PERPETUAL HELP COLLEGE OF MANILA

1240 V., Concepcion St., Sampaloc Manila

COLLEGE OF NURSING

NCM101 Health Assessment

SKILLS LAB

Level Outcome:
At the end of this course, the First year NCM 101 nursing skills students will be able to
perform safe skills that deals with the priciples and technique, given simulated situations in
selected settings, rendering safe and appropriate care utilizing the nursing process.

Learning Outcome:
At the end of this course, the third year NCM 101 nursing skills students will be able to:
1. Systematically and proficiently perform a physical examination of the Mouth and
Oropharynxon adults.
2. Correlate physical examination findings with anatomic and physiologic characteristics of
the Mouth and Oropharynx
Objectives:
During the performance of the activity in Assessing the Mouth and Oropharynx, the nursing
students will be able to:
1. Describe the common methods of physical examination of the Mouth and Oropharynx
2. Gather essential data from examination of the Mouth and Oropharynx
3. Perform the procedure with confidence.
General Instructions:
1. Attend the scheduled skills laboratory class wearing a prescribed school uniform
2. Review the skill(s) to be practiced and demonstrated
3. Secure a copy of checklist provided for skills demonstration
4. Gather the equipment neede for skill performance
5. Students will follow safety measures at all times
6. No food or drink is allowed during the online clinical skills class
7. Secure a convenient place where you can perform the procedure to avoid distractions

Return demonstration in assessing the Mouth and Oropharynx will on Wednesday 7-11am, 3-
5pm during our online/F2F class. Each student will be given a 2 to 5 minutes to perform the
procedure. Video recording during the return demonstration will be automatically saved to
google drive as basis of grading.
 PERPETUAL HELP COLLEGE OF MANILA
1240 V., Concepcion St., Sampaloc Manila
COLLEGE OF NURSING

Assessing the Mouth and Oropharynx

PERFORMANCE DESCRIPTION
RATING SCALE
4 Consistently demonstrates ability to perform skill with no instructor
assisstance of cueing
3 Demonstrates ability to perform skill. Requires instructors verbal cueing
2 Inconsisrently demonstrates ability to perform skil. Requires instructor
assisstance and cueing
1 Unable to perform skill. Demonstrated unsafe patient care

Preparation score REMARKS

1 Assemble equipment and supplies:
 Clean gloves
 Tongue depressor
 2 x 2 gause pads
 penlight
Procedure
2 Introduce yourself, and verify the client’s identity.
Explain to the client what you are going to do, why it is necessary,
and how she can cooperate
3 Perform hand hygiene, and observe other appropriate infection
control procedures
4 Identify the patient
Provide for client privacy
5 Determine client’s history of the following:
 Routine pattern of dental care
 Last visit to the dentist
 Length of time ulcers or other lesions have been present
 Any denture discomfort
 Any medications the client’s receiving
6 Position the client comfortably- seated, if possible.
ASSESSMENT
Lips and Buccal Mucosa
7 Inspect the outer lips for symmetry of contour, color, and texture.
Ask the client to purse lips as if to whistle
8 Inspect and palpate the inner lips and buccal mucosa for color,
moisture, texture, and the presence of lesions.
Teeth and Gums
9 Inspect the teeth and gums while examining the inner lips and buccal
mucosa
1 Inspect the dentures
0
Ask the client to remove complete or partial dentures. Inspect their
condition, noting in particular broken or worn areas
Tongue/floor of the mouth
1 Inspect the surface of the tongue for position, color, and texture
1
Ask the client to protrude the tongue and to move it from side to side
1 Inspect tongue movement
2
Ask the client to roll the tongue upward and to move it from side to
side
1 Inspect the base of the tongue, the mouth floor, and the frenulum.
3
1 Ask the client to place the tip of hi/her tongue against the roof of the
4 mouth
1 Palpate the tongue and floor of the mouth for any nodules, lumps, or
5 excoriated areas
 PERPETUAL HELP COLLEGE OF MANILA
1240 V., Concepcion St., Sampaloc Manila
COLLEGE OF NURSING

1 Use a piece of gauze to grasp the tip of the tongue and, with the
6 index finger of your other hand, plapate the back of the tongue, its
borders, and its base.
Salivary Glands
1 Inspect salivary duct openings for any swelling or redness
7
Palates and Uvula
1 Inspect the hard and soft palate for color, shape, texture, and the
8 presence of bony prominences.
1 Ask the client to open mouth wide and tilt head backward. Then,
9 depress tongue with a tongue blade as necessary and use a penlight
for appropriate visualization.
2 Inspect the uvula for position and mobility while examining the
0 palates
2 To observe the uvula, ask the client to say,” ah” so that the soft palate
1 rises.
Oropharynx and Tonsils
2 Inspect the oropharynx for color and texture
2
2 Inspect one side at a time to avoid eliciting the gag reflex. To expose
3 one side of the oropharynx, press a tongue blade against the tongue
on the side about halfway back while the client tilts head back and
opens mouth wide. Use a penlight for illumination, if needed.
2 Inspect the tonsils for color, discharge, and size.
4
2 Elicit the gag reflex by pressing the posterior tongur wit a tongue
5 blade
2 Document finding in the client’s record.
6
Total Score

COMPUTATION OF GRADE
Formula for Grading
Raw Score/Total Score x 60+40 = Grade

Clinical Instructor: Date: