clean the wound. Clean the wound from top Cleaning from top to bottom and
to bottom and from the center to the outside. center to outside ensures that
Following this pattern, use new gauze for cleaning occurs from the least to
each wipe, placing the used gauze in the most contaminated area and a
waste receptacle. Alternately, spray the previously cleaned area is not
wound from top to bottom with a contaminated again. Using a single
commercially prepared wound cleanser. gauze for each wipe ensures that
the previously cleaned area is not
contaminated again.
45. Once the wound is cleaned, dry the area Moisture provides a medium for
using a gauze sponge in the same manner. growth of microorganisms. The
Apply ointment or perform other treatments, growth of microorganisms may be
as ordered. inhibited and the healing process
improved with the use of ordered
ointments or other applications.
46. If a drain is in use at the wound location, Cleaning the insertion site helps
A.Y. 2021-2022
clean around the drain. (Refer to care for prevent infection.

1st SEMESTER,
Penrose drain, T-tube drain, Jackson-Pratt

drain and Hemovac drain).
47. Apply a layer of dry, sterile dressing over the Primary dressing serves as a wick
wound. Forceps may be used to apply the for drainage. Use of forceps helps
dressing. ensure that sterile technique is
maintained.
48. Place a second layer of gauze over the A second layer provides for
wound site. increased absorption of drainage.
49. Apply a surgical or abdominal pad (ABD) The dressing acts as additional
over the gauze at the site as the outermost protection for the wound against
layer of the dressing. microorganisms in the
environment.
50. Remove and discard gloves. Apply adhesive Proper disposal of gloves prevents
tape or roller gauze to secure the dressings. the spread of microorganisms.
Alternately, many commercial wound Tape or other securing products
products are self-adhesive and do not are easier to apply after gloves
require additional tape. have been removed.
51. After securing the dressing, label dressing Recording date and time provides
with date and time. Remove all remaining communication and demonstrates
equipment; place the patient in a comfortable adherence to plan of care. Proper
position, with side rails up and bed in the patient and bed positioning
lowest position. promote safety and comfort.
52. Remove PPE, if used. Perform hand Removing PPE properly reduces
hygiene. the risk for infection transmission
and contamination of other items.
Hand hygiene prevents the spread
of microorganisms.
53. Check all wound dressings every shift. More Checking dressings ensures the
frequent checks may be needed if the wound assessment of changes in patient
is more complex or dressings become condition and timely intervention to
saturated quickly. prevent complications.
DOCUMENTATION:
54. Document the location of the wound and that
the dressing was removed.
55. Record your assessment of the wound
including approximation of wound edges,
presence of sutures, staples or adhesive
closure strips, and the condition of the
surrounding skin.
56. Note if redness, edema, or drainage is
observed.
57. Document cleansing of the incision with
normal saline and any application of
antibiotic ointment as ordered.
58. Record the type of dressing that was
reapplied.
59. Note pertinent patient and family education
and any patient reaction to this procedure,
including patient’s pain level and
effectiveness of nonpharmacologic
interventions or analgesia if administered.
EVALUATION:
60. The expected outcome is met when the
patient exhibits a clean, intact wound with a
clean dressing in place.
61. The wound is free of contamination and
trauma.
62. Patient reports little to no pain or discomfort
during care.
63. Patient demonstrates signs and symptoms of
progressive wound healing.
TOTAL
/ 126

REMARKS:
____________________________________________________________________________________
A.Y. 2021-2022
____________________________________________________________________________________
1st SEMESTER,
____________________________________________________________________________________
NAME OF STUDENT:

INSTRUCTOR:
Correctly Needs
Not Done
SKILL: FIRST AID RATIONALE Done Improvement
(0)
(2) (1)
ASSESSMENT
1. Assess if the scene is safe
2. Assess the client's condition to be sure the The condition of the client may
order of the health care provider is have changed.
appropriate.
3. Assess the client's age. As pediatric/geriatric clients may
have special needs.
4. Assess the client’s understanding of the
purpose of the intervention
5. To prevent further complications
A.Y. 2021-2022
6. The client will be able to discuss the purpose

1st SEMESTER,
of the intervention
7. The client will encounter minimum
discomfort.
8. The client will receive the maximum benefit
from the intervention
9. The client will show the desired response to
the intervention such as pain relief, and
stable
MATERIALS:
10. Clean gloves
11. Ice compress
12. 0.9% normal saline
13. Sterile gauze
14. Splints
IMPLEMENTATION:
15. Put on the necessary PPE
16. Explain the procedure to patient
17. Remove watches, rings and bracelet on the To prevent any further injury cause
affected limb. And put to a properly labelled by possible swelling.
container.
BLEEDING
18. Cover the wound with a gauze or a cloth Applying a tourniquet may do more
damage to the limb than good. The
2010 American Heart Association
guidelines also discount the value
of elevation and using pressure
19. Apply direct pressure to stop the blood flow points.
20. If gauze is already soak, don't remove the Upon removal of soaked gauze,
gauze. Add more layers of gauze if needed. possibility of removing of clotted
parts in the injury. Clots help stop
the flow.
21. Remove PPE and dispose to the proper
receptacle
22. Advise patient to seek medical evaluation or
call EMS, if necessary
FRACTURES
23. Put on necessary PPE
24. Expose and examine injury
25. Don’t try to straighten it.
26. Assess the distal pulse, motor and sensory
function of the affected extremity
27. Measure splint appropriately
28. Stabilize the limb using a splint and padding
to keep it immobilized. Apply splint above
and below injury.
29. Secure splint in place
30. Reassess circulation, motor and sensory
function
31. Loosen splint and/or bandages if necessary
32. Put a cold pack on the injury, avoid placing
ice directly on the skin.
33. Elevate the extremity or the splinted part, if
possible
34. Remove PPE and dispose to the proper
receptacle
35. Advise patient to seek medical evaluation or
call EMS, if necessary
BURN
36. Remove watches, rings and bracelet on the To prevent any further injury cause
affected limb. And put to a properly labelled by possible swelling.
container.
37. Flush the burned area with cool running
water for several minutes. Do not use ice.
38. Apply a light gauze bandage. Do not break Do not apply ointments, butter, or
any blisters that may have formed. oily remedies to the burn.
39. Classify the degree and depth of a burn. Use The extent of burn, clinically
rule of nines to determine the measurement referred to as the total surface area
or extent of burn. (Lund and Browder Chart burned, is defined as the
is used for children younger than 10 years). proportion of the body burned.
40. Call EMS for serious burns The severity of burn is based on
depth and size.
NOSEBLEED
41. Ask the patient to lean forward Do not ask the patient to lean back
A.Y. 2021-2022
42. Pinch the nose just below the bridge Do not pinch the nostril closed by
1st SEMESTER,
pinching lower.
43. Check after five minutes to see if bleeding If not, continue pinching and check
has stopped. after another 10 minutes.
44. Apply cold pack to the bridge of the nose
while pinching.
45. Call EMS or bring to nearest medical center
to be assessed
EVALUATION:
46. Client was able to discuss the purpose of the
procedure
47. Bleeding was controlled, with minimal blood
loss
48. No untoward incident; fracture was
immobilized
49. For burns. Client was removed from the
source and given the appropriate treatment
50. Appropriate intervention was provided to the
client
TOTAL
/ 100

REMARKS:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
NAME OF STUDENT:

INSTRUCTOR:
SKILL: INTRADERMAL Correctly Needs

Not Done
(0)
INJECTION (2) (1)
ASSESSMENT
1. Assess the 10 Rights of Medication
Administration
3. Assess the client’s allergies to medication
4. Check the specific drug action, side effects,
interactions and adverse effects.
5. Check the appearance of injection site.
(redness, hair distribution, skin condition)
6. Assess client’s knowledge about the
A.Y. 2021-2022
1st SEMESTER,
procedure.
7. The client will experience minimal discomfort
at the injection site.
8. Medication will be administered properly.
9. The client will verbalize understanding of the
procedure.
MATERIALS:
10. 1 cc syringe or tuberculin syringe with
needle
11. Cotton balls (1 wet cotton ball, 1 dry cotton
ball)
12. Pen (black or blue)
13. Micropore
14. Sterile water or PNSS for injection
15. Medication for testing
16. Clean gloves
17. Medication Administration Record (MAR)
IMPLEMENTATION:
PREPARATION
18. Check the doctor’s order and MAR Ensures safety of the client and
19. Perform three checks for administering prevent medication error. Check
medications. Read the label on the the label on the medication
medication: carefully against the MAR.
1. When it is taken from the medication cart
2. Before withdrawing the medication
3. After withdrawing the medication.
PERFORMANCE
20. Perform hand hygiene. Don gloves.
21. Prepare the medication to be administered.
22. Prepare the client. Identify the correct patient
using two identifiers.
23. Explain the procedure to the client. Information can facilitate
•Explain that the medication will produce a acceptance of and compliance with
small wheal or bleb. (A wheal/ bleb is a the therapy.
small raised area like a blister.
•Explain that the client will feel a slight prick
as the needle enters the skin.
•Explain that once the medication is
administered, the client should not touch the
area and that it will be interpreted at a
particular time. (Medication test: after 30
minutes; Mantoux test: 24-48 hours)
24. Provide for privacy.
25. Assist/ place the client in a comfortable
position.
SKIN PREPARATION
26. Select an appropriate site.
27. Cleanse the skin at the site using a firm
circular motion starting at the center and
widening the circle outward. Allow the area to
dry thoroughly.
SYRINGE PREPARATION
28. Remove the needle cap while waiting for the
antiseptic to dry.
29. Expel any air bubbles from the syringe.
*Small bubbles that adhere to the plunger
are of no consequences.
30. Grasp the syringe in your dominant hand,
close to the hub, holding it between the
thumb and forefinger.
31. Hold the needle almost parallel to the skin
surface, with the bevel of the needle up.
INJECTION PREPARATION
32. Assist the client to a comfortable position
33. Discard the uncapped needle and syringe in
a sharps container
34. With the nondominant hand, pull the skin at Taut skin allows for easier entry of
the site until it is taut. the needle hence less discomfort
for the client.
35. Insert the tip of the needle far enough to
place the bevel through the epidermis into the
dermis. The outline of the needle should be
visible under the skin.
A.Y. 2021-2022
36. Stabilize the syringe and needle. Slowly inject

1st SEMESTER,
the medication producing the wheal/ bleb.

37. Withdraw the needle, gently wipe the Massage can disperse the
injection site with clean dry cotton. Do not medication into the tissue or out
massage the site. through the needle insertion site.
38. Dispose the syringe and needle into the Prevent needle stick injury.
sharp’s container.
DO NOT RECAP THE NEEDLE.
39. Remove and discard gloves.
40. Perform hand hygiene.
41. Encircle the wheal, note the time of injection,
name of medication and initials of the nurse.
DOCUMENTATION:
42. Document the relevant information:
medication, time, site, route and nursing
assessment.
EVALUATION:
43. Evaluate the client’s response to the
procedure. The client verbalized
understanding of the procedure.
44. Evaluate the site after 30 mins depending on
the test. Measure the area of redness and
induration.
45. The client experienced minimal discomfort
during the procedure.
TOTAL
/ 90

REMARKS:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
NAME OF STUDENT:

INSTRUCTOR:
SKILL: INTRAMUSCULAR Correctly Needs

Not Done
(0)
INJECTION (2) (1)
ASSESSMENT
1. Assess the 10 rights of giving medication
2. Review the physician’s orders
3. Review information regarding the drug
ordered such as action, purpose, time, of
onset and peak action, normal dosage,
common side effects, and nursing
implications
4. Assess the client for factors that may
influence any injection, such as circulatory
shock, reduced local tissue perfusion, or
muscle atrophy
A.Y. 2021-2022
5. Assess for previous intramuscular injections

1st SEMESTER,
6. Assess for the indications for intramuscular

injections
7. Assess the client’s age
8. Assess the client’s knowledge regarding the
medication to be received
9. Assess the client’s response to discussion
about an injection
10. Assess the client’s size and muscle
development
11. The client will experience only minimal pain
or burning at the injection site
12. The client will experience no allergic reaction
or other side effects from the injection
13. The client will be able to know and
understand the reason for taking medication
and side effects of the drugs
MATERIALS:
14. 3 cc syringe with needle (g. 23, 25)
ball)
17. Micropore
19. Medication
20. Clean gloves
IMPLEMENTATION:
PREPARATION
PERFORMANCE
acceptance of and compliance with
the therapy.
position.
SELECT, LOCATE AND CLEAN SITE
30. Select an appropriate site. If the injections changing sites can reduce the
are to be frequent, alternate the sites. discomfort of intramuscular
injections.
31. Don clean gloves.
widening the circle outward (about 5cm).
Allow the area to dry thoroughly.
SYRINGE PREPARATION
antiseptic to dry.
34. *IF USING A PRE-FILLED UNIT-DOSE Medication left on the needle can
MEDICATION: cause pain when it is tracked
Take caution to avoid dripping medication on through the subcutaneous tissue.
the needle prior to injection. If this occurs,
wipe the medication off the needle with a
sterile gauze or replace the needle.
INJECTION PROCEDURE
35. While holding the swab/ cotton ball between Pulling the skin and subcutaneous
the fingers of the nondominant hand, use the tissue or pinching the muscle make
ulnar side to pull the skin approximately it firmer and facilitates needle
2.5cm into the side, or pinch the muscle for insertion.
emaciated infant or child.
36. Hold the syringe between thumb and
forefinger using the dominant hand like a
pen/ dart.
A.Y. 2021-2022
1st SEMESTER,
37. Inject the needle quickly and smoothly at a using a quick motion lessens the
90-degree angle. client’s discomfort.
38. Hold the barrel of the syringe steady with
your nondominant hand.
39. The dominant hand will aspirate by pulling if the needle is in a small blood
back on the plunger. Aspirate for 5 – 10 vessel, it takes time for blood to
seconds. appear. If blood appears, withdraw
the needle and discard the syringe
and prepare a new set.
40. Inject the medication steadily and slowly injecting medication slowly
(approx. 10 seconds per mL) while holding promotes comfort and allows time
the syringe steadily. for tissue to expand and begin
absorption of the medication.
Holding of the syringe steadily will
minimize the discomfort.
41. Withdraw the needle quickly at the same
angle of insertion
42. With the nondominant hand, apply pressure massaging the site may cause the
on the site. Do not massage the area. leakage of the medication from the
site of injection.
43. Assist the client to comfortable position.
44. Discard the uncapped needle and syringe
into the sharp container.
45. Remove gloves and perform hand hygiene.
DOCUMENTATION:
assessment.
EVALUATION:
48. Evaluate the effectiveness of the medication
at the time it is expected to act.
TOTAL
/ 98
Clinical Instructor: ____________________________________

%
REMARKS:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
NAME OF STUDENT:

INSTRUCTOR:
Correctly Needs
SKILL: SUBCUTANEOUS Not Done
(0)
INJECTION (2) (1)
ASSESSMENT
1. Assess the 10 Rights of Medication
Administration
3. Assess the client’s allergies to medication
4. Check the specific drug action, side effects,
interactions and adverse effects.
5. Check the appearance of injection site and
tissue integrity. (redness, hair distribution,
skin condition)
6. Assess client’s knowledge about the
A.Y. 2021-2022
procedure and willingness to participate.

