OUR LADY OF FATIMA UNIVERSITY
College of Nursing, Cabanatuan Campus
PROGRAM Bachelor of Science in Nursing STUDENT NAME
NCMA-312 RLE YEAR & SECTION
Care of Clients with Problems in INSTRUCTOR
Oxygenation, Fluid and electrolytes,
COURSE
infectious, Inflammatory, and
immunologic Response, and Cellular DATE
Abberations (acute and chronic)
PROCEDURE : INCENTIVE SPIROMETRY
EXPECTED OUTCOME : The student should be able to perform incentive spirometry correctly.
ASSESSMENT TASK : Return Demonstration
Assessment Exceptional Good Average Poor
SCORE
Dimension (4) (3) (2) (1)
1. Verify the doctor’s Verified the Verified the Verified the Failed to verify
order doctor’s order doctor’s order doctor’s order the doctor’s
properly and with minimal improperly and order.
accurately. error. inaccurately.
2. Wash hands Observed Hand washing Hand washing Hand washing
principles of was done with was done with was not done.
medical hand minimal errors. maximal errors.
washing.
3. Gather the materials. Gathered Gathered Gathered and Failed to gather
Identify the patient. materials and materials and performed one and identify
identified patient performed the (1) way of patient.
by asking his/her two (2) ways of identifying
name and identifying patient.
checking his/her patient.
ID band politely.
4. Greet and explain the Greeted and Greeted and Greeted and Failed to greet
procedure. explained explained explained and explain the
procedure to the procedure but procedure but in procedure.
client clearly and lacks details. an unclear
completely with manner.
client’s approval.
5. Position the patient Positioned the Positioned the Positioned the Failed to
comfortably and provide patient patient patient provide privacy
privacy. comfortably and comfortably and comfortably and and position
provided privacy provided privacy provided privacy the patient
during the entire but not in the but was observed comfortably.
procedure. entire only at times.
procedure.
6. Instruct client to: Held the Held the Held the Failed to hold
incentive incentive incentive the incentive
spirometer spirometer spirometer spirometer.
incorrectly with
Hold the incentive correctly with incorrectly with further
spirometer upright, with both hands. one hand. instructions.
both hands
7. Slide the indicator Performed the Performed the Performed the Failed to do the
(located in the left-hand step correctly. step with little step with some step.
column when you are instructions. instructions.
facing the spirometer) to
the desired level. For
example, start at 1250
milliliters and slowly
increase as your
treatment
progresses
8. Place the mouthpiece Performed the Performed the Performed the Failed to do the
into your client’s mouth step correctly. step with little step with some step.
and instruct the patient to instructions. instructions.
tightly seal his/her lips
around it
9. With lips tightly sealed Performed the Performed the Performed the Failed to do the
around the mouthpiece, step correctly. step with little step with some step.
breathe in slowly and as instructions. instructions.
deeply as possible. The
piston that is resting
below the indicator
should now rise toward
the top of the
column
10. Hold breath for at Performed the Performed the Performed the Failed to do the
least 3 seconds and allow step correctly. step with little step with some step.
the piston to fall back to instructions. instructions.
the bottom of the column
11. After each set of deep Performed the Performed the Performed the Failed to do the
breathing, cough to help step correctly. step with little step with some step.
clear the airways of instructions. instructions.
mucus. Ask client to rest
for a few seconds and
repeat steps
2-8, 10 times each hour
while your patient is awake
12. Provide comfort. Provided comfort Provided Provided comfort Documentation
Document the procedure. and documented comfort and but most of the was not done.
the information some of the details of
about the details of procedure were
procedure procedure were not documented.
properly and not
completely. documented.
OVERALL SCORE:
Target Raw Score: 36 out of 48. If raw score is less than 36, repeat the return demonstration.
FACULTY SIGNATURE OVER PRINTED NAME
