NORTHWESTERN UNIVERSITY

Don Mariano Marcos Ave., Laoag City, Ilocos Norte, Philippines

College of Allied Health Sciences
Department of Nursing
Laoag City

NAME: ______________________________________________________ DATE: _______________

YEAR/SECTION & GROUP NUMBER: __________________________ SCORE: ______________
CRITERIA EVALUATION ON DEEP BREATHING AND COUGHING EXERCISES

The evaluation tools use the following scales of measurement:

2 - Able to perform without assistance
1 - Able to perform with assistance
0 - Unable to perform

2 1 0 1. Assembles equipment and brings it to the bedside.

2 1 0 2. Identifies the client.
2 1 0 3. Explains procedure to the client.
2 1 0 4. Assesses the general condition of the client (vital signs, discomfort,
color of feet and legs, breath sound)
2 1 0 5. Provides privacy.
2 1 0 6. Assists client to Fowler’s or sitting position.
2 1 0 7. Have the client place hands, with middle fingers touching along the
lower border of the rib cage.
2 1 0 8. Asks the client to inhale slowly through the nose, feeling middle
fingers separate. Hold the breath for count three and exhale through
the mouth with lips pursed. (Client does this 3x)
2 1 0 9. If the client develops dyspnea, ask to stop until the breathing pattern
comes under control.
2 1 0 10. Asks the client to inhale deeply, hold breath, and then cough once
or twice.
2 1 0 11. Place the client in a comfortable position.
2 1 0 12. Discards used materials properly and return the equipment used.
2 1 0 13. Washes hands.
2 1 0 14. Records time, duration, and patient’s response.

Evaluator:
______________________________
Signature over printed name

Tel. Nos. (077) 670-8607-10/670-8510 Direct line: (077) 670-6864 Fax No. (077) 771-3814 Website: www.nwu.edu.ph E-mail: info@nwu.edu.ph