1st SEMESTER,
7. Previous injection sites

8. The client will experience minimal discomfort
at the injection site.
9. Medication will be administered properly.
10. The client will verbalize understanding of the
procedure.
MATERIALS:
11. 3 cc syringe with needle (g. 23, 25)
ball)
14. Micropore
16. Medication
17. Clean gloves
IMPLEMENTATION:
PREPARATION
PERFORMANCE
acceptance of and compliance with
the therapy.
position.
SELECT, LOCATE AND CLEAN THE SITE
27. Select an appropriate site. If the injections Changing sites can reduce the
are to be frequent, alternate the sites. discomfort of intramuscular
injections.
widening the circle outward (about 5cm).
Allow the area to dry thoroughly.
SYRINGE PREPARATION
antiseptic to dry.
31. *IF USING A PRE-FILLED UNIT-DOSE Medication left on the needle can
MEDICATION: cause pain when it is tracked
Take caution to avoid dripping medication on through the subcutaneous tissue.
the needle prior to injection. If this occurs,
wipe the medication off the needle with a
sterile gauze or replace the needle.
INJECTION PROCEDURE
32. Grasp the syringe in your dominant hand by
holding it between your thumb and fingers.
33. With the nondominant hand, pinch or spread
the skin at the site.
34. With palm facing to the side or upward for a
45-degree angle insertion, prepare to inject.
35. Insert the needle using the dominant hand
and a firm steady push.
36. Hold the barrel of the syringe steady with
your nondominant hand.
37. The dominant hand will aspirate by pulling
back on the plunger.
38. Inject the medication steadily and slowly Injecting medication slowly
(approx. 10 seconds per mL) while holding promotes comfort and allows time
the syringe steadily. for tissue to expand and begin
absorption of the medication.
A.Y. 2021-2022
1st SEMESTER,
Holding of the syringe steadily will

minimize the discomfort.
39. Remove the needle smoothly, pulling along Depressing the skin places counter
the line of the insertion while depressing the traction on it, minimizing the
skin with your nondominant hand. client’s discomfort when the needle
is withdrawn.
40. Apply pressure on the site with the cotton
swab.
41. Assist the client to comfortable position.
42. Discard the uncapped needle and syringe
into the sharps container.
43. Remove gloves and perform hand hygiene.
DOCUMENTATION:
assessment.
EVALUATION:
46. Evaluate the effectiveness of the medication
at the time it is expected to act.
TOTAL
/ 94

REMARKS:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
NAME OF STUDENT:

INSTRUCTOR:
Correctly Needs
Not Done
SKILL: BREAST EXAMINATION RATIONALE Done Improvement
(0)
(2) (1)
ASSESSMENT
1. Ask the client’s age, menstrual period,
number of pregnancies and lactation
2. Assess the client’s breast for obvious lumps,
nodules, or lesions
3. Assess the client’s previous breast surgeries
4. Assess the amount and color of breast
discharges
5. Assess for anxiety, restlessness and fear of
the procedure
A.Y. 2021-2022
1st SEMESTER,
6. Assess the client’s understanding of the of

the procedure
7. Procedure will be performed without trauma
to the client
8. Client’s anxiety will be minimal during
procedure
9. Client’s breast will be free of redness and
excoriation
MATERIALS:
10. Antimicrobial soap
11. water
12. Clean gloves
13. Drape sheet or blanket
14. screen
IMPLEMENTATION:
15. Identify the client, introduce yourself and
explain the procedure
16. Ask the client’s menstrual period
17. Provide privacy. Expose only the area to be
examined
18. For male examiner, ask someone to be with
while performing the procedure
19. Wash and warm hands. Don clean gloves if
necessary
20. Ask the patient to sit and raise arm over her
head (one arm at a time)
21. With the patient’s arm raised, inspect the
axilla for any rash, infection or unusual
pigmentation
22. Palpate the tail of the breast tissue and any
lymph or nodules on the axilla
23. Ask the patient to press her hands against
her hips and assess for asymmetry.
24. Lower the head of the bed and position
patient in supine
25. Place a small pillow under the patient’s
shoulder on the side you are examining
26. Ask her to raise her arms above her head
27. Begin with the lateral portion of the breast
28. Palpate one breast at a time, starting from
the tail using parallel line technique
29. Palpate in circular motion, soft to medium.
30. Use a systematic pattern to palpate the
entire breast
31. Try to identify any nodule or mass that is
larger or different from the rest of the breast
tissue
32. To examine the median portion of the
breast, position patient in supine
33. Palpate in straight line with one hand above
the shoulder between nipple and bra line
then up to the clavicle using the same
systematic pattern
34. Palpate the nipple, note for the elasticity and
check for discharges
35. Drape the breast and proceed to the other
using the same technique
MALE:
36. Inspect for symmetry and size
37. Inspect each nipple and areola for nodules
38. Check for axillary’s lymph nodes in the
same technique you used for female clients
39. Make sure male patients arm remains on
the side
40. If the breast appears to be large at the
areola, try to distinguish some fats from the
firm disc of tissue
41. Wash hands
42. Document necessary findings such as color,
contour, symmetry description of nodules
EVALUATION:
43. Presence of lymph, nodules, lesions, color,
and discharges was noted
A.Y. 2021-2022
44. Client’s anxiety was minimal during the

1st SEMESTER,
procedure
45. Procedure was performed without trauma to
the patient
TOTAL
/ 90

REMARKS:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
NAME OF STUDENT:

INSTRUCTOR:
Correctly Needs
Not Done
SKILL: LEOPOLD’S MANUEVER RATIONALE Done Improvement
(0)
(2) (1)
ASSESSMENT
51. Assessment of the maternal pelvis’ shape
52. Assess the need for cesarean section
53. Assess the presenting part into the maternal
pelvis, extent of flexion of the fetal head,
estimated fetal weight and size,
54. Determine if complication will occur during
delivery
55. Determine the fetal position in the maternal Accuracy is greatest after 36
abdomen. weeks of gestation
56. Identify the upper and lower fetal poles
A.Y. 2021-2022
namely, the proximal and distal fetal parts.

1st SEMESTER,

57. Patient verbalizes decrease discomfort
58. Patient understands the reason for the
procedure performed
59. Patient remains free from injury
60. Patient exhibits no untoward incident
MATERIALS:
61. Clean gloves
62. Soap or Alcohol
IMPLEMENTATION:
64. Perform hand hygiene and put on PPE, if Hand hygiene and PPE prevent
indicated. the spread of microorganisms.
PPE is required based on
transmission precautions.
65. Identify the patient Identifying the patient ensures the
right patient receives the
intervention and helps prevent
errors.
66. Instruct the patient to empty her bladder Patient will be comfortable and the
before the procedure. contour of the fetus is not
obscured.
67. Close curtains around bed and the door to This ensures the patient’s privacy.
room, if possible.
68. Position the patient. Back slightly elevated. Relieve the stress on the patient.
Put her in a comfortable position with her
knees flexed. Make sure the table is slightly
elevated.
69. Drape the patient and place pillow under her
head.
70. Explain the purpose of the procedure and Explanation relieves anxiety and
what you are going to do. Answer any facilitates cooperation.
questions.
71. Rub hands together vigorously. Make sure To prevent uterine contractions
that hands are warm before coming in and use the palm of the hand
contact with the patient’s abdomen. instead of the fingers.
FIRST MANEUVER (UPPER FETAL POLE)
72. Stand at the woman’s side, facing her head.
73. Palpate the uppermost part of gravid uterusThe fetal buttocks are usually at
gently, with the fingertips together, to the upper fetal pole; they feel firm
determine what fetal part is located at the
but irregular, and less globular
fundus, which is the “upper fetal pole”. than the head. The fetal head feels
firm, round, and smooth.
Occasionally, neither part is easily
palpated at the fundus, as when
the fetus is in a transverse lie.
SECOND MANEUVER (SIDES OF THE MATERNAL ABDOMEN)
74. Place one hand on each side of the woman’s By 32 weeks’ gestation, the fetal
abdomen, capturing the fetal body between back has a smooth, firm surface as
them. long or longer than the examiner’s
hand.
75. Steady the uterus with one hand and palpate The fetal arms and legs feel like
the fetus with the other, looking for the back irregular bumps. The fetus may
on one side and extremities on the other. kick if awake and active.
THIRD MANEUVER (LOWER FETAL POLE AND DESCENT INTO
PELVIS)
76. Face the woman’s feet.
77. Place the flat palmar surfaces of the Again, the fetal head feels very
fingertips on the fetal pole just above the firm and globular; the buttocks feel
pubic symphysis. firm but irregular, and less globular
78. Palpate the presenting fetal part for texture than the head.
and firmness to distinguish the head from the
buttock. In a vertex or cephalic
79. Judge the descent, or engagement, of the presentation, the fetal head is the
presenting part into the maternal pelvis. presenting part.
80. Alternatively, use the Pawlik grip by grasping
the lower fetal pole with the thumb and If the most distal part of the lower
fingers of one hand to assess the presenting fetal pole cannot be palpated, it is
part and descent into pelvis; however, this usually engaged in the pelvis.
technique tends to be uncomfortable to the
gravid patient. If you can depress the tissues over
the maternal bladder without
touching the fetus, the presenting
part is proximal to your fingers.
A.Y. 2021-2022
FOURTH MANEUVER (FLEXION OF THE FETAL HEAD)

1st SEMESTER,
81. This maneuver assesses the flexion or If the cephalic prominence juts out
extension of the fetal head, presuming that along the line of the fetal back, the
the fetal head is the presenting part in the head is extended.
pelvis.
82. Still facing the woman’s feet, with your hands If the cephalic prominence juts out
positioned on either side of the gravid uterus, along the line of the fetal anterior
identify the fetal front and back sides. side, the head is flexed.
83. Using one hand at a time, slide your fingers
down each side of the fetal body until you
reach the “cephalic prominence,” that is,
where the fetal brow or occiput juts out.
EVALUATION:
84. Patient verbalizes knowledge regarding the
procedure
85. No untoward incident for both patient
86. Patient remains free from injury
87. Patient tolerate the procedure
TOTAL
/ 74

REMARKS:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
NAME OF STUDENT:
YEAR/SECTION: COMMUNITY HEALTH NURSING 1

CHECKLISTS
SUMMARY OF GRADES
RAW TOTAL PASSED/ CI’s STUDENT’s

ACTIVITY NAME %
SCORE SCORE FAILED SIGNATURE Signature
Bag Technique
Cleaning a Wound and

Applying Sterile
Dressings
A.Y. 2021-2022
1st SEMESTER,
First Aid
Intradermal Injection
Intramuscular Injection
Subcutaneous
Injections
Breast Examination
Leopold’s Maneuver
TOTAL
___________________________________
STUDENT’S NAME AND SIGNATURE
YEAR/GROUP/SECTION: __________
A.Y. 2021-2022
NP 7 - Care of Mother,
1st SEMESTER,
Child, Adolescent
(Well Client)
NAME OF STUDENT:

INSTRUCTOR:
SKILL: ORAL, BUCCAL, AND Correctly Needs

Not Done
SUBLINGUAL MEDICATION RATIONALE Done Improvement
(0)
(2) (1)
ADMINISTRATION
ASSESSMENT
88. Assess for the 10 rights in medication To avoid medication administration
administration. errors.
89. Review the action, purpose, normal dosage So that the client’s response to the
and route, common side effects, time of medication will be monitored.
onset and peak action and nursing
implications of each drug.
90. Assess the client's condition to be sure the The condition of the client may
order of the health care provider is have changed.
appropriate.
91. Assess the client's ability to swallow food To determine the need for an
A.Y. 2021-2022
and fluid. alternate route for medication

1st SEMESTER,
administration.
92. Assess for any contraindications for Alteration in gastrointestinal
administering oral medication such as function may interfere with drug
nausea and vomiting, gastric suction or absorption and excretion.
gastric surgery.
93. Assess the client's medical record for a To avoid these medications.
history of allergies to food or medications.
94. Assess the client's knowledge about the use So client teaching can be tailored
of medications. to his/her needs as well assessing
compliance for taking the drugs at
home or reveal drug dependence
or abuse.
95. Assess the client's age. As pediatric/geriatric clients may
have special needs according to
their ability to swallow a pill.
96. Assess the client's need for fluids. Swallowing a pill is usually easier
with fluids.
97. Assess the client's ability to sit or turn to the The client must be able to swallow
side. the pill without aspiration.
98. The client will swallow the prescribed
medication.
99. The client will be able to explain the purpose
and schedule for taking the medication.
100. The client will have no gastrointestinal
discomfort or alterations in function.
101. The client will show the desired response to
the medication such as pain relief, regular
heart rate, or stable blood pressure.
MATERIALS:
102. Medication: tablet, capsule, or liquid from a
bottle or unit dose.
103. medication tray/ cart
104. Measuring spoon, calibrated dropper,
medicine cup or straw
105. glass of water
107. mortar and pestle or pill cutter
108. paper towels
109. clean gloves
IMPLEMENTATION:
110. Gather all the materials needed. Arrange the Organizing medications and
medication tray and cups at the medication equipment saves time and reduces
room. the possibility of error.
111. Wash hands and wear gloves. Reduces the transfer of
microorganisms.
112. Prepare the medication for one client at a Comparing the MAR with the label
time following the 10 rights. Select the reduces error.
correct drug according to the MAR.
To prepare the tablet or capsule:
113. Pour the required number of tablets or Avoids wasting expensive
capsules into the bottle cap and transfer it to medications and avoids
the medication cup without touching them. contamination of medication.
114. Scored tablets may be broken, if necessary, Tablets that are not scored are not
using gloved hands or with a pill cutting meant to be broken as this would
device. reduce the effectiveness of the
tablet.
115. Unit dose tablet should be placed directly The wrapper maintains cleanliness
into the medicine cup without opening it until and identification until it is
it is administered to the client. administered.
116. For clients with difficulty in swallowing, some A large tablet is usually easier to
tablets may be crushed into a powder using swallow if it is ground and mixed
a mortar and pestle then mixed in a small with soft food.
amount of soft foods.
To prepare a liquid medication:
117. Remove the bottle cap from the container Placing the bottle cap upside down
and place cap upside down on the cart. prevents contamination of the
inside of the container.
Hold the bottle with the label up and the Holding the bottle with the label up
medication cup at eye level while pouring. keeps spilled liquid from
obliterating the label.
A.Y. 2021-2022
1st SEMESTER,
Fill the cup to the desired level using the Holding the medication cup at eye
surface or base of the meniscus as the level ensures accurate dose.
scale, not the edge of the liquid cup.
Wipe lip of bottle with paper towel. Wiping the lid of the bottle prevents
the bottle cap from sticking.
118. Double-check the MAR with the prepared Reduces error; ensures
drugs. Place the MAR with the client’s identification and safety of the
medications and do not leave the drugs medications.
unattended.
Administration of medication:
119. Via oral route
120. Observe the correct time to give the Ensures the therapeutic effect of
medication. Identify the client. the drug. To confirm that the
medication will be given to the right
client.
121. Check the drug packaging if it is present to Prevents giving the wrong
ensure the medication type and dosage. medication or wrong dose.
122. Reassess the client's condition and form of Allows the nurse to determine the
the medication. route of administration and to know
if this route is appropriate.
123. Explain the purpose of the drug and ask if Improves compliance with drug
the client has any questions. therapy.
124. Assist the client to a sitting or fowler's Prevents aspiration during
position. swallowing.
125. Allow the client to hold the medication cup or So that the client becomes familiar
tablet. with medications.
126. Instruct the client to place the medication in Promotes client comfort in
the mouth and swallow when able to do so. swallowing the medication.
Give a glass of water or other liquid and
straw, if needed.
For sublingual medication:
127. Instruct client to place medication under the Drug is absorbed through the
tongue and allow it to dissolve completely. mucous membranes into the blood
vessels so that if it swallowed, the
drug may be destroyed by gastric
juices.
For buccal medication:
128. Instruct client to place the medication in the Promotes local activity on mucous
mouth against the cheek until it dissolves membranes.
completely.
For medication given thru NGT:
129. Crush tablet or open capsules and dissolve Allows medication administration
powder with 20 to 30 ml of warm water in a via NGT or feeding tube. Ensures
cup. Check placement of the feeding tube that the medication is absorbed
before instilling anything into the tube. and utilized correctly.
130. Remain with the client until each medication To ensure the client receives the
has been swallowed or dissolved. dose and does not save it or
discard it.
131. Assist the client into a comfortable position. Maintains client’s comfort.
132. Remove gloves and dispose of soiled Reduces transfer of
supplies. microorganisms.
133. Document the administration on the MAR. Prevents administration error.
134. Clean the work area. Wash hands. Reduces transmission of
microorganisms.
EVALUATION:
135. The client was able to swallow the
prescribed medication.
136. The client was able to explain the purpose
and schedule for taking the medication.
137. The client has no gastrointestinal discomfort
or alteration in function.
138. The client showed the desired response to
the medication such as pain relief, regular
heart rate, or stable blood pressure.
TOTAL
/ 102

A.Y. 2021-2022
REMARKS:
1st SEMESTER,
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
NAME OF STUDENT:

INSTRUCTOR:
SKILL: ADMINISTRATING EYE (OPTIC) Correctly Needs

Not Done
(0)
AND EAR (OTIC) MEDICATIONS (2) (1)
ASSESSMENT
1. Assess the 10 rights of medications. Prevent errors in medication
administration.
2. Assess the client's eye and ear condition. Reassessing the client prior to
every medication dose prevents
possibly injuring the client.
3. Assess the medication order for what part of Prevents error in medication
the eye or ear. administration.
4. The client will receive the right dose,
A.Y. 2021-2022
medication, dosage, route and time.

