UNIVERSITY of SAINT LOUIS

Tuguegarao City

SCHOOL OF HEALTH AND ALLIED SCIENCES

Name: __________________________________________________ Date: __________________

Course/Year : ____________________ Set/Group #: ____________

LEOPOLD’S MANEUVER

Instruction: Please put a check ( ) mark on the appropriate column.

PREPARATION
1. Introduce yourself and verify the client’s identity. Explain to the client and the family what you are going to
do and why it is necessary and how the client can cooperate.

2. Perform hand hygiene and observe other appropriate infection control procedures.

3. Provide for client privacy by drawing the curtains or closing the door.

4. Prepare the client.

a. Instruct the client to empty the bladder.

b. Position the woman supine with knees slightly flexed. Place a small pillow or folded towel under one hip.

c. Drape patient. Expose the abdomen only.

d. Wash your hands using warm water or rub your hands.

PROCEDURE
5. Perform the first maneuver.
a. Stand beside the woman, facing her and place both hands flat on her abdomen.
b. Palpate the uterine fundus. Determine consistency, shape and mobility.
6. Perform the second maneuver.
a. Face the client and place the palms of each hand on either side of the abdomen.
b. Palpate the sides of the uterus.
 Hold the left hand stationary on the left side of the uterus while the right hand palpates the opposite side of
the uterus from top to bottom.
 Then hold the right hand steady and repeat palpation using the left hand on the left side.
7. Perform the third maneuver.
 Gently grasp the lower portion of the abdomen just above the symphysis pubis between the thumb and index
finger and try to press the thumb and finger together. Determine any movement and whether the part is form or
soft.
8. Perform the fourth maneuver.
a. Turn so that you face the woman’s feet.
b. Place fingers on both sides of the uterus with your fingers pointed towards the pelvic inlet to determine
whether the head is flexed (vertex) or extended (face). Slide your hands downward and inward on each side
of the uterus.
 UNIVERSITY of SAINT LOUIS
Tuguegarao City

SCHOOL OF HEALTH AND ALLIED SCIENCES

Name: __________________________________________________ Date: __________________

Course/Year : ____________________ Set/Group #: ____________

PERINEAL CARE

Instruction: Please put a check ( ) mark on the appropriate column.

Procedure

1. Gather materials needed for the procedure.

 clean gloves
 waterproof pad
 bath blanket
 hospital gown
 top linen
 wash cloth
 basin of water
2. Introduce yourself and verify the client’s identity. Explain to the client and the family what you are going to do and
why it is necessary and how the client can cooperate. Obtain permission.

3. Perform hand hygiene and observe other appropriate infection control procedures.

4. Provide for client privacy by drawing the curtains or closing the door.

5. Close door and pull curtain around bed.

6. Wear gloves.

7. Place waterproof pad under client’s buttocks.

8. Position the female in a back-lying position with the knees flexed and spread well apart. Position the male client in a
supine position with his knees slightly flexed and his hips slightly externally rotated.

9. Expose perineal area. Fold client’s gown up above the genital area. Place a bath blanket over the client using a
“diamond” draping technique. Corners of bath blanket should point toward the head, sides of body, and between the
client’s legs. Fold top linen down to the end of the bed. Tuck side corners of bath blanket around client’s legs. Lift
corner between client’s legs to expose perineal area.

10. Inspect the perineal area.

a. Note particular areas of inflammation, excoriation, or swelling, especially between the labia in females and the
 scrotal folds in males. Note excessive discharge or secretions from the orifices and the presence of odors.
b. Wash and dry the perineal area.

FEMALE

a. Clean perineal area in the downward direction (from pubic area to rectum). Clean and dry upper thighs. Use
separate quarters of the washcloth for each stroke.
b. Clean the labia majora. Separate the labia majora to clean between the labia majora and labia minora. With the
labia separated, clean the clitoris, urethral meatus, and vaginal orifice.
c. Rinse the area well with warm water. Pat perineal area dry. Apply lotion to upper thighs.
MALE

a. Gently raise penis. If the client develops an erection, delay perineal care. Gently grasp the shaft of the penis.
b. If the client is uncircumcised, retract the foreskin to expose the glans penis for cleaning.
c. Use a circular motion to clean the meatus of the penis and glans in an outward direction. Clean the shaft of the
penis. Rinse penis. Pat glans and shaft of penis dry.
d. Replace the foreskin after cleansing the glans.
e. Clean and dry the scrotum. The posterior folds of the scrotum may need to be cleaned when the buttocks are
cleaned. Scrotum may need to be lifted during cleaning.
11. Perform anal care.

