EMILIO AGUINALDO COLLEGE

Gov. D. Mangubat Ave., Brgy. Burol Main, City of Dasmariñas, Cavite 4114, Philippines
Tel. Nos. (046) 416-4339/41 www.eac.edu.ph
ISO 9001:2015 CERTIFIED

SCHOOL OF NURSING QUALITY MANAGEMENT SYSTEM

HEALTH ASSESSMENT RLE CHECKLIST

ASSESSING BODY TEMPERATURE

NAME: ______________________________________________ SCORE: ______________________

YEAR/SEC/GRP: _________________________________________ DATE: _______________________

PERFORMED
PREPARATION MASTERED COMMENTS
YES NO
1. Assess:
 Clinical signs of fever
 Clinical signs of hypothermia 3
 Site most appropriate for measurement
 Factors that might alter core body temperature
2. Assemble Equipment:
 Thermometer
 Thermometer sheath or cover
 Water soluble lubricant for a rectal thermometer 3
 Disposable gloves
 Towel for axillary temperature
 Tissue /wipes
PROCEDURE
1. Introduce yourself and verify the client’s identity.
Explain to the client what you are going to do, why 3
it is necessary, and how the client can cooperate.
2. Perform hand hygiene and observe other
3
appropriate infection control procedures.
3. Provide for client privacy 3
4. Place the client in the appropriate position. 3
5. Place the thermometer
3
Clean the thermometer using an alcohol
Place the thermometer in the axilla 3
6. Wait for the appropriate amount of time.
Electronic or tympanic thermometers will indicate that
the reading is complete via light or tone.
3
Check package instructions for length of time to wait for
prior to reading chemical dot or tape thermometer.
7. Remove the thermometer from the axilla 3
8. Read the temperature
If the temperature is obviously too high, too low, or
3
inconsistent with the client’s condition, to recheck it with
a thermometer known to be functioning property.
9. Clean the thermometer, if necessary, and return it
3
to the storage location.
10. Document the temperature in the client`s record. 3
TOTAL SCORE 4 2 24 30/39

EVALUATED BY: CONFORME:

_____________________________ ____________________________________
Signature over Printed Name of the Faculty Signature over Printed Name of the Student

• VIRTUE • EXCELLENCE • SERVICE

 ASSESSING A PERIPHERAL PULSE

NAME: ______________________________________________ SCORE: ______________________

YR/SEC/GRP: _________________________________________ DATE: _______________________

PERFORMED
PREPARATION MASTERED COMMENTS
YES NO
1. Assess:
 Clinical signs of cardiovascular alterations
3
 Factors that might alter pulse rate.
 Site most appropriate for assessment
2. Assemble equipment:
 Watch with a second hand or indicator.
3
 Stethoscope
 Tickler or vital signs sheet/Monitoring sheet
PROCEDURE
1. Introduce yourself and verify the client’s
identity. Explain to the client what you are
3
going to do, why it is necessary, and how the
client can cooperate.
2. Perform hand hygiene and observe other
3
appropriate infection control procedures.
3. Provide for client privacy 3
4. Select the pulse point 3
5. Assist the client to a comfortable sitting
3
position
6. Palpate and count the pulse. Place two or
three middle fingertips lightly and squarely
over the pulse point.
 Count for 15 seconds and multiply by 4. Record
the pulse in beats per minute on your 3
worksheet. If taking a client’s pulse for the first
time, if obtaining baseline data, or if the pulse
is irregular, count for a full minute. An irregular
pulse also requires taking the apical pulse.
7. Assess the pulse rhythm and volume. 3
8. Document the pulse rate, rhythm, and
volume. And your actions in the client’s 3
record.
TOTAL SCORE 30

EVALUATED BY: CONFORME:

_____________________________ ____________________________________
Signature over Printed Name of the Faculty Signature over Printed Name of the Student
 EMILIO AGUINALDO COLLEGE
Gov. D. Mangubat Ave., Brgy. Burol Main, City of Dasmariñas, Cavite 4114, Philippines
Tel. Nos. (046) 416-4339/41 www.eac.edu.ph
ISO 9001:2015 CERTIFIED

SCHOOL OF NURSING QUALITY MANAGEMENT SYSTEM

ASSESSING AN APICAL-RADIAL PULSE

NAME: ______________________________________________ SCORE: ______________________

YR/SEC/GRP: __________________________________________ DATE: _______________________

PERFORMED
PREPARATION MASTERED COMMENTS
YES NO
1. Assess:
 Clinical signs of hypovolemic shock (pale skin, 3
rapid breathing, rapid heartbeat, sweating)
2. Assemble equipment:
 Watch with a second hand.
3
 Stethoscope
 Antiseptic wipes
PROCEDURE
1. Introduce yourself and verify the client’s
identity. Explain to the client what you are
3
going to do, why it is necessary, and how the
client can cooperate.
2. Perform hand hygiene and observe other
3
appropriate infection control procedures.
3. Provide for client privacy 3
4. Position the client appropriately. 3
5. Locate the apical and radial pule sites. 3
6. Count the apical and radial pulse rates. 3
Assess the apical pulse for 60 seconds or one full
3
minute.
Assess the radial pulse for 60 seconds or one full
3
minute.
7. Document the apical and radial (AR) pulse
rates, rhythm, volume, and any pulse deficit 3
in the client record, also record related data.
TOTAL SCORE 33

EVALUATED BY: CONFORME:

