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Name_______________________ Date___________ Instructor’s Name_____________________________

Performance Checklist: Skill 26-4

Providing Oral Hygiene

S U NP Comments
1. Wash hands, and apply disposable gloves. _____ _____ _____ ______________________________

2. Inspect integrity of lips, teeth, buccal _____ _____ _____ ______________________________

mucosa, gums, palate, and tongue.

3. Identify presence of common oral problem. _____ _____ _____ ______________________________

4. Remove gloves, and wash hands. _____ _____ _____ ______________________________

5. Assess risk for oral hygiene problems. _____ _____ _____ ______________________________

6. Determine client’s oral hygiene practices. _____ _____ _____ ______________________________

7. Assess client’s ability to grasp and _____ _____ _____ ______________________________

manipulate toothbrush.

8. Prepare equipment at bedside. _____ _____ _____ ______________________________

9. Explain procedure to client and discuss _____ _____ _____ ______________________________

preferences regarding use of hygiene aids.

10. Place paper towels on over-bed table, and _____ _____ _____ ______________________________
arrange other equipment within easy reach.

11. Raise bed to comfortable working position. _____ _____ _____ ______________________________
Raise head of bed (if allowed) and lower
side rail. Move client, or help client move
closer. Side-lying position can be used.

12. Place towel over client’s chest. _____ _____ _____ ______________________________

13. Apply gloves. _____ _____ _____ ______________________________

14. Apply toothpaste to brush, holding brush _____ _____ _____ ______________________________
over emesis basin. Pour small amount of
water over toothpaste.

15. Client may assist by brushing. Hold _____ _____ _____ ______________________________
toothbrush bristles at 45-degree angle to
gum line. Be sure tips of bristles rest against
and penetrate under gum line. Brush inner
and outer surfaces of upper and lower teeth
by brushing from gum to crown of each
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S U NP Comments
tooth. Clean biting surfaces of teeth by
holding top of bristles parallel with teeth
and brushing gently back and forth. Brush
sides of teeth by moving bristles back
and forth.

16. Have client hold brush at 45-degree angle _____ _____ _____ ______________________________
and lightly brush over surface and sides of
tongue. Avoid initiating gag reflex.

17. Allow client to rinse mouth thoroughly by _____ _____ _____ ______________________________
taking several sips of water, swishing water
across all tooth surfaces, and spitting into
emesis basin.

18. Allow client to gargle to rinse mouth with _____ _____ _____ ______________________________
mouthwash as desired.

19. Assist in wiping client’s mouth. _____ _____ _____ ______________________________

20. Allow client to floss. _____ _____ _____ ______________________________

21. Allow client to rinse mouth thoroughly _____ _____ _____ ______________________________
with cool water and spit into emesis basin.
Assist in wiping client’s mouth.

22. Assist client to comfortable position, _____ _____ _____ ______________________________

remove emesis basin and bedside table,
raise side rail, and lower bed to original
position.

23. Wipe off over-bed table, discard soiled linen _____ _____ _____ ______________________________
and paper towels in appropriate containers,
remove soiled gloves, and return equipment
to proper place.

24. Wash hands. _____ _____ _____ ______________________________

25. Ask client if any area of oral cavity feels _____ _____ _____ ______________________________
uncomfortable or irritated.

26. Apply gloves, and inspect condition of _____ _____ _____ ______________________________
oral cavity.

27. Ask client to describe proper hygiene _____ _____ _____ ______________________________
techniques.

28. Observe client brushing. _____ _____ _____ ______________________________

29. Record procedure, noting condition of oral _____ _____ _____ ______________________________
cavity.

30. Report bleeding or presence of lesions to _____ _____ _____ ______________________________

nurse in charge or physician. Copyright © 2003, Mosby, Inc. All rights reserve d