a. Remove any fecal material with toilet tissue.

b. Clean perineal area by wiping from genitals to anus with one stroke.
c. Clean anus in circular motion. Rinse anal area. Pat dry.
12. Remove gloves. Wash hands. Remove bath blanket.

13. Place gown down over genitals. Place top linen on client.

14. Document procedure performed, client’s response, and assessment findings.

Reference:

Fundamentals of Nursing Checklist by Maria Teresa Padilla, RN, MAN

 UNIVERSITY of SAINT LOUIS
Tuguegarao City

SCHOOL OF HEALTH AND ALLIED SCIENCES

Name: __________________________________________________ Date: __________________

Course/Year : ____________________ Set/Group #: ____________

POSTPARTUM EXERCISES

Procedure

1. Teach the mother postpartum exercises in the early postpartum period to strengthen the abdominal muscles and firm
the waist

ABDOMINAL BREATHING

2. Assume a supine position with knees bent. Inhale through the nose, keep the rib cage as stationary as possible, and
allow the abdomen to expand. Then contract the abdominal muscles while exhaling slowly through the mouth.

HEAD LIFT

3. Assume a supine position with knees bent and arms out-stretched at the side. Inhale deeply to begin then exhale
while lifting the head slowly. Hold position for a few second then relax.

MODIFIED SIT-UPS

4. Assume a supine position with arms outstretched and knees bent. Raise head and shoulders as hands reach for knees.
Raise shoulders only as far as the back will bend; waist remains on the floor.

KNEE AND LEG ROLLS

5. Lie flat on the back with knees and feet flat on the floor or bed. Keep shoulders and feet stationary and roll knees to
touch first one side of the bed then the other.

CHEST EXERCISES

6. Lie flat with arms extended straight out to the side then bring the hands together above the chest while keeping the
arms straight. Hold for a few seconds and return to the starting position

ISOMETRIC EXERCISES

7. Bend elbows, clasp hands together above chest, and press hands together for a few seconds.

8. Instruct mother to repeat each exercise up to five times twice a day, at first then gradually increase as the mother
gains strength.
Reference: Emily Slone Mc Kinney, Susan Rowena James, Sharon Smith Murray &Jean Weiler Ashwill Maternal-Child
Nursing 2nd Edition

UNIVERSITY of SAINT LOUIS

Tuguegarao City

SCHOOL OF HEALTH AND ALLIED SCIENCES

Name : __________________________________ Date : ____________

Course/Year: ___________________ Set/Group #: _____________

INJECTING MEDICATION THROUGH SUBCUTANEOUS INJECTION

Instruction: Please put a check ( ) mark on the appropriate column using the scale.

PROCEDURE
PREPARATION
1. Assess:
 Allergies to medication.
 Specific drug action and the expected response.
 Client’s knowledge of drug action and response.
 Status and appearance of Sc site for lesions, erythema, swelling, ecchymosis and etc.
 Ability of the client to cooperate
 Previous injection sites used.
2. Assemble equipment and supplies
 Doctor’s order
 Vial or ampule
 Syringe and needle
 Antiseptic swabs
 Dry, sterile gauze for opening an ampule
 Clean gloves
3. Check the Doctor’s Order.
a. Check the label on the medication carefully against the Doctor’s Order to make sure that the correct medication is
being prepared.
b. Follow the three checks for administering medications. Read the label on the medication:
 When it is taken from the medication cart
 Before withdrawing the medication
 After withdrawing the medication
4. Organize the equipment
Procedure
1. Perform hand hygiene, and observe other appropriate infection control procedures.
2. Prepare the medication from the vial or ampule for drug withdrawal.
3. Provide for client privacy.
4. Prepare the client.
a. Check the client’s identification band.
b. Assist the client to a position in which the arm, leg or abdomen can be relaxed depending on the site to be
PROCEDURE
used.
c. Obtain assistance in holding an uncooperative client.

5. Explain the purpose of the medication and how it will help, using language that the client can understand.

6. Select and clean the site.

a. Select a site free of tenderness, hardness, swelling, scarring, itching, burning, or localized information.
b. Put on gloves.
c. As agency protocol indicates, clean the site with an antiseptic swab. Start at the center of the site and clean in a
widening circle. Allow the area to dry thoroughly.
d. Place and hold the swab between the third and fourth fingers of the nondominant hand.

7. Prepare the syringe for injection.

 Remove the needle cap while waiting for the antiseptic to dry. Pull the cap straight off to avoid contaminating
the needle by the outside edge of the cap.
8. Inject the medication.
a. Grasp the syringe in your dominant hand by holding it between your thumb and fingers. With palm facing to the
side or upward for a 45-degree angle insertion, or with palm downward for a 90-degree angle insertion to inject.
b. Using the non-dominant hand, pinch or spread the skin at the site, and insert the needle using the dominant hand
and a firm steady push.
c. When the needle is inserted, move your non-dominant hand to the end of the plunger.
d. Dependent upon personal choice and type of medication, aspirate by pulling back on the plunger.
e. Inject the medication by holding the syringe steady and depressing the plunger with slow, even pressure.

9. Remove the needles.

 Remove the needle slowly and smoothly, pulling along the line of while depressing the skin with your non-
dominant hand.

10. Dispose of supplies appropriately.

 Discard the uncapped needle and attached syringe into designated receptacles.

11. Document all relevant information.

a. Document the medication given, dosage, time, route, and any assessments.
b. Many agencies prefer that medication administration be recorded on the medication record.

12. Assess the effectiveness of the medication at the time it is expected to act.

TOTAL SCORE

______________________________________
Printed Name & Signature of Clinical Instructor

Reference: Kozier & Erb's Fundamentals of Nursing Checklist Eighth Edition by Berman Audrey; Snyder Shirlee;
Kozier, Barbara; Erby, Glenora

UNIVERSITY of SAINT LOUIS

 Tuguegarao City

SCHOOL OF HEALTH AND ALLIED SCIENCES

Name: __________________________________________________ Date: __________________

Course/Year : ____________________ Set/Group #: ____________

PREPARING MEDICATION FROM VIAL

Instruction: Please put a check ( ) mark on the appropriate column.

PREPARATION
1. Gather materials needed for the procedure.
Vial of sterile medication
 Antiseptic swabs
 Safety needle and syringe
 Filter needle
 Sterile water or normal saline, if drug is in powdered form
2. Implement same preparation as described in Skill: Preparing Medications from Ampules.
PROCEDURE
3. Perform hand hygiene and observe other appropriate infection control procedure.
4. Prepare the medication vial for drug withdrawal.
a. Mix the solution, if necessary, by rotating the vial between the palms of hands, not by shaking.
b. Remove the protective cap or clean the rubber cap of a previously opened vial with an antiseptic wipe by
rubbing in a circular motion.
5. Withdraw the medication
a. Attach a filter needle, as agency practice dictates, to draw up premixed liquid medications from multidose
vials.
b. Ensure that the needle is firmly attached to the syringe.
c. Remove the cap from the needle, then draw up into the syringe the amount of air equal to the volume of the
medication to be withdrawn.
d. Carefully insert the needle into the upright vial through the center of the rubber cap, maintaining the sterility
of the needle.
e. Inject air into the vial, keeping the bevel of the needle above the surface of the medication.
f. Withdraw the prescribed amount of medication, using either of the following methods:
 Hold the vial down, move the needle tip so that it is below the fluid level, and withdraw the medication.
Avoid drawing up the last drops of the vial;
or
 Invert the vial, ensure the needle tip is below the fluid level, and gradually withdraw the medication.
g. Hold the syringe and vial at eye level to determine that the correct dosage of the drug is drawn into the
syringe. Eject the air remaining at the top of the syringe into the vial.
h. When the correct volume of medication plus a little more is obtained, withdraw the needle from the vial, and
replace the cap over the needle using the scoop method thus maintaining the sterility.
i. If necessary, tap the syringe barrel to dislodge any bubbles present in the syringe.
j. If giving an injection, replace the filter needle, if used, with a regular or safety needle of the correct gauge
and length. Eject air from new needle and verify correct medication volume.

