OLIVAREZ COLLEGE

Dr. A. Santos Avenue, San Dionisio, Parañaque City

PACUCOA Accredited
COLLEGE OF HEALTH SCIENCES EDUCATION
NURSING DEPARTMENT
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HYGIENE

Student’s Name: _______________ Rating: ____________

Level/Group No.: _______________ CI Name: ____________
Date: _______________

Directions: Evaluate each step/task by putting (✔) under the proper heading. A numerical number
may also be assigned and a minimum passing level determined.

Rate the students from 2 - 0, where:

( 2 ) Performed Correctly Students performed the step according to the standard
procedure or guidelines
( 1 ) Attempted Not Correctly Students unable to perform the steps/task according to
procedure or guidelines
( 0 ) Not Done Students did not do the step/task
(NO) Not Observed (NO) Evaluator unable to observe the step/task for various
reasons like interruptions/inattentiveness,.

STEPS Performed Attempted Not Done Not

Correctly Not (0) Observed
(2) Correctly (NO)
(1)

ORAL CARE (CONSCIOUS)

1. Prepare and gather the equipment.

2. Introduce yourself and explain the

procedure.

3. Provide client’s privacy.

4. Raise head of bed so client is sitting

up

5. Put on gloves

6. Drape towel below client’s chin

7. Wet brush and put on small amount of

toothpaste

8. First brush upper teeth and then

lower.

9. Hold the kidney basin under the

patient's chin.

10. Have the client rinse mouth with

water and spit into the kidney basin.

11. If requested, give the client

mouthwash diluted with half water.

12. Check teeth, mouth, tongue, and lips

for odor, cracking, sores, bleeding and
discoloration.

13. Check for loose teeth

14. Remove the towel and wipe the

patient's mouth.

15. Remove gloves.

ORAL CARE (UNCONSCIOUS)
16. Drape towel over pillow.

17. Turn the client onto unaffected side.

18. Put on gloves.

19. Place a kidney basin under the

client's chin.

20. Hold the mouth open with a padded

tongue depressor.

22. Dip swab in cleaning solution and

wipe teeth, gums tongue and inside
surfaces of mouth, changing swab
frequently

23. Rinse with a clean swab dipped in

water.

24. Check teeth, mouth, tongue, and lips

for odor, cracking, sores, bleeding and
discoloration.

25. Check for loose teeth.

26. Cover lips with a thin layer of

petroleum jelly.

27. Remove gloves.

BED BATH
28. Gather and check supplies and
equipment.
29. Perform hand washing
30. Close the curtains, drapes and
doors.
31. Keep the client covered.
32. Expose only the body parts that need
to be used.
33. Explain the procedure in every set of
the way.
34. Encourage cooperation from the
client.
35. Lift the side rails before raising be to
a comfortable working height (usually at
the level of the waist).
36. Lower the side rails on the side
where care is given.
37. Use appropriate body mechanics.
38. Offer the patient a urinal or bedpan.
39. Draped client.
40. Fill the bath basin with warm water
and have the client check water
temperature.
41. If a client has open lesions or
wounds, put on gloves.
42. Fold washcloth and wet.
43. Gently wash eyes from the inner
corner out. Using a different part of cloth,
wash the other eye.
44. Wet washcloth and apply soap, if
requested.
45. Wash, rinse (2x) and pat dry face,
neck, ears and behind ears.
46. Remove client’s gown
47. Place towel under far arm
48. Wash, rinse and pat dry your hand,
arm, shoulder and underarm.
49. Repeat steps 10 and11 with other
arm
50. Place a towel over your chest and
abdomen.
51. Lower bath blanket to waist.
52. Lift towel and wash, rinse and pat dry
chest and abdomen.
53. Pull up the bath blanket and remove
the towel.
54. Place towel under far leg.
55. Wash, rinse and dry leg and foot.
56. Place towel under near leg.
57. Wash, rinse and dry the leg and foot.
58. Change bath water as necessary.
59. Turn the client away from you.
60. Wash, rinse and pat dry from neck to
buttocks including anal area.
61. Change bath water and gloves. Use
a clean washcloth and towel.
62. Provide perineal care.
63. Help the client put on a clean gown.
64. Use good body mechanics.
65. Be sure that the client is comfortable
and in a good alignment.
66. Lower the bed height and position
the side rails appropriately.
67. Remove the supplies and clean the
equipment accordingly.
68. Perform hand washing.
69. Document the
procedures.
BED MAKING (OCCUPIED)
70. Wash hands.
71. Collect clean linen in order of use.
72. Carry linen away from your uniform
73. Gather and check supplies and
equipment.
74. Perform hand washing.
75. Close the curtains, drapes and
doors.
76. Keep the client covered.
77. Expose only the body parts that need
to be used
78. Explain the procedure in every set of
the way.
79. Encourage cooperation from the
client.
80. Lift the side rails before raising be to
a comfortable working height (usually at
the level of the waist).
81. Lower the side rails on the side
where care is given.
82. Use appropriate body mechanics
83. Place linen on a clean surface
(bedside stand, over bed table or back of
chair).
84. Lower head of bed.
85. Drape clients.
86. Turn clients away from you toward
the side rail.
87. Loosen bottom linens and roll linen
toward client, tucking it snugly against
client’s back.
88. Fanfold bottom sheet to center of
bed and fit corners over mattress.
90. Then rubber and draw sheets.
91. Turn client’s onto back, raise side
rails, to move to the other side of bed
and lower side rails.
92. Turn patient away from you toward
the side rail.
93. Loosen soiled linens.
94. Roll linens from head to foot of bed
and place in a hamper/ bag at foot of bed
or in chair.
95. Unfold bottom, rubber and draw
sheet and tuck.
96. Fit corners over the mattress.
97. Place the patient in a supine position
and raise the side rail.
98. Remove pillowcase, change pillow
case & place pillow under clients head
with open end away from the door.
99. Place a clean top sheet over the
client and remove the drape.
100. Unfold the blanket over the top
sheet and make a cuff.
101. Tuck top linens under foot of
mattress and miter corners.
102. Loosen top linens over client’s feet.
103. Use good body mechanics.
104. Be sure that the client is
comfortable and in a good alignment.
105. Lower the bed height and position
the side rails appropriately.
106. Remove the supplies and clean the
equipment accordingly.
107. Perform hand washing.
108. Document the
procedures

Computation for student rating:

Raw score X 60 + 40
Perfect score

Student’s Signature and Date: ______________________

Signature of Clinical Instructor and Date: ______________________

Remarks:
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