1st SEMESTER,
5. The client will encounter minimum discomfort

during the administration.
from the medication.
MATERIALS:
7. eye and ear medication
8. clean gloves
9. Tissue
10. medication tray
11. MAR
IMPLEMENTATION:
12. Verify physician’s order
13. Assemble all the materials needed. Promotes efficiency.
14. Identify your client. Introduce yourself.
Explain the procedure
15. Place client in supine or sitting position.
16. Wash hands. Wear gloves. Decrease contact with bodily fluids.
Instilling eye drops and ointment:
17. Remove cap from the eye medication bottle Prevents contamination of the
and place on its side at the medication tray. bottle cap / medication.
18. Instruct the client to look up and slightly tilt The cornea is protected as client
the head. looks up and reduces stimulation
of blink reflex.
19. With the non-dominant hand, hold the upper To expose the conjunctival sac.
and lower eyelid with the thumb and index
finger
20. With the dominant hand, hold the eye Reduces risk of touching the eye
medication ½ to ¾ inch above the eyeball; structure and causing injury. Rest
rest hand on client’s forehead. the hands on client’s forehead to
stabilize.
21. Holding the eye medication, squeeze the Prevents injury to the cornea.
prescribed drop/s of medication on the lower
conjunctival sac. If administering eye
ointment, apply from inner to outer canthus.
22. Instruct the client to close eyes gently and Distributes solution over
blink several times. conjunctival surface and anterior
eyeball
23. Apply gentle pressure over the opening to Nasal occlusion prevents systemic
the nasolacrimal duct. absorption of medication through
the mucous membrane of the
nose.
24. Provide the patient with a clean tissue to be A clean tissue may be used to
placed below the lower lid absorb the medication that may
escape from the eye and roll down
the face.
25. Remove gloves. Wash hands. Reduces transmission of
microorganisms.
26. Record on the MAR the route, site (which Provide documentation that the
eye), time administered. medication was given.
Instilling ear drops:
27. Follow steps from 12 to 16.
28. Place client’s face on the side with the This prevents loss of any
affected ear. medication from the effect of
gravity.
29. Straighten ear canal by pulling the pinna Straightening the ear canal helps
down and back for children and upward and the medication to reach the lowest
outward in adults. area of the ear canal and become
distributed over all the surfaces in
the outer ear.
30. Instill the drops into the ear canal by holding Touching the tip of the dropper to
the dropper at ½ inch above the ear canal. the skin contaminates the dropper.
31. Ask the client to maintain the position for 2-3 Maintaining the position allows
minutes then place on comfortable position. time for medication to flow into the
lowest area of the ear canal,
avoiding the possibility of
excessive loss from the ear.
32. Remove gloves. Wash hands. Reduces the transmission of
microorganisms.
EVALUATION:
33. The client received the right dose,
medication, route and time.
34. The client encountered minimum discomfort
35. The client received the maximum benefit
A.Y. 2021-2022
1st SEMESTER,

TOTAL
/ 70

REMARKS:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
NAME OF STUDENT:

INSTRUCTOR:
SKILL: ADMINISTERING VAGINAL AND Correctly Needs

Not Done
(0)
RECTAL SUPPOSITORIES (2) (1)
ASSESSMENT
1. Assess the ten rights of medication To prevent medication
administration. administration error.
2. Assess the client's need and Allows nurse to determine
appropriateness for rectal and vaginal effectiveness of the medication.
medication.
3. Consider any adjustment that maybe taken.
4. Observe the client for desired therapeutic
effect or adverse reactions.
A.Y. 2021-2022
5. The client will receive the right medication,

1st SEMESTER,
dose, route and time.

6. The client will encounter minimum discomfort
MATERIALS:
8. vaginal / rectal suppositories
9. clean gloves
10. tissue
11. medication tray
12. underpad
IMPLEMENTATION:
13. Verify physician’s order. To ensure safe and accurate
administration of medication.
14. Assemble the materials needed. Prevents numerous trips to gather
supplies and helps the procedure
flow smoothly.
15. Identify your client. Introduce yourself. Ensures correct client.
Explain the procedure to the client.
16. Provide privacy, adequate lighting and lower The patient should be protected
the side rails. from being viewed by others during
any procedure. Good light
facilitates better visualization.
17. Wash hands and wear gloves. Gloves acts as barrier from contact
with stool with vaginal discharges
and/or fecal matters.
Administering vaginal suppository:
18. Ask the patient whether she needs to void A full bladder may cause
prior to inserting medications within the discomfort during insertion, or
vagina. patient may wish to get up too
soon after the drug has been
administered.
19. Remove underwear and place client in This position helps when locating
dorsal recumbent with buttocks elevated and the vaginal orifice for proper
expose the perineum. insertion of the medication.
20. Assess the client's peri-anal skin condition. To assess the need for perineal
care prior to medication
administration.
21. Spread the labia with the non-dominant hand The opening to the vagina is best
while holding the medication with the other visualized when the labia are
hand. retracted.
22. Instruct the client to take slow deep breaths To relax the sphincter muscle and
(inhale through the nose and exhale through
the mouth) while inserting the suppository prevent expulsion.
and tell the patient that she will experience a
cool sensation and pressure during
administration.
23. Advance the medication further by pushing it To avoid expelling the suppository.
with your little finger.
24. Instruct the client to hold medication and Retaining the suppository allows
remain in lying position for 15-30 minutes. time to achieve maximal effect
25. Wash hands. To prevent the spread infection.
26. Document procedure. Communicates with other
healthcare team the effectives of
treatment.
Administering rectal suppository:
27. Place client in left lateral position for rectal To facilitate adequate viewing and
suppository. easy insertion of suppository.
28. Place side rails up. To ensure safety of the client.
29. Drape the client. To maintain privacy.
30. Bring materials to bed side and provide Prevents numerous trips to gather
adequate lighting. supplies and helps the procedure
flow smoothly.
31. Lower side rails. To facilitate easy access to the
client.
32. Place patient comfortably in side lying The descending colon is on the left
position. side; this is a more anatomically
correct position.
33. Expose patient's buttocks and assess the To assess the need for perineal
client’s peri-anal skin condition. care prior to medication
administration.
34. Wash hands and apply gloves. Gloves acts as barrier from contact
with stool within the rectum.
35. Open the medication package. To expose the medication from the
A.Y. 2021-2022
wrapper.
1st SEMESTER,
36. Instruct the client to take slow deep breath. To relax the sphincter muscle and
Inhale thru the nose and exhale thru the
mouth while inserting the suppository and tell prevent expulsion.
patient that he/she will experience cool
sensation and pressure during
administration.
37. In administering rectal suppository, spread Anus is best visualized when
the buttocks with non-dominant hand while buttocks are retracted.
holding the medication with the other hand.
38. Slowly and gently advance the medication Slow insertion minimizes pain.
further by pushing it with your little finger Correct placement ensures
past the anal sphincter. adequate absorption and less
chance for expulsion of
medication.
39. Remove gloves. Reduces transfer of
microorganisms.
40. Instruct patient to hold medication and Retaining the suppository allows
remain in lying for 15-30 minutes. time to achieve maximal effect
41. Raise side rails and turn off the drop light. To ensure safety of the client.
42. Wash hands. To prevent the spread infection.
43. Document procedure. Communicates with other
healthcare team the effectives of
treatment.
EVALUATION:
44. The client received the right medication,
dose route and time.
45. The client encountered minimum discomfort
46. The client received the maximum benefit
TOTAL
/ 92

REMARKS:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
NAME OF STUDENT:

INSTRUCTOR:
Correctly Needs
Not Done
SKILL: OXYGEN ADMINISTRATION RATIONALE Done Improvement
(0)
(2) (1)
ASSESSMENT
1. Assess environment for oxygen safety
administration.
2. Assess immediate respiratory status.
3. Identify type of oxygen equipment and
source.
4. Ensure proper concentration of oxygen.
5. Provide for adequate O2 humidification.
6. Ensure a patent airway.
A.Y. 2021-2022
7. Observe the client's reaction to 0₂ therapy.

1st SEMESTER,
8. Ensure the client's comfort.

MATERIALS:
9. oxygen apparatus or source
10. oxygen flow meter with humidifier
11. Nasal cannula
12. Face mask
13. Clean gloves
14. Penlight
IMPLEMENTATION:
15. Verify physician’s order for the procedure.
16. Gather all the materials needed.
17. Identify client and introduce self. Explain
procedure.
18. Place client on semi-fowler’s position.
19. Wash hands. Wear gloves. Assess the
nostrils and mouth
20. Fill the humidifier with H20
21. Attach the oxygen supply tubing to the O₂
equipment.
22. Turn on the oxygen and test for flow.
Administer O₂ flow via nasal cannula as
ordered or until 5-6 liters per minute (LPM)
only. Administer O₂ flow via face mask as
ordered or until 10-15 LPM.
23. Position the oxygen equipment properly onto
the client.
24. Explain safety precautions to the client and
significant others.
25. Stay with the client until you are sure that the
flow is maintained and the client is stable.
26. Wash hands.
EVALUATION:
27. Client’s breathing pattern is regular and in
normal rate.
28. Client is free of cyanosis.
29. Client is resting comfortably.
30. Arterial blood gas values are within normal
limits.
31. No disorientation, confusion and difficulty or
cognition.
TOTAL
/ 62
REMARKS: %
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
A.Y. 2021-2022
1st SEMESTER,
NAME OF STUDENT:

INSTRUCTOR:
Correctly Needs
Not Done
SKILL: EINC RATIONALE Done Improvement
(0)
(2) (1)
1. In advance, prepare decontamination

solution by mixing 1 part 5% chlorine
bleach to 9 parts water to make 0.5%
chlorine solution. Change chlorine solution at
the beginning of each day or whatever
solution is very contaminated or cloudy.
PRIOR TO WOMAN’S TRANSFER TO THE DELIVERY ROOM
2. Ensured that mother is in her position of
choice while in labor
3. Asked mother if she wishes to eat/drink or
A.Y. 2021-2022
void
1st SEMESTER,
4. Communicated with the mother-informed her

of progress of labor, reassurance and
encouragement
WOMAN ALREADY IN THE DELIVERY ROOM
PREPARING FOR DELIVERY
5. Checked temperature in DR area to be 25-
28 Celsius eliminating air draft
6. Asked the woman if she comfortable in the
semi-upright position (the default position of
delivery table)
7. Ensured the woman’s privacy
8. Removed all jewelry, then washed hands
thoroughly observe WHO 1-2-3-4-5-
procedure
9. Prepare a clean newborn resuscitation area.
Checked the equipment if clean, functional
and within easy reach
10. Arranged materials/ supplies in a linear
sequence
11. Gloves, dry linen, bonnet, oxytocin injection,
plastic clamp, instrument clamp, scissors, 2
kidney basins,
12. In separate sequence, for after the 1st
breastfeed:
13. Eye ointment, stethoscope, to symbolize
PE), vit k, hepatitis B, and BCG vaccines
(plus cotton balls etc.)
14. Cleaned perineum with antiseptic solution
15. Washed hands and put on 2 pairs of sterile
gloves aseptically. (If same worker handles
perineum and cord)
AT THE TIME OF DELIVERY
16. Encouraged woman to push as desired.
17. Draped the clean dry linen over the mother’s
abdomen or arms in preparation for drying
the baby.
18. Applied perineal support and did controlled
delivery of the head
19. Called out time of birth and sex of baby
20. Informed the mother of outcome
1-3 MINUTES
21. Removed the wet cloth
22. Placed baby in skin to skin contact on the
mother’s abdomen or chest
23. Covered baby with dry cloth and the baby’s
head with a bonnet
24. Excluded a 2nd baby by palpating the
abdomen in preparation for giving oxytocin
25. Used wet cloth to wipe the soiled gloves.
Give IM oxytocin within 1 minute of baby’s
birth. Disposed of wet cloth properly.
26. Removed first set of gloves and
decontaminated them properly (in
0.5%chlorine solution in 10 mins.)
27. Palpated umbilical cord to check for
pulsations
28. After pulsation stopped, clamped cord using
the plastic cord or cord tie 2 cm. from the
base.
29. Placed the instrument clamp 5 cm. from the
base.
30. Cut near plastic clamp not midway
31. Performed the remaining steps
32. Waited for a strong uterine contraction then
applied controlled cord traction and counter
traction on the uterus, continuing until
placenta was delivered.
33. Massaged uterus until it is firm
34. Inspect lower vagina and perineum for
lacerations/tears and repaired
lacerations/tears necessary
35. Examined the place for completeness and
abnormalities
A.Y. 2021-2022
36. Cleaned the mother, flushed the perineum

1st SEMESTER,
and applied perineal pad/cloth
37. Checked the baby’s color and breathing;

checked that mother was comfortable, uterus
contracted.
38. Disposed of the placenta in a leak-proof
container or plastic bag.
39. Decontaminated (soaked in 0.5% chlorine
solution) before cleaning, decontaminated
2nd pair of gloves before disposal, stating
that decontamination lasts for at least 10
mins.
40. Advised mother to maintain skin to skin
contact. Baby should be prone on mother’s
chest/ in between the breasts with the head
turned to side
15-90 MINUTES
41. Advised mother to observe for feeding cues
(cited examples of feeding cues)
42. Supported mother, instructed her on
positioning and attachment
43. Waited for FULL BREASTFEED to be
completed
44. After complete breastfeed, administered eye
ointment (first), did thorough physical
examination, then give Vit K, hepatitis B
and BCG injections (simultaneously
explained purpose of each intervention)
45. Advised OPTIONAL DELAYED bathing of
baby (and was able to explain the rationale)
46. Advised breastfeeding per demand
47. In the first hour, checked baby’s breathing
and color and checked mother’s vital signs
and massaged uterus every 15 minutes.
48. In the second hour, checked mother-baby
dyad every 30 minutes to 1 hour
49. Completed all RECORDS.
50. Advised mother to observe for feeding cues
(cited examples of feeding cues)
TOTAL
/ 100
REMARKS: %
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
A.Y. 2021-2022
1st SEMESTER,
NAME OF STUDENT:

