PPE Checklist2

A.Y.
2022-2023
CON
Wesleyan University Philippines
2022-2023
Wesleyan University –Philippines
Mabini Extension, Cabanatuan City 3100
College of Nursing
Tel. No. 044-463-2162/2074; Fax No. 463-0596 local 126
PERFORMANCE EVALUATION TOOL

NCM 109 – CARE OF MOTHER AND CHILD AT RISK OR WITH PROBLEMS
(ACUTE AND CHRONIC)
DIRECTIONS:
ASSESSMENT OF PATELLAR REFLEX &
● The evaluation tool will be discussed by the clinical instructor/s.
● During the discussion, the instructor/s may demonstrate the procedures or may use
MAGNESIUM SULFATE
video viewing for students’ orientation.
● The students should be given sufficient time to prepare for the return demonstration.
ADMINISTRATION
● The students will do the return demonstration based on the checklist given.
● The following rating scale shall be used in grading student’s performance:
DONE- able to perform

Perform the procedure safely and accurately in a very consistent and
independent manner without supportive assistance from the instructors.
Perform a difficult action quickly and skillfully
Spends minimal time on task
Focuses on client while giving care
NOT DONE - unable to perform

Unable to perform procedure even under close supervision of guidance
Require continuous, supportive and directive cues
Takes longer time to complete the procedure.
Performs in unskilled manner
● At the end of each laboratory session, the instructor/s will give remarks based on the
student’s performance in accordance to the procedures indicated.
College of Nursing
PERFORMANCE EVALUATION TOOL

NCM 109 – CARE OF MOTHER AND CHILD AT RISK OR WITH PROBLEMS
(ACUTE AND CHRONIC)
NAME OF STUDENT: _____________________
Block #______
PROCEDURE: MAGNESIUM SULFATE (MGSO4) ADMINISTRATION WITH

PATELLAR REFLEX ASSESSMENT
PURPOSE DONE NOT DONE

1 To lower the mother’s blood pressure and to
prevent complications to occur.
ASSESSMENT
1- BLOOD PRESSURE
2
● Give the second dose if the blood pressure
taken is higher than the initial one.
● Hold the dose if the blood pressure taken
is lower than the initial one.
3- URINE OUTPUT
4
● Urine output should be 20 to 30 cc/hr for
clients with foley catheter
● Do not give the second dose if the client
presents an output lower than normal
5- RESPIRATION RATE
6
● Respiration rate should be more than 12
breaths per minute.
● Do not give the second dose if the client
presents respiration rate lower than normal
7- PATELLAR REFLEX
10
● If the client presents (+) knee jerk,
College of Nursing
continue administering the medication

● If the client presents (-) knee jerk, do not
administer the medication and notify the
physician immediately
● Observe the normal extension or kicking
out of the leg as the quadriceps muscle
contracts
⎯ 0 = absent (abnormal).
⎯ +1 = diminished.
⎯ +2 = average/normal
⎯ +3 = brisker than average.
⎯ +4 = very brisk.
PROCEDURE RATIONALE
1 Do hand washing Hand hygiene and PPE
before and after prevent the spread of
the preparation of microorganisms.
equipment as
PPE is required based on
follows:
transmission precautions.
● Hypotray
with lining
● Prefilled
syringe
with
medication
(Magnesiu
m Sulfate)
● Medication
Card
● 70%
isopropyl
alcohol
College of Nursing
● 1 pair of
clean
gloves
● Alcohol
swab or
cotton
balls with
alcohol
● 1 strip of
plaster
with
attached
dry cotton
ball
2 When all To ensure accuracy and

medications for prevent errors.
one patient have
The last checking should be
been prepared,
done after identifying the
Re check the patient and before
label with the administration.
MAR before
taking the
medications to
the patient.
3 Place the Careful handling and close
hypotray on the observation prevent
bedside table accidental or
deliberate disarrangement of
medications.
4 Identify the To ensure the right patient
patient. receives the medications and
helps prevent errors.
5 Set the bed to a
comfortable
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height to work
and lower the
side rails where
you will work.
6 Close the doors To provide privacy of your
of the room or patient.
pull the bedside
curtain
7 Complete Assessment is a prerequisite
necessary to administration of
assessments medications.
before
Explanation provides
administering
rationale, increases
medications.
knowledge, and
Check the
patient’s allergy reduces anxiety.
bracelet or ask
the patient
about allergies.
Explain the
purpose and
action of the
medication to the
patient.
8 Put on clean
gloves
9 Assist the client Appropriate positioning for
on a side lying the site chosen prevents
position and injury. Draping helps
expose the maintain the patient’s
gluteal muscle of privacy.
the client, drape
as needed
10 Select the Moving from the center
injection site and outward prevents
clean it with the contamination of the
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antiseptic swab site.