Reference: Kozier & Erb's Fundamentals of Nursing Checklist Eighth Edition by Berman Audrey; Snyder Shirlee;
Kozier, Barbara; Erby, Glenora
 UNIVERSITY of SAINT LOUIS
Tuguegarao City

SCHOOL OF HEALTH AND ALLIED SCIENCES

Name: __________________________________________________ Date: __________________

Course/Year : ____________________ Set/Group #: ____________

PREPARING MEDICATION FROM AMPULE

Instruction: Please put a check ( ) mark on the appropriate column.

PREPARATION
1. Gather materials needed for the procedure.
 Ampule of sterile medication
 File and small gauze square or plastic ampule opener
 Antiseptic swabs
 Syringe
 Filter needle for drawing medication from the ampule
2. Check Doctor’s Order.
 Check the label on the ampule carefully against the doctor’s order to make sure that the correct medication is
being prepared.
 Follow the three checks for administering medications. Read the label on the medication:
*When it is taken from the medication cart
*Before withdrawing the medication
*After withdrawing the medication
3. Organize Equipment.
PROCEDURE
1. Perform hand hygiene and observe other appropriate infection control procedure.
2. Prepare the medication ampule for drug withdrawal.
 Flick the upper stem of the ampule several times with fingernails.
 Place a piece of sterile gauze between your thumb and the ampule neck or around the ampule neck and break
off the top by bending it toward you.
 Place the antiseptic wipe packet over the top of the ampule before breaking off the top.
 Dispose of the top of the ampule in the sharp container.
3. Withdraw the medication.
 Place the ampule on a flat surface. Attach the filter needle to the syringe.
 Remove the cap of the needle and insert the needle into the center of the ampule and avoid touching the rim of
the ampule with the needle tip or shaft.
 With a single dose ampule, hold the ampule slightly on its side, if necessary to obtain all the medication.
 Dispose the filter needle by placing it in a sharps container.

Reference: Kozier & Erb's Fundamentals of Nursing Checklist Eighth Edition by Berman Audrey; Snyder Shirlee;
Kozier, Barbara; Erby, Glenora
 UNIVERSITY of SAINT LOUIS
Tuguegarao City

SCHOOL OF HEALTH AND ALLIED SCIENCES

Name : __________________________________ Date : ____________

Course/Year: ___________________ Set/Group #: _____________

INJECTING MEDICATION THROUGH INTRADERMAL

Instruction: Please put a check ( ) mark on the appropriate column using the scale:

PROCEDURE
PREPARATION
5. Assess
 Appearance of the injection site.
 Specific drug action and the expected response.
 Client’s knowledge of drug action and response.
 Check agency protocol about sites to use for skin tests.
6. Assemble equipment and supplies
 Vial or ampule of the correct medication
 Sterile 1-mL syringe calibrated into hundredths of a millilitre (i.e., tuberculin syringe) and a 25- to 27- gauge
needle that is ¼ - 5/8 inch long
 Alcohol swabs
 2x2 sterile gauze square (optional)
 Clean gloves (accdg. to agency protocol)
 Band-Aid (optional)
 Epinephrine
7. Check the Doctor’s Order
a. Check the label on the medication carefully against the Doctor’s Order to make sure that the correct
medication is being prepared.
b. Follow the three checks for administering medications. Read the label on the medication:
 When it is taken from the medication cart
 Before withdrawing the medication
 After withdrawing the medication
8. Organize the equipment
PROCEDURE
13. Perform hand hygiene, and observe other appropriate infection control procedures.
14. Prepare the medication from the vial or ampule for drug withdrawal.
15. Prepare the client.
16. Explain to the client that the medication will produce a small wheal, sometimes called a bleb.
17. Provide for client privacy.
18. Select and clean the site.
a. Select a site.
b. Avoid using sites that are tender, inflamed, or swollen, and those that have lesions.
c. Put on gloves as indicated by agency policy.
d. Cleanse the skin at the site using firm, circular motion, starting at the centre and widening the circle outward.
Allow the area to dry thoroughly.
19. Prepare the syringe for the injection.
a. Remove the needle cap while waiting for the antiseptic to dry.
 PROCEDURE
b. Expel bubbles from the syringe.
c. Grasp the syringe in your dominant hand, holding in between thumb and forefinger. Hold the needle almost
parallel to the skin surface with the bevel of the needle up.
20. Inject the fluid.
a. With the non-dominant hand, pull the skin at the site until it is taut.
b. Insert the tip of the needle far enough to place the bevel through the epidermis into the dermis. The outline of
the bevel should be visible under the skin surface.
c. Stabilize the syringe and needle, and inject the medication carefully and slowly so that it produces a small
wheal on the skin.
d. Withdraw the needle quickly at the same angle at which it was inserted. Activate the needle safety device.
Apply Band-Aid, if indicated.
e. Do not massage the area.
f. Dispose of the syringe and needle in the sharps container.
g. Remove your gloves.
h. Circle the injection site with ink to observe for redness or induration per agency policy.
21. Document all relevant information.
 Record the testing material given, the time, dosage, route, site, and nursing assessments.
TOTAL SCORE

