OUR LADY OF FATIMA UNIVERSITY

College of Nursing – Pampanga Campus

PROGRAM Bachelor of Science in Nursing STUDENT NAME

YEAR & SECTION

NCMA 219 RLE
Care of Mother and Child at Risk or Problems INSTRUCTOR
COURSE
(Acute and Chronic)
SKILLS LABORATORY
DATE

PROCEDURE : REMOVING OF NASOGASTRIC TUBE

EXPECTED OUTCOME : The student should be able to perform the removal of nasogastric tube correctly. ASSESSMENT
TASK : Return Demonstration

Exceptional Good Average Poor

Assessment Dimension SCORE
(4) (3) (2) (1)
1. Verify the order Verified the doctor’s Verified the Verified the Failed to verify
confirming the removal of order properly and doctor’s order doctor’s order the doctor’s
nasogastric tubes. accurately. with minimal improperly and order.
error. inaccurately.
2. Hand washing Observed principles Hand washing Hand washing Hand washing
of medical hand was done with was done with was not done.
washing. minimal errors. maximal errors.

3. Prepare the equipment Gathered materials Gathered Gathered Failed to gather

needed (tissue, clean needed completely. materials with materials with all materials
disposable gloves, 60 ml
little time more time needed.
syringe optional, plastic
disposable bag.).
preparation. preparation.
4. Greet and identify the Greeted and Performed the Performed one Failed to greet
patient. identified patient by two (2) ways of (1) way of and identify
asking his/her name identifying identifying patient.
and checking his/her patient. patient.
ID band politely.
5. Explain the procedure. Explained procedure Explained Explained Failed to explain
Assist the client and its purpose to procedure but procedure but in procedure and
procedure will cause no the client clearly and lacks some an unclear its purpose.
discomfort. completely with details. manner.
client’s consent.
6. Provide privacy if the Provided privacy Provided privacy Provided privacy Failed to
client’s desire. during the entire but not in the but was provide privacy.
procedure. entire observed only at
procedure. times.
7. Assist client to a Properly and skillfully Placed client Placed client Failed to
highfowler’s position if positioned the client comfortably and comfortably and positioned
health permits and comfortably. in any in any client properly
support head on a pillow. preferable preferable and
position with position with comfortably.
less supervision. maximum
supervision.

8. Place towel across the Place the towel across Place the towel Place the towel Failed to place
chest to collect any the chest with ease. across the chest across the chest the towel
spillage of mucous and with little with some across the chest.
gastric secretions from forgetfulness. forgetfulness.
the tube.
 9. Provide tissues to the Provided the patient Provided the Provided the Failed to
client to wipe the nose with tissues. patient with patient with provide the
mouth after tube tissues with tissues with patient with

COLLEGE OF NURSING 1

removal. little some tissues.

forgetfulness. forgetfulness.
10. Detach the tube. Performed the Performed the Performed the Failed to
10.1. Disconnect procedure with ease. procedure with procedure with perform the
the nasogastric tube little errors. some errors. procedure.
to the suction from
the suction apparatus,
if present.
10.2. Unpin the
tube from the client’s
grown.
11. Remove the tube Performed the Performed the Performed the Failed to
11.1. Put on the procedure with ease. procedure with procedure with perform the
disposable gloves little errors. some errors. procedure.
11.2. Ask the client
to take deep breath
and hold it.
11.3. Pinch the
tube with gloved hand
11.4. Quickly and
smoothly withdraw
the tube
11.5. Place the
tube in the plastic
bag.
11.6. Observe the
intactness of the tube.
12. Ensure client comfort. Performed the Performed the Performed the Failed to
Dispose the equipment procedure with ease. procedure with procedures with perform the
appropriately. minimal errors. maximal errors. procedure.
13. Assess the nasogastric Performed the Performed the Performed the Failed to
drainage if suction was procedure with ease. procedures with procedures with perform the
used. little supervision. some procedure.
13.1. Measure the amount supervision.
of gastric drainage
and record it on the
client’s fluid output
record.
11.2. Inspect the drainage
for appearance and
consistency.
14. Wash hands and Washed hands and Washed hands Washed hands Washed hands
documentation documented the and some of the but most of the but
information about the details of details of documentation
procedure properly procedure were procedure were was not done.
and completely. not not
documented. documented.

SCALE:
3 – (EXCEPTIONAL) Works competently and independently at all times
2 – (GOOD) Requires minimum guidance and supervision
1 – (AVERAGE) Requires frequent guidance and supervision
0 – (POOR) Requires close guidance and supervision most of the time
 OVERALL SCORE: ______________
Target Raw Score: 42 out of 56. If the raw score is less than 42, repeat the return demonstration.

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FACULTY SIGNATURE OVER PRINTED NAME STUDENT NURSE SIGNATURE OVER PRINTED NAME

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