COLLEGE OF HEALTH SCIENCES

OXYGEN THERAPY AND OXYGEN DELIVERY

Student Name: __________________________________ID number: ________ Section: _______ Date: _________

Legend:
0 – NOT OBSERVED Task was not performed
1 – INSUFFICIENT Task was performed incorrectly
2 – ACCEPTABLE Task was performed well enough
3 - COMPETENT Task was performed quickly, systematically and accurately

Procedure Steps 0 1 2 3 REMARKS

1. Check the Doctor's order.
2. Identify the patient by checking their ID band and ask the
name

3. Explain the procedure to the parents and gain oral

consent

4. Bring necessary equipment to the bed side stand tray

contains
• Pulse oximeter
• Oxygen mask\nasal cannula\oxygen hood
• PPE kit if necessary
5. Perform hand hygiene

6. Close the door and pull the curtains.

7. Assess the child’s developmental level and ability to
interact.
8. Assess the child for signs and symptoms of inadequate
oxygenation and ventilation.
9. Assess oxygen saturation levels.

10. Select the appropriate oxygen delivery device

11. Adjust the flow meter to deliver the desired amount of

oxygen. Ensure that the liter flow was appropriate for the
device.
12. Apply and secure the noninvasive oxygen delivery device,
ensuring that it was the correct size.
13. Assess the patient level of tolerance and watch for the
complication
 COLLEGE OF HEALTH SCIENCES

14. Discard supplies, remove PPE, and wash hands

15. Perform Hand Hygiene.
16. Replace of articles.
17. Documentation.

Total Score: / 51

Comments/feedback by the evaluator:

_________________________________ _________________________________

Signature of the evaluator Signature of the Student

References: Kulkarni ML [2010] clinical methods in pediatrics,3 rd edition, Jaypee publications