Remarks:
__________________________________________________________________________________________________
__________________________________________________________________________________________________
___________________________________________________________

______________________________________
Printed Name & Signature of Clinical Instructor

Referance: Koziera & Erb's Fundamentals of Nursing Checklist Eighth Edition by Berman Audrey; Snyder Shirlee;
Kozier, Barbara; Erby, Glenora
 UNIVERSITY of SAINT LOUIS
Tuguegarao City

SCHOOL OF HEALTH AND ALLIED SCIENCES

Name : __________________________________ Date : ____________

Course/Year : _______________________ Set/Group #: ____________

ADMINISTERING ORAL MEDICATIONS

Instruction: Please put a check ( ) mark on the appropriate column using the scale:

Not
PROCEDURE Done Comments
Done
PREPARATION
1. Know the reason why the client is receiving the
medication, the drug classification,
contraindications, usual dosage range, side
effects, and nursing considerations for
administering and evaluating in the intended
outcomes for the medication.
2. Check the doctor’s order for medication.
 Check the medication card for the drug name,
dosage, frequency, route of administration and
expiration date for administering medication, if
appropriate.
 If the medication card is unclear or pertinent
information is missing, compare the medication
card with the most recent prescriber’s written
order.
 Report any discrepancies to the charge nurse or
the prescriber, as agency policy dictates.
3. Verify the client’s ability to take medication
orally.
 Determine whether the client can swallow, is on
NPO, is nauseated or vomiting, has gastric
suction, or has diminished or absent bowel
sounds.
4. Organize the supplies.
 Assemble the medication card for each client
together so that medications can be prepared for
one client at a time.
PERFORMANCE
1. Perform hand hygiene and observe other
appropriate infection control procedure.
2. Unlock the dispensing system.
3. Obtain appropriate medication.
a. Read the medication card and take the
 Not
PROCEDURE Done Comments
Done
appropriate medication from the shelf,
drawer or refrigerator.
b. Compare the label of the medication
container or unit-dose package against the
order on the medication card.
c. Check the expiration date of the
medication. Return expired medications to
the pharmacy.
d. Use only medications that have clear,
legible labels.
4. Prepare the medication.
a. Calculate the medication dosage accurately.
b. Prepare the correct amount of medication
for the required dose, without
contaminating the medication.
c. While preparing the medication, recheck
each prepared drug and container with the
medication card again.
Tablets or Capsules
a. Place packaged unit-dose capsules or tablets
directly into the medicine cup. Do not remove
the medication from the package until at the
bedside.
b. If using a stock container, pour the required
number into the bottle cap, and then transfer
the medication to the disposable cup without
touching the tablets.
c. Keep narcotics and medications that require
specific assessments, such as pulse
measurements, respiratory rate or depth, or
blood pressure, separate from the others.
d. Break only the scored tablets if necessary to
obtain the correct dosage. Use a cutting or
splitting device if needed. Check the agency
policy as to whether unused portions of a
medication can be discarded and, if so, how
they are to be discarded.
e. If the client has difficulty swallowing, crush
the tablets to a fine powder with a pill crusher
or between two medication cups. Then, mix
the powder with a small amount of food such
as applesauce.
Liquid Medication
a. Thoroughly mix the medication before pouring.
Discard any medication that has changed color
or turned cloudy.
b. Remove the cap and place it upside down on
the countertop.
c. Hold the bottle so the label is next to your palm
and pour the medication away from the label.
d. Place the medication cup on a flat surface at
eye level and fill it to the desired level using the
bottom of the meniscus to align with the
 Not
PROCEDURE Done Comments
Done
container scale.
e. Before capping the bottle, wipe the lip with a
paper towel.
