TRIBHUWAN UNIVERSITY

INSTITIUTE OF MEDICINE
MAHARAJGUNJ NURSING CAMPUS
GENERIC BACHELOR OF SCIENCE IN NURSING PROGRAMME
Course: Adult and Geriatric Nursing Practicum Student’s name: Sabita Tiwari
Programme: Bachelor of science in nursing Full mark:
Year: 2nd year Pass mark:
Clinical area: Neuromedicine ward, TUTH Obtained mark:

CHECKLIST FOR PERFORMING CHEST PHYSIOTHERAPY

Direction: Each student will be evaluated on the following points performed.
Keys for marking:
If performed: Yes, and If not performed: No

S.N Expected behavior Yes No Remarks

1. Identify the patient and assess breathing pattern.

2. Review medical record for signs, symptoms and

conditions that indicate need to perform chest
physiotherapy.

3. Explain procedure in detail: patient’s positioning,

how it will be done, how long it will take, and any
discomforts or side effects.

4. Gather the articles at the patient’s bedside.

5. Close room door or pull curtains around patient’s

bed. Perform hand hygiene and apply clean gloves
as indicated.

6. Auscultate the patient’s lungs to determine baseline

respiratory status.

7. Help patient to relax and deep breathing during

procedure. Have patient practice exhaling slowly
 through pursed lips while relaxing chest wall
muscles.

8. Position the patient as ordered. The spine should be

straight to promote rib cage expansion.

9. Cover the area with towel.

10. Percussion
Place hand side by side on chest wall over area to be
drained. Clap with cupped hands over chest wall for
1-2 minutes in each lung area. Percuss from
a) Lower ribs to shoulder on the back.
b) Lower ribs to top of chest in front.

11. Vibration
Remove towel and place hand, palm down on chest
area to be drained with one hand over the other and
fingers together or place hands side by side.

12. Instruct patient to inhale deeply and exhale slowly

through pursed lips and perform abdominal
breathing.

13. Tense all the muscles of hand and arm and vibrate
the hand especially heels with moderate pressure
during exhalation.

14. Stop vibration and relieve pressure on inspiration.

15. Vibrate for 5 exhalations over each lung area which

is affected. After 3-4 vibrations, encourage patient to
cough and expectorate sputum into sputum
mug/polythene bag.

16. Allow patient to rest for several minutes.

17. Auscultate with stethoscope for change in breath

sounds.

18. Repeat percussion and vibration cycles according to

patient’s tolerance and clinical condition, usually for
10-15 minutes.

19. Assist patient to comfortable position.

 20. Assist with oral hygiene.

21. Replace articles.

22. Perform hand hygiene.

23. Obtain vital signs, pulse oximetry.

24. Inspect colour, character and amount of sputum.

25. Document procedure and patient’s response in

nurse’s record.

Date:
Note: Point no. 3, 7, 10, 11, 13, 14 and 23 must be followed by students.
Comments:
Signature of Evaluator:

Strength areas:
Areas to be improved: