REGISTRATION NUMBER ……………………………………………………….

EXAMINATION NUMBER ……………………………………………

THE UNITED REPUBLIC OF TANZANIA

MINISTRY OF HEALTH
NMT 05104: CARE OF MEDICAL CONDITION
SECTION B: ASSESSMENT OF LEARNER COMPETENCES

Instructions
 This checklist is used to assess learners’ competences on every Module during end of semester I practical examination
 This examination should not be conducted in skills laboratory
 Time allocated is 1 hour (50 minutes for procedure and 10 minutes for evaluation)
 The assessor is required to assign maximum score when sub-criteria is done/observed, if not done or done incorrectly assign zero (0) and write
comment in the comments ‘column
 Write the total score at the end of assessment

Formula:
Total sub criterion achieved in section (A + B) x 100%
Total sub-criterion in section (A+B)
 Write the final average score obtained by internal and external examiner at the top right corner after getting the average score from internal and external
examiner
 Write general comments below the checklist, if any, after the examination
 The setting of practical examination is in health care facility (Medical/surgical Ward, Pediatric ward, ICU UNITY Emergency ward )

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 REGISTRATION NUMBER ………………………………………………………. EXAMINATION NUMBER ……………………………………………

CHECKLIST I: FOR MOUTH WASH TO AN UNCONSCIOUS PATIENT

(To be used to assess performance)
S/N Description of Sub-criterion Comments

Maximum

Obtained
criterion

score

score
1.0 Building rapport 1.1 Creates rapport with patient and relatives 01
1.1.1 Greets the patient
1.1.2 Introduces him/herself
1.2 Screens the bed to ensure patient privacy 01
1.3 Washes hands before 01
2.0 2.1 Prepares Mouth wash solution e.g. sodium bicarbonate teaspoonful to 1 pint of water in galipot 02
2.2 Prepares Hydrogen peroxide 1% if mouth is very dirty 01
2.3 Prepares Potassium permanganate solution 01
2.4 Prepares Toothpaste 01
Equipment and 2.5 Prepares Toothbrush or padded tongue depressor – padded with gauze swab and secured with plaster 01
supplies 2.6 Prepares Gloves 01
2.7 Prepares Glycerin with borax or Vaseline for lip care 01
2.8 Prepares Receiver for used swabs 01
2.9 Prepares Potassium permanganate solution 01
2.10 Prepares Hydrogen peroxide 1% if mouth is very dirty 01
2.11 Prepares Hydrogen peroxide 1% if mouth is very dirty 01
2.12 Prepares Mackintosh and towel 01
2.13 Prepares Mouth gauge for opening the mouth 01
3.0 Steps for bed 3.1 Inform the patient about the procedure 01
bathing an adult 3.2 Wash hands and put on gloves 02
client 3.3 Screen the bed for privacy 02
0.1 Position back of head on a pillow so that face tips downwards. This will allow fluid to flow out of the mouth. 02
Client lays head turned to the side
3.5 Place towel and Mackintosh under the client’s head and chin to protect bed linen 02

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 REGISTRATION NUMBER ………………………………………………………. EXAMINATION NUMBER ……………………………………………

3.6 Apply some toothpaste on toothbrush or moisten padded tongue depressor in mouth solution 02
3.7 Wash surface of teeth, between cheeks and gums, roof of mouth, the tongue and lips 02
3.8 Rinse mouth with sodium bicarbonate, changing the gauze swabs as necessary 02
3.9 Apply Glycerin or Vaseline to lips if they are dry or cracking 02
3.10 Thank the patient 01
4.0 3.14 Remove screen and leave client comfortable lying on the side 01
3.11 Clear equipment, remove screens and open windows 01
Documentation 3.12 Record and report any abnormalities observed 01
Returns equipment to the respective area 01
4.2.2 Hand washing after procedure 01
TOTAL SCORE 40

General Comments:
…………………………………………………………………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………………………………………………..………………

Name of the Internal Examiner: ………………………………………………Signature…………………………….Date……………………………………….………

Name of the External Examiner: …………………………………..…………Signature…………………..…………Date……………..…………………………..……