2022-2023

MEDICAL-SURGICAL NUSING CHECKLIST

CONAMS
Wesleyan University Philippines
2022-2023
 WESLEYAN
AN AUTONOMOUS METHODIST UNIVERSITY

COLLEGE OF NURSING AND ALLIED MEDICAL SCIENCES

PERFORMANCE EVALUATION TOOL
NCM 112 – Care of Clients with Problems in Oxygenation, Fluid and Electrolyte Balance,
Nutrition and Metabolism and Endocrine

NAME OF STUDENT:
Block #

I. Procedure: NEBULIZATION

I. Purposes: DONE NOT REMARKS

DONE
1. To administer medication in the form of a mist
inhaled into the lungs.
2. To loosen respiratory secretions and promote
bronchodilation.
3. To exhibits improved lung sounds and
respiratory effort.
II. Assessment:
Assess for the following:
1. Assess lung sounds before and after use to
establish a baseline and determine the
effectiveness of the medication.
2. Assess patient’s oxygenation saturation level
before medication administration.
3. Assess the patient’s knowledge and
understanding of the medication’s purpose and
action.
III. PLANNING:
1. Gather and prepare the following materials:

a. Nebulizer tubing and chamber

b. Air Compressor or Oxygen Hook-up

c. Stethoscope

d. Ordered Medication

e. PPE as indicated
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AN AUTONOMOUS METHODIST UNIVERSITY

COLLEGE OF NURSING AND ALLIED MEDICAL SCIENCES

IV. Procedure/Implementation
1. Check and verify doctor's order. Check the
patient’s chart for allergies. Know the actions,
special nursing considerations, safe dose ranges,
purpose of administration, and adverse effects
of the medications to be administered.
2. Identify patient with at least two identifiers.
3. Explain the procedure to the patient and family.
4. Gather all equipment needed.
5. Perform hand hygiene and put on PPE, if
indicated.
6. Placed patient in appropriate position. (Semi or
High Fowlers position)
7. Remove the nebulizer cup from the device and
open it. Place premeasured unit-dose
medication in the bottom section of the cup or
use a dropper to place a concentrated dose of
medication in cup and add prescribed diluent, if
required.

8. Screw the top portion of the nebulizer cup

back in place and attach the cup to the
nebulizer. Attach one end of tubing to the
stem on the bottom of the nebulizer cuff and
the other end to the air compressor or oxygen
source.
9. Turn on the air compressor or oxygen. Check
that a fine medication mist is produced by
opening the valve. Have patient place
mouthpiece into mouth and grasp securely with
teeth and lips.
10. Instruct patient to inhale slowly and deeply
through the mouth. A nose clip may be
necessary if the patient is also breathing through
the nose. Hold each breath for a slight pause,
before exhaling.
11. Continue this inhalation technique until
all medication in the nebulizer cup has
been aerosolized (usually about 15
minutes). Once the fine mist decreases
in amount, gently flick the sides of the
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AN AUTONOMOUS METHODIST UNIVERSITY

COLLEGE OF NURSING AND ALLIED MEDICAL SCIENCES

nebulizer cup.

12. Have the patient gargle and rinse with tap water
after using the nebulizer, as necessary. Clean the
nebulizer according to the manufacturer’s
directions.
13. Remove gloves and additional PPE, if used.
Perform hand hygiene.

14. Document the administration of the medication

immediately after administration.
15. Evaluate patient’s response to medication
within appropriate time frame. Reassess lung
sounds, oxygenation saturation if ordered, and
respirations.
TOTAL SCORE: /22

Student’s Signature: Instructor’ Signature

Date : Date:

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