INSTRUCTOR:
SKILL: ENEMA Correctly Needs

Not Done
(0)
ADMINISTRATION (2) (1)
ASSESSMENT
1. Assess the patient when was the last bowel
movement and the amount, color and
consistency of the feces.
2. Presence of abdominal distention Distended abdomen appears
swollen and feels firm rather than
soft when palpated.
3. Assess whether the patient has sphincter
control.
4. Assess whether the patient can use a toilet
A.Y. 2021-2022
or commode or must remain in bed and use

1st SEMESTER,
a bed pan.
5. The patient verbalizes decreased discomfort
and abdominal distention.
6. The patient remains free of any evidence of
trauma to rectal mucosa or other adverse
effect.
MATERIALS:
7. Clean gloves
8. Linen, pads or paper towels
9. Tubing clamp
10. Enema Solution
IMPLEMENTATION:
11. Verify doctor’s order and gather the To identify the right patient and
equipment conserves energy and time.
12. For large-volume enema: Solution container
with tubing of correct size and tubing clamp,
ensure correct solution, amount and
temperature.
13. For small-volume enema: Prepackage
container of enema solution with lubricated
tip.
14. Identify the patient, introduce yourself and
explain the procedure.
15. Perform hand hygiene and put on PPE’s To ensure the right patient and
provide patient cooperation
To prevent transmission of
microorganism.
16. Provide patient privacy, lower the side rails of
the bed.
17. Lubricate about 5cm (2inch) of the rectal To facilitates insertion through the
tube. sphincters and minimizes trauma.
18. Run some solution through the connecting Air instilled into the rectum may
tubing of a large-volume enema set and cause unnecessary distention.
rectal tube to expel any air in the tubing.
19. Assist adult patient to a left lateral position This position facilitates the flow of
with right leg as acutely flexed as possible. solution by gravity into the sigmoid
colon and descending colon.
Having right leg flexed provides for
adequate exposure of the anus.
20. Insert the enema tube:
A. For patient in the left lateral position, lift the
upper buttock to ensure good visualization of
the anus.
B. Insert the tube smoothly and slow into the The angle follows the normal
rectum, directing it toward the umbilicus. contour of the rectum. Slow
C. Insert the tube 7 to 10 cm (3 to 4 in) into insertion prevents spasm of the
the anal canal. sphincter.
D. If resistance is encountered at the internal Anal canal is about 2.5 to 5 cm
sphincter, ask the client to take a deep long in the adult.
breath then run a small amount of solution
through the tube to relax the internal anal
sphincter.
21. Never force tube or solution entry. Withdraw
the tube. Check for any stool that have
blocked the tube during insertion.
22. Slowly administer the enema solution: The higher the solution container is
A. Compress a pliable container by hand. held above the rectum, the faster
B. During low enemas: Hold or hang the the flow and the greater the force
solution container no higher than 30 cm pressure in the rectum.
(12inch) above the rectum.
C. During high enemas: Hang the solution The fluid must be instilled farther to
container about 45 cm (18inch). clean the entire bowel.
23. Administer fluid slowly, if the patient Administering enema slowly and
complains of fullness or pain, lower the stopping the flow momentarily
container or use the clamp to stop the flow decreases the like hood of
for 30 seconds, then restart the flow at a intestinal spasm and premature
slower rate. ejection of solution.
24. If you are using a plastic commercial
container, roll it up as the fluid is instilled.
This prevents subsequent suctioning of
solution.
25. After the solution has been instilled or when
the patient cannot hold any more and feels
A.Y. 2021-2022
1st SEMESTER,
the desire to defecate; close the clamp and

remove the enema tube from the anus.
Place enema tube in a disposable towel as
you withdraw it.
26. Ask the patient to remain lying down. It is Because gravity promotes
easier for the patient to retain enema when drainage and peristalsis.
lying down than sitting or standing.
27. Request the patient retain the solution for This amount of time usually allows
appropriate amount of time, 5 to 10 minutes muscle contractions become
for cleansing enema or at least 30 minutes sufficient to produce good result.
for retention enema. Promotes comfort.
28. Assist the patient to defecate.
29. Assist the patient returned to bed and raise
side rails afterwards
30. Document amount and type of enema
solution used; amount, consistency and color
of stool.
31. Verify doctor’s order and gather the To identify the right patient and
equipment conserves energy and time.
EVALUATION:
32. The patient verbalizes decreased discomfort
and abdominal distention.
33. Patient remain free from any evidence of
trauma to rectal mucosa.
34. Patient verbalizes knowledge after the
procedure.
TOTAL
/ 68

REMARKS:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
NAME OF STUDENT:

INSTRUCTOR:
Correctly Needs
Not Done
SKILL: SURGICAL HANDWASHING RATIONALE Done Improvement
(0)
(2) (1)
ASSESSMENT
1. Prepare yourself.
2. Put on-surgical attire (scrub suit garment).
3. Put on surgical cap or hood, mask and shoe

covers.
4. Remove watches, rings and bracelets.
5. Remove nail polish or artificial nails if worn,

A.Y. 2021-2022
and trim nails so they are no longer in length

1st SEMESTER,
than the fingers.

6. To perform the scrubbing technique
aseptically.
7. To prevent transfer of pathogens to patient.
8. To perform the scrubbing technique within 8-
10 minutes only.
MATERIALS:
9. Liquid cleanser solution
10. Sterile scrub brush
11. Surgical cap or hood
12. Shoe coverings / new slip-on shoes
13. Surgical mask
14. Sterile towel
IMPLEMENTATION:
17. Turn on water faucet and check for water’s
temperature.
18. Moisten hands and arms with liquid cleanser

solution.
19. Lather hands and arms for 1 minute with
antiseptic solution (betadine soap/phisohex)
20. Rinse hands and arms (finger tips first, then

palms, hands, wrist to elbow) until the suds
perished.
21. Keep hands higher than the elbows. Water

drips should be in the elbow area.
22. Remove sterile brush from dispenser / sterile
pack and start scrubbing.
Counted Brush-Stroke Method:

23. Add liquid cleanser to sterile brush if
necessary.
24. Scrub nails to left hand 30 strokes and all

skin surfaces 20 strokes using anatomical
position.
25. Scrub over dorsal surface of the hand.
26. Scrub over palmar surface of the hand.
27. Scrub over the wrist.
28. Scrub up in the arm in thirds, ending 2
inches above the elbow.
29. Repeat step 24 to 28 in the right hand and
arms.
EVALUATION:
30. Confirm that the scrubbing procedure is from
8-10 minutes only.
31. Confirm that the scrubbing procedure is
done aseptically.
32. Confirm that right stroke and technique are
practiced.
TOTAL
/ 64

REMARKS:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
A.Y. 2021-2022
1st SEMESTER,
NAME OF STUDENT:

INSTRUCTOR:
SKILL: GOWNING AND GLOVING Correctly Needs

Not Done
(0)
(CLOSED METHOD) (2) (1)
ASSESSMENT
1. Assess the surrounding environment.
2. Assess the condition of your hands.
3. The caregiver will don a sterile gown and
gloves without compromising their sterility.
MATERIALS:
4. Sterile gown
5. Clean face mask
A.Y. 2021-2022
1st SEMESTER,
6. Sterile gloves
IMPLEMENTATION:
Gowning:
7. Perform surgical handwashing.
8. The sterile gown comes folded inside out

Grasp the gown using the lower portion of
the gown. Pat dry hands, wrist to forearms
to elbow. Unfold the gown(upright manner )
to expose the neckline. Hold the neckline of
the gown and locate for the sleeves.
9. Slip both arms into the sleeves; keep your
hands inside the sleeves of the gown and fit
in the gown.
10. Keep hands above the waist.
11. The circulating nurse will secure the ties at

the neck and waist.
Closed Gloving:
12. With hands still inside the gown sleeves,
open the inner wrapper of the sterile gloves.
13. With your non-dominant sleeved hand,

place the palm of the dominant hand glove
over the sleeved palm of the dominant
hand.
14. Manipulate the glove cuff with your

dominant, sleeved thumb. With your non-
dominant hand, turn the cuff over the end of
dominant hand and gown’s cuff.
15. With sleeved non-dominant hand, grasp the

cuff of the glove and the gown’s sleeve of
the dominant hand; slowly extend the
fingers in the glove, making sure the cuff of
the glove remains above the cuff of the
gown’s sleeve.
16. With your dominant sleeved hand, place the

palm of the non-dominant hand glove inside
the sleeved palm of the non-dominant hand.
17. Manipulate the glove cuff with your non-

dominant, sleeved thumb. With your
dominant hand, turn the cuff over the end of
non-dominant hand and gown’s cuff.
18. With sleeved dominant hand, grasp the cuff

of the glove and the gown’s sleeve of the
non-dominant hand; slowly extend the
fingers in the glove, making sure the cuff of
the glove remains above the cuff of the
gown’s sleeve.
19. Interlock gloved fingers and secure fit.
TOTAL
/ 38

REMARKS:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
A.Y. 2021-2022
1st SEMESTER,
NAME OF STUDENT:

INSTRUCTOR:
SKILL: SKIN PREPARATION Correctly Needs

Not Done
(0)
FOR SURGERY (2) (1)
ASSESSMENT
1. Determine the area to be shaved. Allows the nurse to verify the
appropriateness of the type of
enema ordered
2. Assess the physical condition of the client. Allows the nurse to plan the
Determine if the client has bowel sounds. procedure with the client’s
Assess for history of constipation, limitations in mind.
hemorrhoids or diverticulitis.
3. Assess the client’s mental state, including To ensure if the client can
ability to understand and cooperate with the comprehend and cooperate with
A.Y. 2021-2022
procedure. the procedures.

1st SEMESTER,

4. Area to be shaved depends upon the nature
of the operation.
5. Area is shaved thoroughly and sufficiently on
wide body areas than small operative sites.
6. No signs of skin eruptions noted which may
serve as potential site of infection.
7. Excess and visible hair be removed.
8. To render the operative site as free as
possible from bacteria.
9. Surgical incision can be made with a
minimum danger of infection.
MATERIALS:
10. Razor/Blade
11. Kidney Basin
12. Gauze or Cotton balls
13. Cotton applicator
14. Drape and Patient Gown
15. Soap
16. Pick-up forceps
17. Flashlight / Goose Lamp
18. Tissue
19. Clean and Sterile Gloves
20. Face mask & Surgical Cap
21. Povidone Iodine
OPERATIVE FIELD AND AREAS TO BE SHAVED/SKIN PREP:
22. Cranial Operation
a. Head or per doctor’s order
23. Chest
a. Shaved the affected side from posterior
supine to beyond anterior midline.
From clavicle to umbilicus
24. Breast Surgery
a. From axilla on affected side
b. Clavicle line to umbilicus
c. Anterior Midline to Posterior midline
Arm to elbow
25. Abdomen
a. From nipple line (below breast in
female) to pubic area
b. Laterally to anterior axillary lines
Cleanse umbilicus with applicator
26. Lower bowel and rectum
a. Umbilical line to medial thigh
Lumbar region to medial thigh
27. Neck (Thyroid)
a. Anterior neck up to lateral neck line
b. Mandible
Top of shoulders to chest almost to nipple
lines
28. Vaginal
a. Pubic area
Perineum and adjacent areas – include the
inner aspect of the upper third of thighs
IMPLEMENTATION:
29. Verify order for shaving and skin prep.
30. Check the client’s identification, introduce
yourself and explain the procedure.
31. Provide privacy. Screen patient.
32. Wash hands and wear clean gloves.
33. Remove or raise patient’s gown up as
indicated. Drape adequately.
34. Place towel under area being shaved.
35. Lather area freely with soap or any detergent
36. Using razor, remove the hair with one hand
while stretching the skin with other.
37. Hold razor about 30°-40° angles to the skin.
Use long gentle strokes, pulling razor in the
direction in which the hair grows. Remove
repeatedly the excess hair from razor with
tissue paper.
38. Inspect skin under direct light to make
certain it is free of all hair. On areas where
A.Y. 2021-2022
hair is barely visible inspect skin by

1st SEMESTER,
continually bending forward so that the eyes

are on level with the skin.
39. After hair is removed, clean with soap and /
or antiseptic solution. Avoid vigorous
rubbing.
40. Rinse skin with warm water and dry.
41. Put patient’s gown and keep comfortable.
42. Document the time, area prepared,
observation on the condition of the skin.
EVALUATION:
43. Area shaved was appropriate upon the
nature of the operation.
44. Area shaved was thoroughly and sufficiently
on wide body areas of operative site.
45. No signs of skin eruptions were.
46. Excess and visible hair was removed.
47. Operative site is free as possible from
bacteria.
48. Surgical incision was made with a minimum
danger of infection.
TOTAL
/ 98

REMARKS:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
NAME OF STUDENT:

INSTRUCTOR:
SKILL: URINARY CATHETERIZATION Correctly Needs

Not Done
(0)
(MALE & FEMALE) (2) (1)
ASSESSMENT
1. Assess the need for catheterization. To make certain the procedure is
appropriate for the client’s
condition.
2. Determine the type of catheterization To ensure the proper procedure is
ordered. carried out.
3. Assess the ability of the client to perform To reduce the transmission of
perineal wash before catheterization. microorganisms.
To promote independence and
cooperation.
A.Y. 2021-2022
4. Assess if the client can tolerate supine or To facilitate visualization of the

1st SEMESTER,
dorsal recumbent position perineum and determine if the

client can hold still during the
procedure.
5. Observe for indication of distress or To determine what teaching and
embarrassment. support are needed.
6. Determine adequate lighting. Good lighting is necessary for
proper visualization of the meatus.
7. Inspect the urinary meatus’ condition and Determine any history of difficulty
determine any allergies to povidone-iodine or and avoid potential complications
latex of catheterization.
8. The catheter will be inserted with minimal Insertion should not be performed
discomfort. immediately before (possible loss
of appetite) or after eating (will
induce vomiting).
9. The client's bladder will be emptied without To relieve bladder discomfort,
complication. distension, gradual decompression
and emptying.
10. The nurse will maintain sterility throughout To prevent ascending infection to
the procedure. the kidneys.
MATERIALS:
11. Screen or curtains
12. Drape sheet
13. Clean gloves
14. Cotton balls soaked with povidone-iodine
15. Underpad
16. Droplight or penlight
17. Sterile gloves
18. Sterile urinary catheter (straight or
indwelling of appropriate size)
19. Water-soluble lubricant
20. Urine bag
21. Bandage scissors
22. Adhesive tape (Leucoplast)
23. 10 cc syringe
24. Normal saline solution (NSS) or sterile water
25. Alcohol swab
26. 2% Xylocaine gel (optional)
27. Sterile fenestrated drape (optional)
IMPLEMENTATION:
28. Verify physician’s order. To prevent catheterization error.
29. Identify client. Introduce yourself. Explain the Promotes cooperation.
procedure.
30. Assemble all the materials needed. Organization facilitates
performance of the task
31. Provide privacy. Usage of curtains or screen would
prevent unnecessary exposure.
32. Position drop light to ensure adequate Good lighting is necessary for
lighting of the perineal area. proper visualization of the urinary
meatus.
33. Set the bed to a comfortable height to work Promotes proper body mechanics
and lower side rail near you. and ensures client’s safety.
34. Wash hands. Hand hygiene deters spread of
microorganisms.
35. Stand on the client’s right side if you are right Observe proper body mechanics.
– handed or on the other side if left-handed.
36. Place an underpad.
I. MALE:
37. Assist the client to a supine position with Relaxes muscles and allows
legs spread and feet apart. visualization of the area to facilitate
insertion of the catheter.
To expose genitalia.
38. Drape the client appropriately exposing only To provide privacy and establish a
the penis. sterile field.
39. Open the sterile gloves. Set aside the inner
wrapper and use the outer wrapper for the
cotton balls soaked with povidone iodine.
40. Apply clean gloves and cleanse perineal Removes dirt and minimizes the
area. With your nondominant hand, gently risk of urinary tract infection by
grasp the penis perpendicular to the body removing surface pathogens.
and retract the foreskin (if uncircumcised).
41. With your other hand, cleanse the glans Moving from the meatus towards
A.Y. 2021-2022
penis with antimicrobial cleanser or the base of the glans penis

