St.

Scholastica’s College Tacloban

Maharlika Highway, Brgy. Campetic, Palo, Leyte
COLLEGE OF NURSING

Name: ___________________________ Date: ___________________ Score: ______________

Procedure: Nebulization

Check (/) Correctly Done, Incorrectly Done, or Not Done

Procedure Correctly Incorrectly Not Done Remarks

Done (2) Done (1) (0)
1. Perform hand hygiene.
2. Explain the procedure to the patient.
3. Provide privacy.
4. Add medication to nebulizer administration container
as ordered by provider.
5.Connect nebulizer to power source (oxygen or
compressed air as ordered by provider.
6. Place in the individual’s mouth having them use their
lips to form a
tight seal on the mouthpiece. If client is using a mask
instead of a
mouthpiece be sure the mask fits well.
7. Turn the machine on. Have the patient breathe
normally.
8. If appropriate, continue the treatment until all
medication is given,
usually 10-15 minutes.
4. Wash hands.
5. Record in the patient’s chart.

Recommendation:
A. Pass_________
B. Pass but Needs More Practice________
C. Failed__________

Assessed and Graded by: ______________________________________________

Signature Over Printed Name of Clinical Instructor