f. When giving small amounts of liquids, prepare
the medication in a sterile syringe without the
needle or in a specially designed oral syringe.
Label the syringe with the name of the
medication and the route (PO).
g. Keep unit dose liquids in their package and
open them at the bedside.
Oral Narcotics
a. If an agency uses a manual recording system
for controlled substances, check the narcotic
record for the previous drug count and compare
it with the supply available.
b. Remove the next available tablet and drop it in
the medicine cup.
c. After removing a tablet, record the necessary
information on the appropriate narcotic control
record and sign it.
Note: Computer-controlled dispensing systems
allow access only to the selected drug and
automatically record its use
All Medications
a. Place the prepared medication and medication
card together on the medication cart.
b. Recheck the label on the container before
returning the bottle, box or envelope to its
storage place.
c. Avoid leaving prepared medications
unattended.
d. Lock the medication cart before entering the
client’s room.
e. Check the room number against the medication
card if agency policy does not allow the
medication card to be removed from the
medication cart
5. Provide for client privacy.
6. Check the client.
 Check the client’s identification band.
 Assist the client to a sitting position or, if not
possible to a side-lying position.
 If not previously assessed, take the required
assessment measures, such as pulse and
respiratory rates or blood pressure.
7. Explain the purpose of the medication and how
it will help, using language that the client can
understand, Include relevant information about
effects.
8. Administer the medication at the correct time.
 Take the medication to the client within the
period of 30 minutes before or after the
 Not
PROCEDURE Done Comments
Done
scheduled time.
 Give the client sufficient water or preferred
juice to swallow the medication. Before using
juice, check for any food and medication
incompatibilities.
 If the client is unable to hold the pill cup, use
the pill cup to introduce the medication into the
client’s mouth, and give only one tablet or
capsule at a time.
 If an older child or adult has difficulty
swallowing, ask the client to place the
medication on the back of the tongue before
taking the water.
 If the medication has an objectionable taste, ask
the client to suck a few ice chips beforehand or
give the medication with juice, applesauce, or
bread if there are no contraindications.
 If the client says that the medication you are
about to give is different from what the client
has been receiving, do not give the medication
without first checking the original order.
 Stay with the client until all medications have
been swallowed.
9. Document each medication given.
 Record the medication given, dosage, time, any
complaints or assessments of the client, and
your signature.
 If medication was refused or omitted, record
this fact on the appropriate record; document
the reason, when possible and the nurse’s
actions according to the policy.
10. Dispose of all supplies appropriately.
 Replenish stock and return the cart to the
appropriate place.
 Discard used disposable supplies.
11. Evaluate the effects of the medication.
 Return to the client when the medication is
expected to take effect to evaluate the effects of
the medication on the client.
TOTAL SCORE

Remarks:
__________________________________________________________________________________________________
__________________________________________________________________________________________________
___________________________________________________________

_________________________________________
Printed Name & Signature of Clinical Instructor

Reference: Kozier & Erb's Fundamentals of Nursing Checklist Eighth Edition by Berman Audrey; Snyder Shirlee;
Kozier, Barbara; Erby, Glenora
 UNIVERSITY of SAINT LOUIS
Tuguegarao City

SCHOOL OF HEALTH AND ALLIED SCIENCES

Name : __________________________________ Date : ____________

Course/Year : _______________________ Set/Group #: ____________

ADMINISTERING OPHTHALMIC INSTILLATIONS

Instruction: Please put a check ( ) mark on the appropriate column using the scale.

