Republic of the Philippines

Cebu Normal Universit

Osmeña Blvd. Cebu City, 6000 Philippines

College of Nursing
Center of Excellence (COE) | Level IV Re-Accredited (AACCUP)
Telephone No.: (+63 32) 254 4837
Email: cn@cnu.edu.ph; secretary@cnunursing.org
Website: www.cnu.edu.ph

Instructional Module 3
Disorders of the Endocrine System
PERFORMANCE RATING SCALE FOR BLOOD GLUCOSE MONITORING

CRITERION PROFICIENT (3) DEVELOPING (2) BEGINNER (1)

Performs Performs Not able to
procedure without procedure with perform the
any error or error and specific procedure
reminder correction
1. Prepares all the necessary equipment X
and materials. Ensures that the
glucometer is functional.
2. Prepare the meter by validating the X
proper calibration with the strips to be
used.
(This usually involves matching a code
number on the strip bottle to the code
registered on the meter.)
3. Identify the patient and explain the X
procedure to the patient
4. Prepare the finger to be lanced by X
having the patient wash hands,
preferably with warm water. Dry
thoroughly. May use an alcohol wipe
to cleanse the finger for convenience.
Let it dry.
5. Don disposable gloves X
6. Prick the patient’s finger lateral to the X
fingertip using lancet/lancing device,
obtaining a drop of blood large
enough to satisfy the requirements of
the testing strips being used.
7. Apply the blood carefully to the strip X
test area. Ensuring the strip is
adequately filled-up.
8. Allow the device to process and X
complete the result
9. Cover the lanced finger with a gauze X
or cotton until the bleeding stops. May
use adhesive tape if necessary.
10.Take note of the result from the X
glucometer. May inform the client of
the result.
11.Dispose the used materials to the X
yellow and red bin (for the sharps).

Page 1 of 4
Registration No. 52Q18778
Certification Date: 6 August 2018
Recertification due date: 24 January 2021
For verification of the certificate please access
www.globalgroup.net (Certification check and
type the registration number)

 Republic of the Philippines

Cebu Normal Universit
Osmeña Blvd. Cebu City, 6000 Philippines

College of Nursing
Center of Excellence (COE) | Level IV Re-Accredited (AACCUP)
Telephone No.: (+63 32) 254 4837
Email: cn@cnu.edu.ph; secretary@cnunursing.org
Website: www.cnu.edu.ph

12.Disinfect the device following the X

manufacturers guidelines.
13.Remove gloves and wash hands. X
14.Record the results accurately. X
15.Ensure clients comfort and X
cleanliness throughout the procedure.

PERFORMANCE RATING SCALE FOR PREPARING AND ADMINISTERING INSULIN

CRITERION PROFICIENT (3) DEVELOPING (2) BEGINNER (1)
Performs Performs Not able to
procedure without procedure with perform the
any error or error and specific procedure
reminder correction
1. Verify doctors order for insulin X
administration. Pay particular
attention to type of insulin, amount
and timing
2. Prepares all the necessary X
equipment and materials. Ensures
to secure the prescribed insulin
for the client.
3. Wash hands and dry them well. X
4. Inspect the insulin for its X
expiration date and for clumps or
any signs of damage. If expired or
presence of damage, discard and
obtain a new insulin.
5. Roll inulin vial between your n/a
hands to mix it. DO NOT shake
the bottle.
6. Wipe the top of the bottle with an n/a
alcohol wipe. Let it dry. DO NOT
blow on it.
7. Introduce air into the vial same as n/a
the insulin dosage
8. When mixing Regular insulin with n/a
other insulin types: WITHDRAW
FIRST from the Regular Insulin.

When mixing Clear and Cloudy

insulin: WITHDRAW FIRST from
the Clear Insulin.

Page 2 of 4
Registration No. 52Q18778
Certification Date: 6 August 2018
Recertification due date: 24 January 2021
For verification of the certificate please access
www.globalgroup.net (Certification check and
type the registration number)

 Republic of the Philippines

Cebu Normal Universit
Osmeña Blvd. Cebu City, 6000 Philippines

College of Nursing
Center of Excellence (COE) | Level IV Re-Accredited (AACCUP)
Telephone No.: (+63 32) 254 4837
Email: cn@cnu.edu.ph; secretary@cnunursing.org
Website: www.cnu.edu.ph

9. Check the syringe for air bubbles. n/a

If there are bubbles, hold both the
bottle and syringe in one hand,
and tap the syringe with your
other hand.
10.Make sure you have the right total n/a
dose of insulin. Put the syringe
down carefully so the needle does
not touch anything.
Preparing Insulin Pen
11. Remove the pen cap and check X
insulin for the prescribed type,
expiration date and any signs of
damage.
12.Wipe the tip of the pen with an X
alcohol swab
13.Remove the protective pull tab X
from the needle and screw the
needle onto the pen. Remove the
needle cap.
14.Looking at the dose window, turn X
the dosage knob to one or two
units.
15.Holding the pen up with the X
needle pointing upwards, then
press the injection button all the
way until you see a drop of insulin
at the needle tip. The dosage
knob should be back at zero after
completing this step.
16.Turn the dosage knob to dial the X
number of units of insulin needed.
Administering Insulin
17.Identify the client and Explain the X
procedure to the client
18.Choose the appropriate site: X
-It should be on the recommended
anatomical site.
-Should be 1 inch away from scars
and 2 inches away from the navel
-No inflammation, bruising, swelling
19.Clean the injection site with X
alcohol wipe and let air dry.

Page 3 of 4
Registration No. 52Q18778
Certification Date: 6 August 2018
Recertification due date: 24 January 2021
For verification of the certificate please access
www.globalgroup.net (Certification check and
type the registration number)

 Republic of the Philippines

Cebu Normal Universit
Osmeña Blvd. Cebu City, 6000 Philippines

College of Nursing
Center of Excellence (COE) | Level IV Re-Accredited (AACCUP)
Telephone No.: (+63 32) 254 4837
Email: cn@cnu.edu.ph; secretary@cnunursing.org
Website: www.cnu.edu.ph

20.Pinch the skin and put the needle X

in at a 45º or 90 º angle
21.Push the needle all the way into X
the skin. Let go of the pinched
skin. Inject the insulin slowly and
steadily until it is all in.
22.Leave the syringe in place for 5 X
seconds after injecting
23.Dispose the syringe/needles X
properly
24.Ensure client’s comfort and X
cleanliness of procedure
25.Record the procedure. X

AMIL, ADRIAN MIGUEL

CBG = 45/45

Insulin = 60/60 (plus 3 points bonus are already included as per Mr. Pananganan)

Feedback: Well done with your return demonstration..:)

Page 4 of 4
Registration No. 52Q18778
Certification Date: 6 August 2018
Recertification due date: 24 January 2021
For verification of the certificate please access
www.globalgroup.net (Certification check and
type the registration number)