1st SEMESTER,
povidone-iodine solution in a circular motion prevents transfer of

from inner to outer aspect then dispose used microorganisms to the meatus.
cotton ball.
42. Using a separate cotton ball, cleanse the Prevents transmission of
shaft with a downward stroke towards the microorganisms to the meatus
base.
43. Remove gloves and wash hands. To prevent transfer of
microorganisms.
44. Take the 10 cc syringe from its wrapper and It is necessary to open all supplies
prepare appropriate volume for anchorage. and prepare for the procedure.
(Apply technique of withdrawing solution
from a vial. Open and disinfect rubber port of
NSS vial with alcohol swab. Apply negative
pressure principle in withdrawing solution by
injecting needle into the rubber port of the
vial and instill air into the solution as the
same amount of solution to be withdrawn
and aspirate 8-10 cc. Keep syringe with NSS
inside its wrapper.)
45. Cut adhesive tape to be used in securing the
catheter.
46. Open the catheter using sterile technique. Avoid exposing the client to
ascending infection from an open-
ended catheter.
47. Open urine bag using the sterile technique. Prevents contamination of the
sterile equipment and the sterile
field.
48. Open inner wrapper of sterile gloves. Utilize Maintain sterility.
wrapper as sterile field. Cut the lubricant
package and pour sufficient amount onto the
sterile surface avoiding the tip to touch
sterile field.
49. Don sterile gloves.
50. Designate the non-dominant hand as clean
hand and the dominant hand as sterile.
51. Open the inner wrapper of the catheter and To prevent the catheter tip from
coil it around the sterile hand while pulling dangling or dropping to the
out. unsterile field.
52. Take hold of the syringe filled with 8-10 cc Tests the patency of the retention
sterile water with the clean hand. Inflate and balloon. Detaching the syringe
deflate the retention balloon then detach the prevents accidental inflation during
water-filled syringe. (This is not applicable catheter insertion.
for straight catheter insertion)
53. Attach the urine bag to the drainage lumen
observing aseptic technique. (This is not
applicable for straight catheter insertion)
54. Coat the tip of the catheter with water- Facilitates catheter insertion.
soluble sterile lubricant avoiding blocking the Blocking the eye port will obstruct
eye port. the drainage of urine.
55. Hold the penis with the non-dominant hand Facilitates catheter insertion by
perpendicular to the body of the client and straightening urethra.
retract gently.
56. Instruct the client to take several deep The catheter can enter the bladder
breaths (inhale through the nose and exhale easily when the client’s sphincter
thru the mouth) while steadily inserting the relaxes.
catheter about 6-8 inches with the other
hand until urine flow is noted. (In straight
catheter insertion, pull–out the catheter after
the bladder has been emptied completely.)
57. Advance the catheter from 1-2 inches more Advancing an indwelling catheter
when urine flow is noted. Do not force to an additional 1-2 inches ensures
insert the catheter further if you meet placement in the bladder and
resistance then notify physician before facilitates inflation of the balloon
proceeding with the procedure. without damaging the urethra.
58. Re-attach the water-filled syringe to the Ensures retention of the balloon.
inflation port. Inflate the retention balloon Retention catheters are available
with 8-10 cc of NSS for anchorage. with a variety of balloon sizes. Use
a catheter with the appropriate size
balloon.
59. If the client experiences pain during balloon If there is presence of pain, the
inflation, deflate the balloon and insert the inflated balloon may still be at the
catheter farther into the bladder. If the pain urethra. Continuing the procedure
continues with balloon inflation, remove the may cause tissue damage.
catheter and notify the client’s health care
provider.
A.Y. 2021-2022
60. Once the balloon has been inflated, gently Maximizes continuous bladder
1st SEMESTER,
pull the catheter until the retention balloon is drainage and prevents urine
resting against the bladder neck. leakage around the catheter.
61. Tape the catheter unto the lower abdomen Prevents excessive traction from
or upper part of the thigh with enough slack the balloon rubbing against the
that will not pull on the bladder. bladder neck, inadvertent catheter
removal, or urethral erosion; this
prevents pressure on the
penoscrotal angle.
62. Place the drainage bag below the level of the Maximizes continuous drainage of
bladder. Do not let it rest on the floor. urine from the bladder (drainage is
prevented when the drainage bag
is placed above the abdomen).
63. Remove gloves, dispose soiled materials Prevents transfer of
and wash hands. microorganisms.
64. Drape and help the client adjust position. Promotes client comfort and
Lower bed. safety.
65. Document the procedure. Document urine's character,
amount, color/odor and the client's
response to the procedure.
Monitor urinary status.
II. FEMALE:
66. Assist the client to a supine position with Relaxes muscles and allows
knees flexed and feet apart. (dorsal visualization of the area to facilitate
recumbent) insertion of the catheter.
To expose genitalia.
67. Drape the client appropriately exposing only To provide privacy and establish a
the vulva. clean field.
68. Open the sterile gloves. Set aside the inner
wrapper and use the outer wrapper for the
cotton balls soaked with povidone iodine.
70. Spread the labia with the non-dominant hand Prevent transfer of
while the other hand cleanses the microorganisms.
periurethral mucosa with cotton balls soaked
with povidone iodine from anterior to
posterior portion. Discard used cotton balls
after each downward stroke.
71. Use 1-7-7 technique in perineal care. The Prevent transfer of
first stroke should start from the clitoris down microorganisms.
to the perineum. The second stroke should
be done on the distal side of the vulva by
moving the cotton balls according to the
figure 7 starting from the mons veneris going
to the labia in inner-to -outer motion. The
third stroke should be done on the proximal
side following the same technique.
72. Remove clean gloves and wash hands. To prevent transfer of
microorganisms.
73. Take the 10 cc syringe from its wrapper and It is necessary to open all supplies
prepare appropriate volume for anchorage. and prepare for the procedure.
(Apply technique of withdrawing solution
from a vial. Open and disinfect rubber port of
NSS vial with alcohol swab. Apply negative
pressure principle in withdrawing solution by
injecting needle into the rubber port of the
vial and instill air into the solution as the
same amount of solution to be withdrawn
and aspirate 8-10 cc. Keep syringe with NSS
inside its wrapper.)
74. Cut adhesive tape to be used in securing the
catheter.
75. Open the catheter using sterile technique.
76. Open urine bag using the sterile technique.
77. Open inner wrapper of sterile gloves. Utilize
wrapper as sterile field. Cut the lubricant
package and pour sufficient amount onto the
sterile surface avoiding the tip to touch
sterile field.
78. Don sterile gloves. Prevents contamination of the
sterile equipment and the sterile
field.
79. Designate the non-dominant hand as clean Tests the patency of the retention
hand and the dominant hand as sterile. balloon. Detaching the syringe
prevents accidental inflation during
catheter insertion.
A.Y. 2021-2022
1st SEMESTER,
80. Open the inner wrapper of the catheter and To avoid exposing the client to
coil it around the sterile hand while pulling ascending infection from an open-
out. ended catheter.
81. Take hold of the syringe filled with 8-10 cc To prevent dangling on unsterile
sterile water with the clean hand. Inflate and surface.
deflate the retention balloon then detach the
water-filled syringe. (This is not applicable
for straight catheter insertion)
82. Attach the urine bag to the drainage lumen Facilitates catheter insertion.
observing aseptic technique. (This is not Blocking the eye port will obstruct
applicable for straight catheter insertion) the drainage of urine.
83. Coat the tip of the catheter with water- For visualization of the urethra.
soluble sterile lubricant avoiding blocking the The nondominant hand separates
eye port. the labia since the dominant hand
is sterile.
84. With the non-dominant hand, expose the
urethral orifice.
85. Instruct the client to take several deep The catheter can enter the bladder
breaths (inhale through the nose and exhale easily when the client’s sphincter
thru the mouth) while steadily inserting the relaxes.
catheter about 4-6 inches in the urethral
meatus with the dominant hand until urine
flow is noted.
86. Advance the catheter from 1-2 inches more Advancing an indwelling catheter
when urine flow is noted. Do not force to an additional 1-2 inches ensures
insert the catheter further if you meet placement in the bladder and
resistance then notify physician before facilitates inflation of the balloon
proceeding with the procedure. without damaging the urethra.
87. Re-attach the water-filled syringe to the Ensures retention of the balloon.
inflation port. Inflate the retention balloon Retention catheters are available
with 8-10 cc of NSS for anchorage. with a variety of balloon sizes. Use
a catheter with the appropriate size
balloon.
88. Once the balloon has been inflated, gently Maximizes continuous bladder
pull the catheter until the retention balloon is drainage and prevents urine
resting against the bladder neck. leakage around the catheter.
89. Tape the catheter unto the upper part of the Prevents excessive traction from
inner thigh with enough slack that will not the balloon rubbing against the
pull on the bladder. bladder neck, inadvertent catheter
removal, or urethral erosion; this
prevents pressure on the
penoscrotal angle.
90. Place the drainage bag below the level of the Maximizes continuous drainage of
bladder. Do not let it rest on the floor. urine from the bladder (drainage is
prevented when the drainage bag
is placed above the abdomen).
91. Remove gloves, dispose soiled materials Prevents transfer of
and wash hands. microorganisms.
92. Drape and help the client adjust position. Promotes client comfort and
Lower bed. safety.
93. Document the procedure. Document urine's character,
amount, color/odor and the client's
response to the procedure.
Monitor urinary status.
EVALUATION:
94. The catheter was inserted with minimal
discomfort.
95. The client's bladder was emptied without
complication.
96. The nurse maintain sterility throughout the
procedure.
TOTAL
/ 192

REMARKS:
____________________________________________________________________________________
____________________________________________________________________________________
A.Y. 2021-2022
____________________________________________________________________________________
1st SEMESTER,
NAME OF STUDENT:

INSTRUCTOR:
SKILL: OBTAINING URINE SPECIMEN Correctly Needs

Not Done
(0)
FROM A CLOSED-DRAINAGE SYSTEM (2) (1)
ASSESSMENT
1. Identify the need for the urine test. To determine the amount of urine
to be collected.
2. Assess the client's understanding of the To determine amount of instruction
procedure. needed.
3. Identify the type of collecting tubing attached To determine the site and the
to the indwelling catheter. appropriate technique to be used
in obtaining a specimen.
4. Client will verbalize understanding of the
A.Y. 2021-2022
reason for the procedure.

1st SEMESTER,
5. Specimen is obtained using the sterile

container in a timely manner.
6. Specimen will remain uncontaminated.
MATERIALS:
7. Sterile specimen container
8. Kelly clamp (if nonserrated clamp is
unavailable)
9. 10 cc syringe with needle
10. Clean gloves
11. Povidone-iodine swab
12. Alcohol swab
IMPLEMENTATION:
13. Verify physician's order for the procedure.
14. Identify client and introduce self. Explain To be sure you are performing the
procedure. procedure on the correct patient.
15. Assemble all the materials needed. Provide Organizes work.
privacy.
16. Clamp the tubing 3 inches below the To allow urine to collect.
sampling port for 15-30 minutes.
17. Wash hands. To prevent the spread of
microorganisms.
18. Lower side rails near you.
19. Apply clean gloves.
20. After 15-30 minutes, disinfect sampling port To prevent the introduction of
with alcohol and povidone-iodine swab microorganisms into the system.
respectively or according to institution’s
policy.
21. Open 10 cc syringe and inject needle into Obtain specimen with sufficient
the sampling port of catheter at 45-degree- volume for most urine tests. 10 ml
angle without penetrating tubing thru and of urine is needed for most
thru. urinalysis.
22. Remove clamp and rearrange tubing. Re-establishes urine flow and
drainage into the system.
23. Label specimen container with client’s name, Ensures accuracy of the result for
room or bed number, specimen type, date the right patient.
and time collected.
24. Send specimen to the laboratory not longer Ensures accuracy of the result.
than 2 hours together with the request slip.
25. Dispose used supplies in appropriate waste Reduces transmission of
receptacle and wash hands. microorganisms.
26. Document the procedure. Procedure done, amount of urine

collected, characteristics of the
urine collected and the client’s
reaction to the procedure.
EVALUATION:
27. Client verbalized understanding of the
reason for the procedure.
28. Specimen was obtained using the sterile
container in a timely manner.
29. Specimen remained uncontaminated.
TOTAL
/ 58

REMARKS:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
A.Y. 2021-2022
1st SEMESTER,
NAME OF STUDENT:

INSTRUCTOR:
SKILL: REMOVING Correctly Needs

Not Done
(0)
INDWELLING CATHETER (2) (1)
ASSESSMENT
1. Determine previous history of incontinence, Assess client for temperature,
infection, urinary patterns, fluid intake and current condition of urinary
rationale for current treatments. meatus, perineal area and urine
character.
2. Assess client's understanding of the To participate in care to the best of
procedure. his/her ability.
3. Assess room set up to determine ability of To facilitate client’s easy return to
the client to reach bathroom or bedside normal voiding patterns if catheter
commode. will remain out.
A.Y. 2021-2022

1st SEMESTER,
4. Catheter will be removed intact.