PROCEDURE
PREPARATION
1. Check the doctor’s order.
 Check the drug name, dose and strength. Also confirm the prescribed frequency of the instillation and which
eye to be treated.
 If the doctor’s order is unclear or pertinent information is missing, compare it with the most recent physician’s
written order.
 Report any discrepancies to the charge nurse or physician, as agency policy dictates.
2. Know the reason why the client is receiving the medication, the drug classification, contraindications, usual
dose range, side effects and nursing considerations for administering and evaluating the intended outcomes of
the medication.
PROCEDURE
1. Compare the label on the medication tube or bottle with the medication record and check the expiration date.
2. If necessary, calculate the medication dosage.
3. Explain to the client what you are going to do, why it is necessary or how he or she can cooperate. The
administration of ophthalmic medication is not usually painful. Ointments are usually soothing to the eye, but
some liquid preparations may sting initially. Discuss how the result s will be used in planning further care or
treatments.
4. Wash hands and observe any appropriate infection control procedures.
5. Provide for client privacy.
6. Prepare the client.
 Check the client’s identification band then ask the client’s name.
 Assist the client to a comfortable position, either sitting or lying.
7. Clean the eye lid and the eyelashes.
 Put on sterile gloves.
 Use sterile cotton balls moistened with sterile irrigating solution or sterile normal saline, and wipe from the
inner canthus to the outer canthus.
8. Administer the eye medication.
 Check for the ophthalmic preparation for the name, strength and number of drops if a liquid is used. Draw the
correct number of drops into the shaft of the dropper if a dropper is used. If ointment is used, discard the first
bead.
 PROCEDURE
 Instruct the client to look up to the ceiling. Give the client a dry sterile absorbent sponge.
 Expose the lower conjunctival sac by placing the thumb or fingers of your nondominant hand on the client’s
cheekbone just below the eye and gently drawing down the skin on the cheek. If the tissues are edematous,
handle the tissues carefully to avoid damaging them.
 Approach the eye from the side and instill the correct number of drops onto the outer third of the lower
conjunctival sac. Hold the dropper 1 to 2 cm (0.4-0.8 in.) above the sac.
Or
 Holding the tube above the lower conjunctival sac, squeeze 2 cm (0.8 in.) of ointment from the tube into the
lower conjunctival sac from the inner canthus outward.
 Instruct the client to close the eyelids but not to squeeze them shut.
 For liquid medications, press firmly or have the client to press firmly on the nasolacrimal duct for at least 30
seconds.
Variation: Irrigation
 Place absorbent pad under the head, neck, and shoulders. Place an emesis basin next to the eye to catch
drainage. Some medications cause systemic reactions such as confusion or a decrease in heart rate and blood
pressure if the eye drops go down the nasolacrimal duct and get into the systemic circulation.
 Expose the lower conjunctival sac. Or to irrigate in stages, first hold the lower lid down, then hold the upper lid
up. Exert pressure on the bony prominences of the cheekbone and beneath the eyebrow when holding the
eyelids.
 Fill and hold the eye irrigator about 2.5 cms or (1 in.) above the eye.
 Irrigate the eye, directing the solution onto the lower conjunctival sac and from the inner canthus to the outer
canthus.
 Irrigate until the solution leaving the eye is clear (no discharge is present) or until all the solution has been used.
 Instruct the client to close and move the eye periodically.
9. Clean and dry the eyelids as needed. Wipe the eyelids gently from inner to the outer canthus to collect excess
medication.
10. Apply an eye pad if needed, and secure it with paper eye tape.
11. Assess the client’s response immediately after the instillation or irrigation and again after the medication should
have acted.
12. Document all relevant assessments and interventions. Include the name of the drug or irrigating solution, the
strength, the number of drops if a liquid medication, the time and the response of the client.
TOTAL SCORE

Remarks:
__________________________________________________________________________________________________
__________________________________________________________________________________________________
___________________________________________________________

_________________________________________
Printed Name & Signature of Clinical Instructor

Reference: Kozier & Erb's Fundamentals of Nursing Checklist Eighth Edition by Berman Audrey; Snyder Shirlee;
Kozier, Barbara; Erby, Glenora
 UNIVERSITY of SAINT LOUIS
Tuguegarao City

SCHOOL OF HEALTH AND ALLIED SCIENCES

Name : __________________________________ Date : ____________

Course/Year: ___________________ Set/Group #: _____________

ADMINISTERING AN INTRAMUSCULAR INJECTION

Instruction: Please put a check ( ) mark on the appropriate column using the scale:

