NCM____ (SKILLS)

PROCEDURE/ACTIVITY: __OXYGEN THERAPY__ _____________Date: ________________________ Name of Student: ______________________________________________Year & Section: ________________

Criteria for Scoring Performed the procedures correctly. Performed the procedures in systematic & organized manner. States rationales/principles correctly. States the definition, purposes & special considerations of the activity/procedure. Finished within specified time. 5 Assessment 1. Determine current vital signs, level of consciousness. 2. Assess breath sounds and signs and symptoms of respiratory distress. 3. Check doctors order. Planning 4. Wash hands. 5. Assemble all equipment. Place a NO SMOKING sign on the patients door. Implementation 6. Identify the client. Explain the procedure. 7. Position the client in a semi-fowlers. 8. Attach nasal cannula to oxygen source with the humidifier. 9. Turn on oxygen flow rate until bubbling is noted. 10. Regulate flow meter at prescribed liters per minute. 11. Place oxygen cannula or mask on client. A. Nasal Cannula a. Clean nostrils of secretion with moist cotton balls. b. Place cannula prongs upward into clients nose. c. Slip attached tubing and around clients nose. d. Tighten tubing to secure cannula. B. Face Mask a. Place mask over nose, mouth and chin. Adjust strap at nose bridge. b. Pull elastic band around back of head. 12. Stay with the client for a time, to observe response to treatment. 13. Remove cannula each shift every 4 hours to assess skin. Remove mask every 2 to 4 hours. Wipe away accumulated mist and assess underlying skin. 14. Discard used equipment appropriately. 15. Wash hands. Evaluation 16. Evaluate clients immediate response to oxygen administration. 17. Evaluate the clients comfort with oxygen use. 18. Assess clients vital signs. Documentation 4 3

Scoring 5 Done all criteria 4 Done at least 4 3 Done at least 3 2 Done at least 2 1 Done at least 1 0 Not done 2 1 Not Done

19. Record date and time of oxygen administration and method of delivery. Record flow rate and route in administration used in oxygen. 20. Record immediate response of oxygen therapy, subjective and objective observation of client. 21. Record clients comfort with oxygen use. Remarks: _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ ________________________ ________________ Rating __________________________________ Name & Signature of Clinical Instructor

NCM____ (SKILLS)
PROCEDURE/ACTIVITY: _STEAM INHALATION__ __________Date: ________________________ Name of Student: ______________________________________________Year & Section: ________________

Criteria for Scoring Performed the procedures correctly. Performed the procedures in systematic & organized manner. States rationales/principles correctly. States the definition, purposes & special considerations of the activity/procedure. Finished within specified time. PROCEDURE Assessment 1. Check the clients respiratory status. Planning 2. Wash hands. 3. Assemble the equipment. Implementation 4. Identify the client. 5. Explain the procedure. 6. Position client in a semi-fowlers. 7. Place your chosen remedy in a bowl or basin of steaming water. 8. Add 2-3 drops of medicated aroma in a bowl of steaming water. 9. Drape a towel over your head and bowl of water 10. Cover the clients eyes with washcloth. 11. Keep the face at 20 cm away from the water. Cover chest with towel. 12. Instruct client to inhale deeply for around 15 minutes. 13. Instruct deep breathing and coughing exercise after the treatment. 5 4 3

Scoring 5 Done all criteria 4 Done at least 4 3 Done at least 3 2 Done at least 2 1 Done at least 1 0 Not done 2 1 Not Done

14. Provide oral hygiene. 15. Do after care of equipment. 16. Wash hands Evaluation 17. Evaluate respiratory condition (Character of respiration, breath sounds). 18. Evaluate the clients response after the procedure. 19. Evaluate the clients tolerance to the procedure. Documentation 20. Record the clients respiratory status before and after the procedure. 21. Record the clients tolerance.

Remarks: _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ ________________________ ________________ Rating __________________________________ Name & Signature of Clinical Instructor