5. Client will void within 8 hours of removal
without burning, urgency or incontinence.
6. Client will not develop any bleeding, pain or
other complications of removal.
7. Client will notify nursing staff when they void
or having difficulty urinating.
MATERIALS:
8. Clean gloves
9. Underpad
10. 10cc syringe
11. Urinal or bedpan
12. Periwash soap
IMPLEMENTATION:
13. Verify order for removal of catheter. To ensure safe and accurate
procedure.
14. Check the client’s identification and Ensures correct client and
introduce yourself. Explain the procedure. treatment. Explaining elicits
cooperation.
15. Gather the materials needed.
16. Provide privacy. Providing privacy demonstrates
respect for client’s dignity.
17. Set the bed to a comfortable height to work For the comfort of the healthcare
and raise the opposite side rail. provider.
18. Remove covers and drape so as to expose Protects client privacy and reduces
catheter, but not exposing unnecessary embarrassment.
area.
19. Put on gloves. Practices standard precautions.
20. Insert underpad under the buttocks and Prevents bed from becoming
thighs. soiled.
21. Empty urine in tubing into the urine bag. Prevents leakage from catheter
onto client when the catheter is
removed.
22. Remove any tape that maybe holding the Allows for easy removal of
catheter in the abdomen or inner thigh. catheter.
23. Grab syringe from its wrapper and insert into Keeping port intact ensures the
the anchor balloon port. (Keep anchor port of ability to drain the contents of the
the catheter straight as you insert the syringe ballon.
needle if port requires needle).
24. Deflate catheter anchor balloon by aspirating Aspirating twice ensures fully
10 cc of fluid twice until depression is seen in deflated balloon.
the port when all contents are evacuated.
25. Ask the client to take several deep breaths if
able, while gently removing the catheter. Damage to the urethra may occur
if the balloon is not fully deflated.
26. Stop if you meet resistance and recheck the
balloon port for further deflation.
27. Note any sediments, mucus, or blood that Assesses for any indications of
may be on the catheter. Culture catheter tip infection or trauma related to the
when ordered and as necessary by cutting it catheter.
off with sterile scissors and placing it on a
sterile specimen container and send to
laboratory.
28. Cleanse the perineal area. Provides comfort and reduces
transmission of microorganisms.
29. Remove gloves, dispose used articles and To prevent the spread infection.
wash hands.
30. Assist the client to position of comfort.
31. Assess and document the procedure – time Communicates with other
of removal, size of the catheter used, urine healthcare team the effectives of
amount, color and consistency and client’s treatment.
response.
32. Instruct the client to drink oral fluids as
tolerated or as prescribed and to call when It is important to determine that
needing to void. client has returned to usual voiding
pattern or other interventions will
need to be implemented.
33. Monitor time and amount of first voiding.
Offer bedpan or urinal if unable to go to
comfort room.
34. Refer to health provider if unable to void Allows assessment and
within 8 hours after catheter removal. intervention to determine the cause
of the client’s inability to void after
the catheter is removed.
A.Y. 2021-2022
1st SEMESTER,
EVALUATION:
35. Catheter was removed intact.
36. Client voided within 8 hours of removal
without burning, urgency or incontinence.
37. Client did not develop any bleeding, pain, or
other complications of removal.
38. Client verbalized understanding of the need
to notify nursing staff when they void or
having difficulty urinating.
TOTAL
/ 76

REMARKS:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
NAME OF STUDENT:
YEAR/SECTION: CARE OF MOTHER, CHILD,

ADOLESCENT (WELL CLIENT)
CHECKLISTS
SUMMARY OF GRADES

ACTIVITY NAME %
Oral, Buccal, and
Sublingual Medication
Administration
Administering Eye and
Ear Medications
Administering Vaginal
and Rectal
A.Y. 2021-2022
Suppositories
1st SEMESTER,
Oxygen Administration
EINC
Enema Administration
Surgical Handwashing
Gowning and Gloving
(closed method)
Skin Preparation for
Surgery
Urinary
Catheterization (Male
& Female)
Obtaining a urine
specimen from a
closed-drainage
system
Removing Indwelling
Catheter
TOTAL
___________________________________
A.Y. 2021-2022
NP 9 - Care of Mother,
1st SEMESTER,
Child at Risk or with

Problems (Acute and
Chronic)
NAME OF STUDENT:

INSTRUCTOR:
SKILL: SETTING UP Correctly Needs

Not Done
(0)
INTRAVENOUS INFUSION (2) (1)
ASSESSMENT
1. Check the written order for the type of IV To determine the optimal needle
solution to be infused and the rate of flow. size and type to use and ensure
accurate administration.
2. Review information regarding the insertion of To insert the catheter and
the IV and nursing implications. administer the solution safely.
3. Know the hospital policy regarding who may Many agencies require that nurses
start an IV. have special training before they
can perform this procedure.
4. Check all additives in the solution and other So that there will be no
A.Y. 2021-2022
medications. incompatibilities of additives with

1st SEMESTER,
the solution.
5. Assess the client's veins. To optimize planning of the IV site.
6. Check the client's fluid, electrolyte and To provide baseline data for
nutritional status. comparison with the client’s
response to IV therapy.
7. Assess the client's understanding of the So that client teaching can be used
procedure. to decrease anxiety.
8. The appropriate fluids at the ordered
dosages will be available.
9. The IV infusion will be sterile without
precipitate or contamination.
10. The IV will be inserted without complications
and will remain patent.
11. Fluid and electrolyte balance will be
restored.
12. Nutrition will be restored or maintained.
13. The IV site will remain free of swelling and
inflammation.
MATERIALS:
14. clean gloves
15. intravenous fluid
16. intravenous set (macroset or microset)
17. IV label
18. IV tray
19. IV cannula
20. Tourniquet
21. Alcohol swab
22. Splint
23. IV stand
24. Micropore
25. Kidney basin
IMPLEMENTATION:
I. Setting-Up:
26. Verify physician’s order and make IV label.
27. Observe 10 rights when preparing and
administering intravenous fluid.
28. Identify client and introduce self. Explain the
procedure to the client and or significant
other.
29. Assess client’s vein: choose appropriate
vein; location and size condition.
30. Wash hands and maintain asepsis
throughout the preparation and during
therapy.
31. Prepare necessary materials for the
procedure.
32. Check the sterility and integrity of the IV
solution, IV set and other devices.
33. Place IV label on IVF bottle the client’s
name, room / bed number, solution, drug
incorporation if any, bottle sequence and
duration.
34. Open the seal of the IVF solution aseptically.
35. Open IV set aseptically and close IV clamp.
36. Spike the IV set aseptically into the rubber
port of the IVF.
37. Fill drip chamber to at least half and prime
the tubing aseptically.
38. Remove air bubbles if any and put back the
cover to the distal end of the IV tubing.
II. Changing an IV infusion:
39. Verify physician’s order in doctor's order
sheet. Countercheck IV label, sequence,
type, amount, additives and duration of
infusion.
40. Observe the 10 rights.
procedure.
42. Assess IV site for redness, swelling and
pain, etc... Check date of IV insertion. Re-
site l if 48-72 hours has lapsed.
43. Check date of changing IV tubings, change if
A.Y. 2021-2022
due for changing. Change tubings within 72

1st SEMESTER,
hours.
44. Wash hands before and after the procedure.
45. Prepare the necessary materials.
46. Check sterility and integrity of IV solution.
47. Place IV label on the IVF bottle.
48. Calibrate new IV bottle according to duration
of infusion.
49. Open the seal of the solution aseptically.
50. Close the IV clamp and kink tubing. Spike
the container aseptically.
51. Regulate the flow rate based on the duration
of infusion. Remove air bubbles if any.
52. Reassure client and significant others.
53. Discard all waste materials according to
MMDA Ordinance # 16.
54. Document accordingly and endorse to
incoming shift.
III. Discontinuing IV infusion:
55. Verify physician’s order to discontinue IV
including IV medication.
56. Identify client and introduce self. Assess and
inform the patient of the order and of any
order of IV medicines. Explain the
procedure.
57. Prepare the necessary materials.
58. Wash hands.
59. Wear gloves.
60. Close IV clamp of the tubing.
61. Moisten adhesive tapes around the IV
catheter with alcoholised cotton ball.
62. Support the IV cannula with one hand while
the other hand removes the plaster. Remove
plaster gently.
63. Get cotton ball with alcohol and without
applying pressure, remove IV catheter then
immediately apply pressure over the
venipuncture site.
64. Discard all waste materials including the IV
cannula according to MMDA Ordinance #16.
65. Reassure client.
66. Document time of discontinuance, status of
insertion site and integrity of IV catheter and
endorse accordingly.
EVALUATION:
67. The appropriate fluids at the ordered
dosages were available for IV infusion.
68. IV infusion was sterile, without precipitate or
contamination.
69. IV was inserted into the vein without
complications and remains patent.
70. Fluids and electrolyte balance were restored.
Nutrition was restored or maintained.
71. IV site remains free of swelling and
inflammation.
TOTAL
/ 142

REMARKS:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
A.Y. 2021-2022
1st SEMESTER,
NAME OF STUDENT:

INSTRUCTOR:
Correctly Needs
Not Done
SKILL: SETTING THE FLOW RATE RATIONALE Done Improvement
(0)
(2) (1)
ASSESSMENT
1. Check written doctor's order for the IV to be To determine the optimal needle
infused and the desired flow rate. site and type to use and ensure
accurate administration.
2. Review information regarding the insertion of To insert the catheter and
the IVF and nursing implications. administer the solution safely.
3. Assess the patency of the IV line. To optimize planning of the IV site.
4. Assess the skin at the IV site. To optimize planning of the IV site.
5. Assess the client's understanding of the IV So that client teaching can be used
infusion. to decrease anxiety
A.Y. 2021-2022
1st SEMESTER,

6. The fluid will be infused into the vein without
complication.
7. The IV catheter will remain patent.
8. The fluid and electrolyte balance will return

to normal.
of IV therapy.
MATERIALS:
10. Wrist watch with 3rd hand
IMPLEMENTATION:
11. Verify physician’s order for the IV solution
and rate of infusion.
12. Check client’s identification, introduce self

and explain procedure.
13. Wash hands.
14. Prepare to set flow rate
15. Have paper and pencil to calculate flow rate.

Formula = Total volume in ml. multiplied by
the drop factor divided by the number of
hours to be infused multiplied by 60 minutes.
16. Review calibration (drops/minute) of each IV

infusion set. For macroset tubing = 15 or 20
drops per minute (gtts/min) depending on
manufacturer's set. For microset tubing = 60
microdrops per minute (mcgtts/min).
17. Determine hourly rate by dividing total

volume in ml. by the total hours to be
administered.
18. Calculate per minute rate interval based on
the drop factor of the infusion set.
19. To set the flow rate: count drops in drip-
chamber for on full minute and adjust the
roller clamp.
20. When using an infusion pump: insert the
tubing into the- pump, select the drip rate,
open the roller clamp and push the start
button.
21. Monitor infusion rate and IV site for
infiltration and phlebitis.
22. Assess infusion when alarm sounds.
23. Wash hands.
EVALUATION:
24. Drug was infused into the vein without
complications.
25. IV site remained free of swelling and
inflammation.
drug.
TOTAL
/ 52

REMARKS:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
A.Y. 2021-2022
1st SEMESTER,
NAME OF STUDENT:

INSTRUCTOR:
SKILL: ADMINISTERING DRUGS Correctly Needs

Not Done
THRU IV PUSH AND HEPARIN – LOCK RATIONALE Done Improvement
(0)
(2) (1)
(HEPLOCK) DEVICE
ASSESSMENT
1. Check the physician’s order for the
medication, dosage, time and route of
administration.
2. Review information regarding the drug,
including action, purpose, side effects,
normal dose, peak onset, nursing
implications, required dilution, length of time
for administration and incompatibility with IV
or other medications.
A.Y. 2021-2022
3. Determine the additives in the solution of an

1st SEMESTER,
existing IV line.
4. Assess the placement of the IV needle to
ensure that the medication will enter the vein
and not the surrounding tissues.
5. Assess the skin at the IV site so that the
medication will not be administered into an
inflamed or edematous site which could
cause injury to tissue.
6. Check the client's drug allergy history.
7. Assess the medication to be given to
determine how much time is needed to
administer the medication safely.
8. Assess the client’s understanding of the
purpose of the medication.
9. The drug will be infused into the vein without
complications.
inflammation.
of the drug.
12. Any adverse reactions to the drug will be
identified and treated.
MATERIALS:
13. Disposable gloves
14. Medication in vial or ampule
15. Syringe of appropriate gauge
16. Sterile needles of appropriate gauge
17. Antiseptic swabs or cotton with alcohol
18. Watch with second hand
19. Medication tray
20. Diluents (sterile water or PNSS)
21. Sharps collector
22. Heparin lock
IMPLEMENTATION:
I.V. Push:
23. Countercheck medication against the written
orders.
administering medication.
25. Identify client and introduce yourself. Explain
procedure before beginning.
26. Wash hands and wear gloves.
27. Check IV site (if infiltrated or not in the vein;
if there are signs of swelling, redness,
phlebitis, do not give drug).
28. Check for skin test result of drug for IV push,
drug IV fluid incompatibility and dosage
computation.
29. Prepare the necessary materials for the
procedure.
30. Disinfect the rubber port of the diluents with
alcoholised cotton ball.
31. Aspirate the right amount of diluent. (use 1:1
ratio such that 100 mg of drug is to 1 cc
diluent or according to institution policy).
32. Disinfect the rubber port of the medication
and dilute.
33. Aspirate the right drug dose.
34. Disinfect the Y -injection port of the IV
administration set and pierce the needle
through the bull's eyed rubber port.
35. Kink the tubing from the IV bottle and push
IV drug slowly as ordered or as per
manufacturer's instructions. Observe
precautionary measures during drug
administration.
36. Remove the needle and discard
appropriately.
37. Regulate rate of IV fluid infusion as ordered
(if needed).
38. Reassure patient and observe for signs and
symptoms of adverse drug reaction, if any.
A.Y. 2021-2022
39. Discard sharps and other waste according to

1st SEMESTER,
MMDA ordinance #16.

40. Document in patient's chart and endorse
accordingly.
Heparin-lock Device:
41. Repeat steps 23-28.
42. Gather equipment such as medicine tray,
heparin solution, normal saline solution, 3 cc
syringe (3 pcs.) and a tuberculin syringe.
43. Prepare medication to be administered. e.g.
antibiotic and draw it up in a syringe.
44. Fill tuberculin syringe with heparin solution.
Aspirate 0.9 cc NSS plus 0.1 cc heparin.
45. Fill the 3cc syringes with isotonic solution or
NSS.
46. If using hep-lock device with 3-way stop cock
with luer-lock, rotate the stop cock so that
the line going to the client is closed (this will
prevent backflow of blood).
47. Disinfect injection port with alcohol swab.
Insert saline syringe into port.
48. Some drugs are incompatible with heparin.
Saline syringe is also used to check the
potency of the infusion set. If so, draw 2
syringes with 2 – 2.5 cc saline solution and
use one syringe at a time.
49. Open the IV line going to the client and pull
back on syringe plunger and check for the
blood into the syringe, flush system.
50. Rationale: the presence of blood indicates
that the IV line is placed into the vein, not
into surrounding tissues.
51. Close the IV line and remove saline syringe
and insert medication syringe into port.
52. Open the IV line and inject medication into
the vein, timing the flow rate according to
doctor’s order or on the drug manufacturer’s
instructions.
53. Observe client for any adverse reactions.
54. Close the IV line and remove medication
syringe.
55. Insert the saline syringe, open the line and
flush catheter tubing and IV cannula to clear
the line.
56. Close and remove saline syringe.
57. Insert heparin syringe; open the IV line and
inject heparin to fill the catheter and needle
lumen.
58. Rationale: the heparin should prevent the
formation of clot in the catheter.
59. Close the IV line and remove syringe.
EVALUATION:
60. The drug was infused into the vein without
complications.
61. The IV site remained free of swelling and
inflammation.
62. The client was able to discuss the purpose of
the drug.
63. Any adverse reactions to the drug were
identified.
TOTAL
/ 126

REMARKS:
____________________________________________________________________________________
____________________________________________________________________________________
A.Y. 2021-2022
____________________________________________________________________________________
1st SEMESTER,
NAME OF STUDENT:

INSTRUCTOR:
SKILL: DRUG INCORPORATION INTO Correctly Needs

Not Done
(0)
IV SOLUTION (2) (1)
ASSESSMENT
1. Observe the 10 rights in administering
medication.
2. Check the health provider's order for the
client, medication, dosage and time of,
administration.
3. Review the information regarding the drug
including action, purpose, side effects,
normal dose, and peak onset and nursing
implications in order to administer the drug
A.Y. 2021-2022
safely.
1st SEMESTER,
4. Determine the additives in the solution of an

existing IV line to determine if the medication
is compatible with the solution.
5. Assess the patency of the IV to ensure that
the medication will enter the vein and not the
surrounding tissue.
6. Assess the skin at the IV site so that the
medication will not be administered into an
inflamed or edematous site which could
cause injury to the tissue.
7. Check the client’s drug allergy.
8. Assess the client's understanding of the
purpose of the medication so that client
teaching can be tailored to client needs.
9. The appropriate fluids medications at the
ordered dosages will be mixed for IV I
infusion.
10. The IV infusion will not be contaminated
11. The nurse mixing the IV will not be injured or
endangered.
12. The medication will be infused without injury
or trauma to the client.
MATERIALS:
13. Prescribed medication in vial or ampule
14. Prescribed diluents for medication
15. Sterile syringe
16. Sterile needle
17. Sterile IV bag with administration set
18. Alcohol swab
19. Label for IV bag or solu-set
20. Solu-set
21. Kidney basin
22. Clean gloves
IMPLEMENTATION:
I. Drug incorporation into intravenous fluid (IVF) bottle:
23. Countercheck with physician’s order and
make medication card.
administering medication.
25. Identify client and introduce self. Explain
procedure to the patient and check IV site.
26. Verify for skin test of drug for IV
incorporation. (If skin testing is required.)
27. Wash hands before and after the procedure.
28. Prepare the materials needed for the
procedure.
29. Disinfect injection port of the vial and
aspirate the drug aseptically.
30. Remove the cover of the airway of the
administration set, disinfect with alcohol and
I incorporate prepared drug into the airway.
Recap airway after.
31. For administration set that has no airway, put
down the bottle, kink the IV tubing or clamp
the tubing. Remove the administration set
from the bottle aseptically. Disinfect the
bottle's rubber stopper; incorporate the right
drug to the IVF bottle aseptically. Return the
administration set to IVF bottle aseptically.
Swirl the bottle to mix the drug with the IVF
and regulate the flow rate as ordered.
32. Swirl the IV bottle to mix the drug with the
IVF and regulate the flow rate as ordered.
33. Observe and reassure the patient.
34. Document in the patient's chart.
35. Discard sharps and other wastes according
to MMDA Ordinance #16.
36. Wash hands.
II. Drug incorporation into solu-set:
37. Repeat steps 23-28.
A.Y. 2021-2022
38. Check present IV fluid label, level, and the

1st SEMESTER,
incorporated medicine if any in the IV bottle.