PROCEDURE
PREPARATION
9. Assess:
 Client allergies to medications.
 Specific drug action, side effects, and adverse reactions.
 Client’s knowledge of and learning needs about the medication.
 Tissue integrity of the selected site
 Client’s age and weight, to determine site and needle size
 Client’s ability or willingness to cooperate.
10. Determine:
 Whether the size of the muscle is appropriate to the amount of medication to be injected.
11. Assemble equipment and supplies:
 Sterile medication (usually provided in an ampule or vial)
 Syringe and needle of a size appropriate for the amount of solution to be administered
 Antiseptic swabs
 Clean gloves
12. Check Doctor’s Order
a. Check the label on the medication carefully against the Doctor’s order to make sure that the correct medication is
being prepared.
b. Follow the “three checks” for administering the medication and dose. Read the label on the medication:
 When it is taken from the medication tray;
 Before withdrawing the medication; and;
 After withdrawing the medication
13. Organize the equipment.
PROCEDURE
22. Perform hand hygiene and observe other appropriate infection control procedures.
23. Prepare the medication from the ampule or vial for drug withdrawal.
 Whenever feasible, change the needle on the syringe before the injection.
 Invert the syringe needle uppermost and expel all excess air.
 PROCEDURE
24. Provide for client privacy.
25. Prepare the client.
a. Check the client’s identification band.
b. Assist the client to supine, lateral, prone, or
sitting position, depending on the chosen site.
c. Obtain assistance in holding an uncooperative
client.
26. Explain the purpose of the medication and how it will help, using language relevant information about effects of
the medication.
27. Select, locate, and clean the site.
a. Select a site free of skin lesions, tenderness, swelling, hardness, or localized inflammation, and one that has not
been used frequently.
b. If injections are to be frequent, alternate sites. Avoid using the same site twice in a row.
c. the exact site for the injection.
d. Put on clean gloves.
e. Clean the site with antiseptic swab. Using a circular motion, start at the center and move outward about 5cm (2
inches).
f. Transfer and hold the swab between the third and fourth fingers of your nondominant hand in readiness for needle
withdrawal or position the swab on the client’s skin to dry prior to injecting medication.
28. Prepare the syringe for injection.
a. Remove the needle cover and discard without contaminating the needle.
b. If using a prefilled unit-dose medication, take caution to avoid dripping medication on the needle prior to
injection. I f this does occur, wipe the medication off the needle with sterile gauze.
29. Inject the medication using a Z- tract technique.
a. Use the ulnar side of the nondominant hand to pull the skin approximately 2.5 (inch) to the side.
b. Holding the syringe between the thumb and forefinger, pierce the skin quickly and smoothly at a 90- degree
angle, and insert the needle into the muscle.
c. Hold the barrel of the syringe steady with your nondominant hand, and aspirate by pulling back on the plunger
with your dominant hand. Aspirate for 5- 10 seconds. If blood appears in the syringe, withdraw the needle,
discard the syringe, and prepare a new injection.
d. If blood does not appear, inject the medication steadily and slowly (approximately 10 seconds per milliliter) while
holding the syringe steady.
e. After injection, wait for 10 seconds.
30. Withdraw the needle.
a. Withdraw the needle smoothly at the same angle of insertion. Release the skin.
b. Apply gentle pressure at the site with a dry sponge.
c. If bleeding occurs, apply pressure with a dry, sterile gaze until it stops
31. Activate the needle device or discard the uncapped needle and attached syringe into the proper receptacle.
Remove gloves. Perform hand hygiene.
11. Document all relevant information.
 Include the time of administration, drug name, dose, route, and the client’s reactions.
12. Assess effectiveness of the medication at the time it is expected to act.
TOTAL SCORE

Remarks:
__________________________________________________________________________________________________
__________________________________________________________________________________________________
___________________________________________________________

______________________________________
Printed Name & Signature of Clinical Instructor
Reference: Koziera & Erb's Fundamentals of Nursing Checklist Eighth Edition by Berman Audrey; Snyder Shirlee;
Kozier, Barbara; Erby, Glenora