Xavier University – Ateneo De Cagayan

College of Nursing

PERFORMANCE RATING SCALE

ORAL CARE: PATIENT WHO IS UNRESPONSIVE

NAME: Ira Velle J. Vios DATE: _________________

BLOCK: NJ SCORE: ________________

PERFORMANCE EVALUATION CRITERIA

Score Description Indicators

4 Very Good
3 Good
2 Fair
1 Needs Improvement
Student performs behaviors/tasks reflecting the highest level of performance:
consistent, independent, effective.
Student performs behaviors/tasks reflecting mastery of performance with
minimal supervision.
Student performs behaviors/tasks reflecting development and movement
toward mastery of performance: with help or direct supervision in some
aspects.
Student performs behaviors/tasks reflecting beginning level of performance;
tasks not done properly majority of the time but demonstrate understanding of
concepts involved with tasks.

ORAL CARE: PATIENT WHO IS UNRESPONSIVE

PROCEDURE: RATIONALE 4 3 2 1 REMARKS

1. Inform the relatives about the To allay fear and
necessity of the procedure apprehension on the
part of the relatives.
2. Screen the bed if the patient is in Provide privacy
general ward.

3. Protect the pillow with a rubber sheet Prevents soiling and

and a towel wetting the flow.
4. Turn the patient’s head to one side This position prevents
with the face slightly downward. choking and aspiration
solution during the
procedure.
5. Drape the towel across the chest. Prevents the patient
gown from soiling or
wetting.
6. Dip the gauze wrapped tongue This is used to brush
depressor in the mouthwash and clean the teeth.
solution.
7. Insert a gauze wrapped tongue Do not use bare hands
depressor to keep the mouth open. to open patients mouth,
 the unconscious patient
may bite down the
nurse finger.
8. Using the wet tongue depressor, The friction of brushing,
clean the buccal cavity starting from not toothpaste, cleans
the inner cheeks; then the teeth teeth, so no toothpaste
is needed.
9. Suction excess solution. To avoid choking, by
removing excess
accumulated solution in
the mouth.
10. Apply petroleum jelly to the lips and Prevents lips and
mucous membrane of the mouth mucous membranes
with cotton applicator from drying.