starting from
inner part of the
site going outside
in a circular
motion
11 Place the strip of
plaster with
cotton ball
attached on it on
your non
dominant hand.
12 Remove the This technique lessens the
needle cap by risk of an accidental
pulling it straight needlestick and also
off. Hold the prevents inadvertently
unscrewing the needle from
syringe in your
the barrel of the syringe
dominant hand
between the
thumb and
forefinger.
13 Displace the skin This ensures medication
in a Z-track does not leak back along the
manner by pulling needle track
the skin down
and into the subcutaneous
or to one side tissue.
about 1 inch (2.5
cm) with your
nondominant
hand and hold the
skin and tissue in
this position
14 Aspirate for blood The process of pulling back
(if blood is on the plunger of the syringe
aspirated, before injection to ensure the
College of Nursing
withdraw the medication is not injected

needle, replace into a blood vessel
the needle with a
sterile one, locate
for another site
and repeat step 9
to 11.
15 Quickly dart the A quick injection is less
needle into the painful. Inserting the needle
tissue so that the at a 72- to
needle is
90-degree angle facilitates
perpendicular to entry into muscle tissue.
the patient’s
body. This should
ensure that it is
given using an
angle of injection
between
72 and 90
degrees
16 As soon as the Moving the syringe could
needle is in place, cause damage to the tissues
use the thumb and inadvertent
and forefinger administration into incorrect
area. Rapid injection of the
of your
solution creates pressure in
nondominant
the tissues, resulting in
hand to hold the
discomfort.
lower end of the
syringe. Slide
your dominant
hand to the end
of the plunger.
Inject the solution
slowly (10 sec/mL
of medication).
College of Nursing
17 Once the Allows medication to begin to

medication has diffuse into the surrounding
been instilled, muscle
wait 10 seconds
tissue
before
withdrawing the
needle.
18 Withdraw the Removing the needle at the
needle smoothly same angle at which it was
and steadily at inserted minimizes tissue
the same angle damage and discomfort for
the patient
at which it was
inserted,
supporting tissue
around the
injection
site with your
nondominant
hand
19 Apply gentle Light pressure causes less
pressure at the trauma and irritation to the
site with dry tissues.
gauze, or cotton
ball with plaster
attached to it.
20 Do not recap the
used needle.
Engage the
safety shield or
needle guard, if
present. Discard
the needle and
syringe in the
appropriate
receptacle.
College of Nursing
21 Remove gloves Removing PPE properly

and additional reduces the risk for infection
PPE, if used. transmission and
Perform hand contamination of other items.
hygiene. Hand hygiene prevents
the spread of
microorganisms.
22 Document the Timely documentation helps
administration of to ensure patient safety.
the medication
immediately
after
administration.
23 Evaluate the The patient needs to be
patient’s evaluated for therapeutic and
response to adverse
medication within
effects from the medication.
an appropriate
Visualization of the site
time frame.
allows for
Assess site, if
possible, within 2 assessment of any untoward
to 4 hours effects
after
administration
TOTAL SCORE=33pts
REMARKS:__________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Expected level of performance
22 to 33 items done: PASS
Below 21 items done: Repeat Procedure to PASS
College of Nursing
Student’s Signature:_______________ Instructor’ Signature________________

Date:_____ Date:__________

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A.Y.

PERFORMANCE EVALUATION TOOL

DONE- able to perform

NOT DONE - unable to perform

PERFORMANCE EVALUATION TOOL

PROCEDURE: MAGNESIUM SULFATE (MGSO4) ADMINISTRATION WITH

PURPOSE DONE NOT DONE

continue administering the medication

2 When all To ensure accuracy and

antiseptic swab site.

withdraw the medication is not injected

17 Once the Allows medication to begin to

21 Remove gloves Removing PPE properly

Student’s Signature:_ Instructor’ Signature__

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