39. Aspirate prepared right drug with correct
dosage.
40. Open the solu-set package and close clamp.
Open the IVF bottle and spike the solu-set
into the IVF.
41. Add desired IVF diluent into the solu-set by
opening the clamp from the bottle.
42. Fill the drip chamber halfway and prime
tubing to expel air inside the tubing by
opening the clamp from the solu-set and
close clamp after.
43. Disinfect rubber injection port of the solu-set
and incorporate the drug. Swirl gently.
Connect the needle; disinfect then attach
piggy back tubing to patent tubing port. Open
the clamp of the airway at the solu-set.
44. Regulate the solu-set into 30 minutes to one
hour. Place IV label on solu-set indicating
drug incorporation.
45. Document in patient’s chart the drug
administered.
46. When incorporated medicine is consumed,
clamp airway of solu-set; add IVF and
regulate flow rate of main IVF as ordered.
Remove IV label from solu-set.
47. Document in patient’s chart and kardex of
changes in IV rate/time due.
48. Observe patient for any untoward effect.
EVALUATION:
49. The appropriate fluids and medication
ordered were mixed for IV infusion.
50. The IV infusion was not contaminated during
the procedure. The medication was infused
without injury or trauma to the client.
TOTAL
/ 100

REMARKS:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
NAME OF STUDENT:

INSTRUCTOR:
SKILL: ADMINISTERING Correctly Needs

Not Done
(0)
MEDICATION VIA PIGGY BACK (2) (1)
ASSESSMENT
1. Check the order for the medication, dosage,
time and route of administration.
2. Review information regarding the drug.
3. Determine the additives in the solution an
existing line.
4. Assess the placement of the IV catheter in
the vein.
5. Assess the skin at the IV site.
A.Y. 2021-2022
6. Check the client's drug allergy history.

1st SEMESTER,
7. Assess the client's understanding of the

purpose of the medication.
8. Assess the compatibility of the piggyback IV
medication with the primary or mainline IV
solution.
9. The drug will be infused into the vein without
complications.
inflammation.
of the drug.
MATERIALS:
12. Medication bag
13. Clean gloves
14. Sterile needle
15. Alcohol swab
16. Label for piggy back medication
17. Medication Administration record (MAR)
18. IV pole
19. Sharp collector
IMPLEMENTATION:
20. Verify physician’s order for IV solution and
additives ordered.
21. Identify client and introduce yourself. Explain
the procedure.
22. Determine whether the ordered additives are
compatible with the IV solution and with each
other.
23. Assemble all materials needed. Wash
hands. Apply gloves.
24. Hang medication bag.
25. Connect needle for piggy back

administration.
26. Disinfect the Y-port with alcohol swab.
27. Connect piggyback tubing to Y-port of
mainline.
28. Administer medication. Open the clamp of
piggyback and regulate at the desired rate.
29. Label with name of client, name of drug,
dose of medication, date and time of
preparation and nurses’ initials.
30. Check infusion of mainline while piggyback
is running.
31. Close clamp of pig9yback and remove when
desired amount had been infused.
32. Remove gloves and dispose of all used
materials appropriately.
33. Wash hands.
EVALUATION:
34. Drug was infused into the vein without
complications.
35. IV site remained free of swelling and
inflammation.
drug.
TOTAL
/ 72

REMARKS:
____________________________________________________________________________________
____________________________________________________________________________________
A.Y. 2021-2022
____________________________________________________________________________________
1st SEMESTER,
NAME OF STUDENT:

INSTRUCTOR:
Correctly Needs
SKILL: CHANGING INTRAVENOUS Not Done
(0)
SITE DRESSING (2) (1)
ASSESSMENT
1. Determine when dressing was last changed. Provides information regarding
Dressing should be labeled to include date length of time that present dressing
and time applied, size and type of venous has been in place. In addition, you
access device (VAD), and date VAD was are able to plan for dressing
inserted. change
2. Observe present dressing for moisture and Moisture is medium for bacterial
intactness. Determine if moisture is from site growth and renders dressing
leakage or external source. contaminated. Non-adhering
dressing increases risk for
bacterial contamination to
A.Y. 2021-2022
venipuncture site or displacement

1st SEMESTER,
of IV catheter.
3. Observe IV system for proper functioning or Unexplained decrease in flow rate
complications (e.g., current flow rate, tubing, indicates problems with VAD
or catheter kinks). Palpate catheter site placement and patency. Pain is
through intact dressing for complaints of associated with phlebitis and
tenderness, pain, or burning. (NOTE: Apply infiltration.
clean gloves if gauze dressing is moist.)
4. Monitor body temperature. Elevated temperature can be
related to infection at VAD site or
systemic complication.
5. Assess patient’s understanding of need for Reveals need for patient
continued IV infusion. instruction.
6. IV insertion site remains free of IV-related Proper care maintains IV site.
complications (redness, swelling,
tenderness, or exudate).
7. Patient and family caregiver can explain Demonstrates learning.
procedure and purpose of VAD dressing
change.
MATERIALS:
8. Antiseptic swabs (2% chlorhexidine
preferred or 70% alcohol, povidone-iodine)
9. Skin protectant swab
10. Clean gloves
11. Strips of sterile, precut tape (or roll of sterile
tape), or stabilization device
12. Commercially available IV site protection
(optional)
13. Sterile transparent semipermeable dressing
14. Sterile 2 × 2 or 4 × 4 inch gauze pad
IMPLEMENTATION:
15. Explain procedure and purpose to patient Decreases anxiety, promotes
and family caregiver. Explain that patient will cooperation, and gives patient time
need to hold affected extremity still. Explain frame around which to plan
how long procedure will take. personal activities.
16. Perform hand hygiene. Collect equipment. Reduces transmission of
Apply clean gloves. microorganisms. Infections related
to IV therapy are most often
caused by catheter hub
contamination; thus, you need to
use careful technique throughout
dressing change
17. Identify patient using two identifiers (i.e., Ensures correct patient. Complies
name and birthday or name and account with The Joint Commission
number) according to agency policy. standards and improves patient
Compare identifiers with information on safety
patient’s identification bracelet.
18. Remove dressing. Technique minimizes discomfort
during removal. Use alcohol swab
on transparent dressing next to
patient’s skin to loosen dressing.
19. For transparent semipermeable dressing:
Remove by pulling up one corner and pulling
side laterally while holding catheter hub with
nondominant hand (see illustration). Repeat
on other side. Leave tape or catheter
stabilization device that secures IC catheter
in place.
20. For gauze dressing:
Stabilize catheter hub while loosening tape
and removing old dressing one layer at a
time by pulling toward insertion site. Leave
tape that secures VAD to skin intact. Be
cautious if IV tubing becomes tangled
between two layers of dressing.
21. Observe insertion site for signs and Presence of complication indicates
symptoms of IV-related complications need to remove VAD at current
(tenderness, redness, swelling, exudate, or site.
complaints of pain). If complication exists or
if ordered by health care provider,
discontinue infusion
22. Prepare new sterile tape strips for use. If IV Exposes venipuncture site.
is infusing properly, gently remove tape or Stabilization prevents accidental
stabilization device securing VAD. Stabilize displacement of VAD. Adhesive
A.Y. 2021-2022
VAD with one finger. Use adhesive remover residue decreases ability of new
1st SEMESTER,
to clean skin and remove adhesive residue if tape to adhere securely to skin.
necessary.
23. While stabilizing IV, clean insertion site with Allowing antiseptic solutions to air-
chlorhexidine antiseptic swab, using friction dry completely effectively reduces
vertically and horizontally and moving from microbial counts. 2% Chlorhexidine
insertion site outward with a third swab. takes 30 seconds to dry.
Allow antiseptic solution to dry completely.
24. Optional: Apply skin protectant solution to Coats skin with protective solution
area where you will apply tape or dressing. to maintain skin integrity, prevents
Allow to dry. irritation from adhesive, and
promotes adhesion of dressing.
25. While securing catheter, apply a sterile
dressing over site
26. Remove and discard gloves. Prevents transmission of
microorganisms.
27. Anchor IV tubing with additional pieces of Prevents accidental displacement
tape if necessary. When using transparent of VAD.
dressing, avoid placing tape over the
dressing.
28. Label dressing per agency policy. Communicates type of device and
Information on label includes date and time time interval for dressing change
of IV insertion, VAD gauge size and length, and site rotation
and your initials.
29. Discard equipment and perform hand Reduces transmission of
hygiene. microorganisms.
EVALUATION:
30. Observe function, patency of IV system, and Validates that IV is patent and
flow rate after changing dressing. functioning correctly. Manipulation
of catheter and tubing will affect
rate of infusion.
31. Inspect condition of short peripheral site for Complications such as phlebitis
signs and symptoms of IV-related and infiltration require removal of
complications (e.g., redness, complaints of short peripheral catheter and
pain, swelling, or exudate). insertion of new catheter at new
site above area of complication or
other extremity.
32. Monitor patient’s body temperature. Elevated temperature indicates
infection that can be associated
with contamination of venipuncture
site or septicemia.
TOTAL
/ 96
REMARKS: %
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
NAME OF STUDENT:

INSTRUCTOR:
Correctly Needs
Not Done
SKILL: BLOOD TRANSFUSION (BT) RATIONALE Done Improvement
(0)
(2) (1)
ASSESSMENT
1. Check the physician's order. The order
includes the type of blood product, the
number of units and the period over which
the product is to be infused.
2. Check the existing IV infusion or heparin lock
for patency and needle size, or initiate an IV
infusion with a g19 size or larger bore needle
or other means of entering the veins. A 20 to
A.Y. 2021-2022
1st SEMESTER,
23 gauge needle may be used for infants

and other patients with small veins.
3. To transfuse appropriate blood product at a
correct rate.
4. The vital signs will be within normal limits.
5. Will be able to correct fluid imbalance.
MATERIALS:
6. prescribed medication for pre-BT meds
7. plain normal saline solution
8. sterile syringe
9. sterile large bore needle
10. blood unit (FWB, PRBC, platelet
concentrate, etc.)
11. antiseptic swab
12. label for IVF and BT bag
14. IV tray
15. Blood filter set
16. IV tubing
17. Clean gloves
IMPLEMENTATION:
18. Verify physician’s order.
19. Observe the rights of the patient when
preparing and administering any blood
component.
procedure.
21. Secure consent. Gets the client’s history
regarding previous transfusion.
22. Explain the importance of the benefits on
Voluntary Blood Donation. (RA 7719 –
National Blood Service Act of 1994)
23. Request blood/blood component from
hospital blood bank to include blood typing
and cross matching.
24. Obtain compatible blood from the hospital
blood bank.
25. Warm blood at room temperature by
wrapping the blood bag with a dry towel for
30 minutes.
26. Have a doctor and a nurse assess client’s
condition. Countercheck the compatible
blood to be transfused against the cross-
matching sheet noting ABO grouping and
RH, serial numbers of blood and expiration
date with the blood bag label.
27. Get the baseline vital signs before
transfusion. Refer to physician accordingly.
28. Give pre-med 30 minutes before transfusion
if any is ordered by the physician.
29. Wash hands.
30. Prepare equipment needed for BT.
31. Initiate an IV line with PNSS and regulate at
keep vein open (KVO) rate.
32. Open compatible blood set aseptically and
wear gloves.
33. Spike blood bag carefully. Fill the drip
chamber halfway and prime the tubing.
Remove air bubbles if any. Use g 18 or 19
for side drip.
34. Disinfect the Y injection port of the PNSS IV
tubing and insert the needle from the BT
administration set and secure with adhesive
tape.
35. Regulate the PNSS fluid while transfusion is
going on.
36. Transfuse the blood via the injection port at
10-15 drops initially for 15 minutes.
37. Observe client on an ongoing basis for any
untoward signs and symptoms such as
flushed skin, chills, elevated temperature,
itchiness, urticaria, and dyspnea.
38. Regulate the blood at ordered rate if no
transfusion reaction is noted.
A.Y. 2021-2022
1st SEMESTER,
39. If any occurs, stop the transfusion, open the

IV line with PNSS and report to physician
immediately.
40. Swirl the bag once in a while to mix the solid
and liquid elements. One blood filter should
be used for one or two units of blood to
prevent sluggish rate of transfusion.
41. If blood is consumed, close roller clamp of
BT set then disconnect from IV lines.
42. Remove gloves.
43. Regulate the IVF as ordered.
44. Continue to observe the client after, for
delayed reaction could still occur.
45. Monitor VS and reassure client.
46. Carry out post BT orders such as re-check
hgb and hct, bleeding time, serial platelet
count, etc.
47. Discard blood bag and BT set according to
MMDA Ordinance #16.
48. Document observations and nursing
interventions and endorse accordingly.
49. Remind the doctor about the administration
of calcium gluconate if client had 4-6 or more
units of blood transfusion.
EVALUATION:
50. The appropriate blood product was
transfused at a correct rate.
51. The vital signs were within normal limits.
52. Was able to correct fluid imbalance.
TOTAL
/ 104

REMARKS:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
NAME OF STUDENT:

INSTRUCTOR:
SKILL: BASIC LIFE SUPPORT – Correctly Needs

Not Done
(0)
PEDIA (2) (1)
ASSESSMENT
1. Prevention of arrest
2. Early, high-quality CPR
3. Rapid activation of the EMS system or
response team to get help on the way
quickly – no matter the patient’s age
4. Effective, advanced life support
5. Integrated post-cardiac arrest care
6. Activation of Emergency Response System,
if unwitnessed, care first; if witnessed, call
A.Y. 2021-2022
first.
1st SEMESTER,

