Rohilkhand College of Nursing

Procedure Checklist
Insertion of Feeding Tube in a baby
S/N Procedure 1 2 3 4 5
1. Identify the baby.
2. Identifies the NG tube of correct size based on the
gestational age (6 or 8 Fr) and leaves the pack partially
open
3. Wash hand and wears gloves.
4. Measures the length by using no-touch method from tragus
to external nares till midpoint between umbilicus and
Xiphisternum. Marks the tube at this point.
5. Remove the cover and inserts gently through one nostril till
the measured distance is reached.
6. Confirms the position of the tube-By aspirating gastric
contents. If no aspirate is obtained then Pushes 3 ml of air
and auscultate for gurgling sound over stomach with the
stethoscope.
7. If there is any doubt about the location of the tube,
withdraw it and insert the NG tube again.
8. Fixes the tube firmly over nose or upper lip with plaster.
9. Attach drainage bag, if there is abdominal distension.
TOTAL SCORE
OBTAINED SCORE

PERCENTAGE

REMARK

Name of the student_____________________________ Date_________________

Course__________________________________ Class ________________

Name of Instructor/Evaluator: _______________________ Ward/Unit________________

Signature: __________________________

6- Highly Satisfactory – 85-100 Percentage

5 -Satisfactory – 69 – 84 Percentage
4 -Moderately Satisfactory- 52 to 68 Percentages
3 - Moderately Unsatisfactory- 35 to 51 Percentages
2 -Unsatisfactory – 18 to 34 Percentages
1 -Highly Unsatisfactory – 0-17 Percentage
Note:
1. 1, 2, 3, 4, 5 denoting attempt made by the students
2. Each statement will be score by Yes/No and yes contain 1 point & no contain zero point
3. Students who get 85 % or above will get full satisfactory and below will have to make attempt till the
candidate get 85% or above
Remarks by Evaluator: ______________________________________
PRINCIPAL
 Rohilkhand College of Nursing
Procedure Checklist
Collection of Urine Specimen from Infants
S/N Procedure 1 2 3 4 5
1. Explain to mother how & why the urine will be collected.
2. Wash dry genital area and surrounding skin.
3. Attack the collection bag to the perineum well over the urethral
meatus.
 In small boy babies, the penis & scrotum are inside the bag.
 In girl’s babies, the perineum is stretched during
application to that area.
4. Place the diaper carefully.
5. Check the bag frequently & remove as soon as specimen is
available.
6. Transfer urine specimen to labelled specimen container for
transporting to the lab.
7. Clean the genital area and apply diaper.
TOTAL SCORE
OBTAINED SCORE
PERCENTAGE
REMARK

Name of the student_____________________________ Date_________________

Course__________________________________ Class ________________

Name of Instructor/Evaluator: _______________________ Ward/Unit________________

Signature: __________________________

6- Highly Satisfactory – 85-100 Percentage

5 -Satisfactory – 69 – 84 Percentage
4 -Moderately Satisfactory- 52 to 68 Percentages
3 - Moderately Unsatisfactory- 35 to 51 Percentages
2 -Unsatisfactory – 18 to 34 Percentages
1 -Highly Unsatisfactory – 0-17 Percentage
Note:
1. 1, 2, 3, 4, 5 denoting attempt made by the students
2. Each statement will be score by Yes/No and yes contain 1 point & no contain zero point
3. Students who get 85 % or above will get full satisfactory and below will have to make attempt till the
candidate get 85% or above
Remarks by Evaluator: ______________________________________

PRINCIPAL