7. Know when to STOP. Patient has
spontaneous circulation.
8. Turned over to trained medical personnel
9. Operator is already exhausted
10. A Physician assumes responsibility
11. The scene becomes unsafe
MATERIALS:
12. Clean gloves
13. Mouth barrier/Pocket mask and/or one-way
valve
14. Stop watch/wrist watch
IMPLEMENTATION:
15. Scene size up. Check for scene safety, Wear of PPE, rather just
standard precautions, number of patients, verbalizing.
nature of illness/mechanism of injury, initial Resources may include: 9-1-1,
impression, including life-threatening Advanced Life Support, Rapid
bleeding, and if additional resources needed Response Team, Code Team, or
additional personnel as needed or
appropriate.
16. Do primary assessment. Position patient in a
supine position if necessary.
17. Assesses the level of consciousness by Shouting elicit verbal stimuli
tapping the patient’s shoulders. And shouts
“Are you ok?” on both ears
Unresponsive patient
18. Call for “Help and get me an AED”
19. Simultaneously, open airway (head-tilt/chin- ABC for responsive patients. CAB
lift for patient without spinal injury; modified for unresponsive patients. Checks
jaw thrust for patient suspected of spinal for breathing and carotid pulse
injury), check for obstruction, check for simultaneously at least 5 seconds,
breathing and pulse check in the carotid but not more than 10 seconds.
pulse nearest the responder using his index
and middle finger.
20. Immediately start chest compressions using Hand position on patient’s
correct hand placement at the proper rate centered on lower of sternum.
and depth, allowing for full chest recoil. Depth of at least 1 ½ inches to 2
inches. Compression of 30, at a
rate of 100-120 per minute. Allow
chest recoil. Expose chest to better
visualization.
21. After 30 compression. Open airway, give 2 Head-tilt/chin-lift past a neutral
ventilations using a pocket mask/mouth position. Ventilation duration of 1
barrier second, with visible chest rise.
Delivered in 5-7 seconds only.
(if two rescuer BLS, 15:2 ratio of
compression and ventilation).
22. Repeat procedure 20 and 21 until 5 cycles.
23. Maintain High Quality CPR. Push Hard. Push Fast. Allow Chest
Recoil. Avoid Excessive Ventilation
and Avoid Interruption on
Compression.
24. When patient has spontaneous movement or
5 cycles of High Quality CPR was done. Do
a quick check of patients pulse on the carotid
artery nearest you.
25. If patient is still without pulse, continue with Remember to always provide high
High Quality CPR. quality CPR.
Patient has pulse
26. Position patient in a left lateral recumbent Keep the patient’s airway open and
position clear to ease breathing and to help
avoid having the casualty aspirate
saliva or vomitus.
27. Check status of patient and pulse time to
time.
28. If patient is not breathing, give rescue
breathing every 3 to 5 seconds (about 15-30
breaths per minute).
29. Check pulse every 2 minutes. If patient’s
pulse is unpalpable, return patient in a
supine position, and start High Quality CPR.
EVALUATION:
30. Do secondary assessment. Used to determine the injury, how
the injury occurred, how severe the
injury is and to eliminate further
A.Y. 2021-2022
1st SEMESTER,
injury.
31. Document the procedure. Endorse
everything to the EMS Personnel.
TOTAL
/ 62

REMARKS:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
NAME OF STUDENT:

INSTRUCTOR:
SKILL: BASIC LIFE SUPPORT – Correctly Needs

Not Done
(0)
NEWBORN with AED (2) (1)
ASSESSMENT
1. Prevention of arrest
2. Early, high-quality CPR
3. Rapid activation of the EMS system or
response team to get help on the way
quickly – no matter the patient’s age
4. Effective, advanced life support
5. Integrated post-cardiac arrest care
6. Activation of Emergency Response System,
if unwitnessed, care first; if witnessed, call
A.Y. 2021-2022
first.
1st SEMESTER,

7. Know when to STOP. Patient has
spontaneous circulation.
8. Turned over to trained medical personnel
9. Operator is already exhausted
10. A Physician assumes responsibility
11. The scene becomes unsafe
12. Determine importance of team dynamics
MATERIALS:
13. Clean gloves
14. Mouth barrier/Pocket mask and/or one-way
valve
15. Stop watch/wrist watch
16. Bag valve mask (infant)
17. Automated External Defibrillator
IMPLEMENTATION:
18. Scene size up. Check for scene safety, Wear of PPE, rather just
standard precautions, number of patients, verbalizing.
nature of illness/mechanism of injury, initial Resources may include: 9-1-1,
impression, including life-threatening Advanced Life Support, Rapid
bleeding, and if additional resources needed Response Team, Code Team, or
additional personnel as needed or
appropriate.
19. Do primary assessment. Position infant on a
firm, flat surface
20. Assesses the level of consciousness by Shouting elicit verbal stimuli,
tapping the infant’s foot. And shouts “Baby, tapping the foot of the infant elicit
Baby, are you ok?” on both ears stimuli
Unresponsive patient
21. Call for “Help and get me an AED”
22. Simultaneously, open airway (head-tilt/chin- ABC for responsive patients. CAB
lift for patient without spinal injury; modified for unresponsive patients. Checks
jaw thrust for patient suspected of spinal for breathing and brachial pulse
injury), check for obstruction, check for simultaneously at least 5 seconds,
breathing and pulse check in the brachial but not more than 10 seconds.
pulse of the infant nearest you.
23. Immediately start chest compressions using Finger position on the center on
correct finger placement at the proper rate the lower half of the sternum about
and depth, allowing for full chest recoil. 1 finger-width below the nipple line.
With a depth of at least 1 to 1 ½
inches. 30 compression, at a rate
of 100-120 per minute. Allow chest
recoil. Expose chest for better
visualization.
24. After 30 compression. Open airway, give 2 Head-tilt/chin-lift past a neutral

ventilations using a pocket mask/mouth position. Ventilation duration of 1
barrier second, with visible chest rise.
Delivered in 5-7 seconds only.
25. Repeat procedure 23 and 24 until 5 cycles.
26. Maintain High Quality CPR. Push Hard. Push Fast. Allow Chest
Recoil. Avoid Excessive Ventilation
and Avoid Interruption on
Compression.
Integration of team member
27. A team member comes back with an AED Note: The purpose of this is to
and Bag valve mask. The AED and Bag check the competency of the first
valve mask is positioned near the first responder.
responder. Second responder position
himself on the opposite side of the patient. Second responder should put the
AED to lessen interruption to CPR.
28. Second responder will switch with the first
responder. Second responder will count 3-2- This is done if EMS personnel
1, then they will switch. Second responder assumes responsibility from a lay
will resume High Quality CPR with his two provider.
thumbs centered on the lower half of
sternum about 1 finger-width below the
nipple line.
29. First responder will turn on the AED. Plug in The AED when turn on, a voice
connectors to the machine, peal of the pads prompt will provide the necessary
and apply pad 1, in the center of the anterior steps.
chest, and pad 2, on the infant’s back Proper positioning of pads is
A.Y. 2021-2022
between the scapulae. If patient’s chest is necessary to properly assess the

1st SEMESTER,
wet, wipe first before applying the pads. cardiac rhythm.
30. AED analysis. First responder says “clear” Ensures no one is touching the
and hovers hands a few inches above chest patient during analysis.
during analysis.
31. Shock advised. First responder says “clear”, Ensures no one is touching the
other team member says “clear”, first patient while shock being
responder says “shocking at 3, 1-2-3” delivered. Depresses shock button
presses shock button to deliver shock “shock within 10 seconds.
deliver, resume High Quality CPR”
32. Second rescuer continues with 10 cycles of Immediately following shock
High Quality CPR (15 compression:2 resume CPR starting with
ventilation). While first responder position compression until prompted by the
himself on top of head with bag valve mask AED for analysis
on hand.
33. After 15 compression, first responder opens Head-tilt/chin-lift past a neutral
airway from top of head by using the position. Ventilation duration of 1
appropriate technique and gives 2 second, with visible chest rise.
ventilations using the infant BVM. Position Delivered in 5-7 seconds only.
the bag valve mask, 2 hands using E-C Squeezes bag enough to make
technique. chest rise; does not fully squeeze
bag avoiding over inflation.
34. Repeat procedure 28 and 29 (switch roles) Coordination plan to switch

until 10 cycles or AED analyzes. compressors prior to AED analysis
Communicates with teammates, prepares for
rotation upon AED analysis
35. AED analysis. First responder says clearly Responders just slide side to side
“stand clear, lets switch”
36. AED analysis. First responder says “clear” Ensures no one is touching the
and hovers hands a few inches above chest patient during analysis.
during analysis.
37. AED advised. “NO SHOCK ADVISED”
38. If “NO SHOCK ADVISED”, check for Rescuer performing ventilations

breathing and pulse. opens the airway and checks for
breathing and pulse
simultaneously for at least 5, but
no more than 10 seconds
39. If still without pulse. First responder Immediately after checking,

immediately starts High Quality CPR, until 5 resumes High Quality CPR starting
cycles or AED prompts. with compressions until prompted
by the AED for analysis
Patient has pulse

40. While keeping the airway open with the While keeping the airway open
proper technique, continue to give Keep the patient’s airway open and
supplemental air via infant bag valve mask, clear to ease breathing and to help
with 1 ventilation every 1 to 2 seconds avoid having the casualty aspirate
(about 25 to 50 breaths per minute). saliva or vomitus.
41. Check pulse every 2 minute. If patient’s
pulse is unpalpable, return patient in a
supine position, and start High Quality CPR.
EVALUATION:
42. Do secondary assessment. Used to determine the injury, how
the injury occurred, how severe the
injury is and to eliminate further
injury.
43. Document the procedure.
TOTAL
/ 84

REMARKS:
____________________________________________________________________________________
____________________________________________________________________________________
A.Y. 2021-2022
1st SEMESTER,
____________________________________________________________________________________
NAME OF STUDENT:

INSTRUCTOR:
SKILL: ADMINISTERING Correctly Needs

Not Done
(0)
NEBULIZATION (2) (1)
ASSESSMENT
1. Assess the 10 rights in medication
administration.
2. Assess the client's respiratory status.
3. Evaluate the history of the episode of client's
distress.
4. Assess the client's ability to use the
nebulizer.
5. Assess the medications the client is currently
taking.
A.Y. 2021-2022
6. Assess the client's knowledge regarding the

1st SEMESTER,
use of nebulizer.
7. The client will experience improved gas
exchange.
8. Breathing pattern will become effective.
9. The client will demonstrate understanding of
the need for nebulization.
10. The client will not experience the adverse
effects secondary to medication interaction.
11. The client's anxiety level will decrease
following treatment.
MATERIALS:
12. nebulization kit
13. nebulizer machine
14. nebules or medication for nebulization
15. paper towel
IMPLEMENTATION:
16. Verify physician’s order.
17. Gather all the materials needed
18. Identify client. Introduce yourself. Explain the
procedure.
19. Place client on high fowlers position
20. Wash hands.
21. Set up the nebulizer machine
22. Open the wrapper of the nebulization kit and
attach to the machine.
23. Open the nebules or medication for
nebulization.
24. Pour the prescribed amount of the drug into
the nebulizer cup carefully.
25. Cover the cup and fasten.
26. Fasten the T-piece to the top of the cup.
27. Fasten the mouthpiece to the other end of
the T-piece.
28. Instruct the client to breathe in and out
slowly and deeply through the mouthpiece.
The client’s lip should be sealed tightly
around the mouthpiece.
29. Turn on the machine and leave for 15-20
minutes until all the medications are
administered.
30. Turn off the machine once the medication is
consumed.
31. Wipe client's mouth with a clean towel.
32. Lower the siderails.
33. Perform back clapping after nebulization
unless contraindicated.
34. Return all equipment properly and wash
hands.
EVALUATION:
35. The client experienced improved gas
exchange.
36. Breathing pattern became effective.
37. The client demonstrated understanding of
the need for nebulization.
38. The client experienced the adverse effects
secondary to medication interaction.
39. The client's anxiety level decreased following
treatment.
TOTAL
/ 78

REMARKS:
____________________________________________________________________________________
A.Y. 2021-2022
____________________________________________________________________________________
1st SEMESTER,
____________________________________________________________________________________
NAME OF STUDENT:
YEAR/SECTION: CARE OF MOTHER, CHILD AT RISK OR

WITH PROBLEMS CHEKLIST
SUMMARY OF GRADES

ACTIVITY NAME %
Setting up Intravenous
Infusion
Setting the flow rate
(IV infusion)
Administering of drugs
through IV push and
Heplock
A.Y. 2021-2022
Drug Incorporation into

1st SEMESTER,
IV Solution
Administering
medication via Piggy
Back
Changing Intravenous
Site Dressing
Blood Transfusion
BLS for Pediatric
Patient
BLS for Infant with
AED
Nebulization
Administration
TOTAL
___________________________________

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UNIVERSITY OF MAKATI

COLLEGE OF ALLIED HEALTH STUDIES

YEAR AND SECTION:

Compiled by: Esmeraldo C. De Las Armas IV MAN, RN, EMT-B

LEVEL 2 NURSING SKILLS

TABLE OF CONTENT PAGE

NP 4 – Community Health Nursing 1 5

2. Cleaning a Wound and Applying Sterile Dressings 8

NP 7 – Care of Mother, Child, Adolescent (Well Client) 25

NP 9 – Care of Mother, Child at Risk or with Problems

25. Administering medication via Piggy Back 65

26. Changing Intravenous Site Dressing 67

COLLEGE OF ALLIED HEALTH STUDIES

YEAR/SECTION: DATE: GRADE: (%) CLINICAL

5. Assess the environment and look for a flat

alcohol to cleanse materials used

Computation: Raw Score / Total Score X 100 = FINAL GRADE

Clinical Instructor: ____________________________________ %

YEAR/SECTION: DATE: GRADE: (%) CLINICAL

SKILL: CLEANING A WOUND AND Correctly Needs

5. Assess the current dressing to determine if it

clean around the drain. (Refer to care for prevent infection.

Penrose drain, T-tube drain, Jackson-Pratt

Computation: Raw Score / Total Score X 100 = FINAL GRADE

Clinical Instructor: ____________________________________ %

YEAR/SECTION: DATE: GRADE: (%) CLINICAL

6. The client will be able to discuss the purpose

Computation: Raw Score / Total Score X 100 = FINAL GRADE

Clinical Instructor: ____________________________________ %

YEAR/SECTION: DATE: GRADE: (%) CLINICAL

SKILL: INTRADERMAL Correctly Needs

36. Stabilize the syringe and needle. Slowly inject

the medication producing the wheal/ bleb.

Computation: Raw Score / Total Score X 100 = FINAL GRADE

Clinical Instructor: ____________________________________ %

YEAR/SECTION: DATE: GRADE: (%) CLINICAL

SKILL: INTRAMUSCULAR Correctly Needs

5. Assess for previous intramuscular injections

6. Assess for the indications for intramuscular

Clinical Instructor: ____________________________________

YEAR/SECTION: DATE: GRADE: (%) CLINICAL

procedure and willingness to participate.

7. Previous injection sites

Holding of the syringe steadily will

Computation: Raw Score / Total Score X 100 = FINAL GRADE

Clinical Instructor: ____________________________________ %

YEAR/SECTION: DATE: GRADE: (%) CLINICAL

6. Assess the client’s understanding of the of

44. Client’s anxiety was minimal during the

Computation: Raw Score / Total Score X 100 = FINAL GRADE

Clinical Instructor: ____________________________________ %

YEAR/SECTION: DATE: GRADE: (%) CLINICAL

namely, the proximal and distal fetal parts.

PLANNING / EXPECTED OUTCOMES:

FOURTH MANEUVER (FLEXION OF THE FETAL HEAD)

Computation: Raw Score / Total Score X 100 = FINAL GRADE

Clinical Instructor: ____________________________________ %

YEAR/SECTION: COMMUNITY HEALTH NURSING 1

RAW TOTAL PASSED/ CI’s STUDENT’s

Cleaning a Wound and

YEAR/SECTION: DATE: GRADE: (%) CLINICAL

SKILL: ORAL, BUCCAL, AND Correctly Needs

and fluid. alternate route for medication