_____________________________ ____________________________________
Signature over Printed Name of the Faculty Signature over Printed Name of the Student

• VIRTUE • EXCELLENCE • SERVICE

 ASSESSING RESPIRATIONS

NAME: ______________________________________________ SCORE: ____________________

YR/SEC/GRP: _________________________________________ DATE: _____________________

PERFORMED
PREPARATION MASTERED COMMENTS
YES NO
1. Assess
 Skin and mucous membrane color,
 Position assumed for breathing.
 Signs of cerebral anoxia
 Chest movements 3
 Activity tolerance
 Chest pain
 Dyspnea
 Medications affecting respiratory rate.
2. Assemble equipment.
3
 Watch with a second hand or indicator
PROCEDURE
1. Identify yourself and verify the client’s
identity. Explain to the client what you
3
are going to do, why it is necessary and
how the client can cooperate.
2. Perform hand hygiene and observe other
3
appropriate infection control procedures.
3. Provide for client privacy. 3
4. Observe or palpate and count the
respiratory rate.
If you anticipate the client’s awareness of
respiratory assessment, place a hand against
the client’s chest to feel the chest movements
3
with breathing or place the client’s arms across
the chest and observe the chest movements
while supposedly taking the radial pulse.
Count the respiratory rate for 30 seconds if the
respirations are regular. Count for 60 seconds
or one full minute if they are irregular. An 3
inhalation and an exhalation count as one
respiration.
5. Observe the depth, rhythm, and
character of respirations.
Observe the respirations for depth by watching
3
the movement of the chest.
Observe the respirations for regular or
3
irregular rhythm.
Observe the character of respiration- the
sound they produce and the effort they 3
require.
6. Document the respiratory rate, depth,
rhythm, and character on the appropriate 3
record.
TOTAL SCORE 33

EVALUATED BY: CONFORME:

_____________________________ ____________________________________
 EMILIO AGUINALDO COLLEGE
Gov. D. Mangubat Ave., Brgy. Burol Main, City of Dasmariñas, Cavite 4114, Philippines
Tel. Nos. (046) 416-4339/41 www.eac.edu.ph
ISO 9001:2015 CERTIFIED

SCHOOL OF NURSING QUALITY MANAGEMENT SYSTEM

Signature over Printed Name of the Faculty Signature over Printed Name of the Student

ASSESSING BLOOD PRESSURE

NAME: ______________________________________________ SCORE: _____________________

YR/SEC/GRP: _________________________________________ DATE: ______________________

PERFORMED
PREPARATION MASTERED COMMENTS
YES NO
1. Assess:
 Signs and symptoms of hypertension
 Signs and symptoms of Hypotension 3
 Factors affecting blood pressure.
 Client allergy for latex cuff
2. Assemble equipment:
 Stethoscope
3
 Blood pressure cuff of the appropriate size
 Sphygmomanometer
PROCEDURE
1. Identify yourself and verify the client’s identity.
Explain to the client what you are going to do, why
3
it is necessary and how the client can cooperate.

2. Perform hand hygiene and observe other

3
appropriate infection control procedures.
3. Provide for client privacy 3
4. Position the client appropriately.
The adult client should be sitting unless otherwise
3
specified. Both feet should be flat on the floor.
The elbow should be slightly flexed, with the palm of the
3
hand facing up and the forearm supported at heart level.
Expose the upper arm. 3
5. Wrap the deflated cuff evenly around the upper
arm. Locate the brachial artery. Apply the center of
the bladder directly over the artery.
3
For an adult, place the lower border of the cuff
approximately 2.5 cm (1 inch) above the antecubital
space.
6. If this is the client’s initial examination, perform a
preliminary palpatory determination of systolic
pressure.
Palpate the brachial artery with the fingertips 3
Close the valve on the bulb 3
Pump up the cuff until you no longer feel the brachial
pulse. Note the pressure on the sphygmomanometer at 3
which the pulse is no longer felt.
Release the pressure completely in the cuff and wait -2
3
minutes before taking further measurements.
7. Position the stethoscope appropriately.
Cleanse the earpiece with antiseptic wipe. 3
Insert the ear attachments of the stethoscope in your
3
ears so that they tilt slightly forward.
Ensure that the stethoscope hangs freely from the ears
3
to the diaphragm.
Place the bell side of the amplifier of the stethoscope 3

• VIRTUE • EXCELLENCE • SERVICE

over the brachial pulse. Place stethoscope directly on the
skin, not on clothing over the site. Hold the diaphragm
with the thumb and index fingers.
8. Auscultate the client’s blood pressure.
Pump up the cuff until the sphygmomanometer is 30mm
Hg and above the point where the brachial pulse will 3
disappear.
Release the valve on the cuff carefully so that the
pressure decreases at the rate of 2-3 mm/hg per second. 3

As the pressure falls, identify the manometer reading at

3
Korotkoff phases I,IV and V
Deflate the cuff rapidly and completely.
3
Wait 1-2 minutes before making further determinations. 3
Repeat the above steps once or twice as necessary to
3
confirm the accuracy of the reading.
9. If this is the client’s initial examination, repeat the
3
procedure on the client’s other arm.
VARIATIONS: OBTAINING A BLOOD PRESSURE BY THE
PALPATION METHOD
Palpate the radial or brachial pulse site as the cuff
3
pressure is released. The manometer reading at the
point where the pulse re appears represents a value
between auscultated systolic and diastolic values.

VARIATIONS: USING AN ELECTRONIC INDIRECT BLOOD

-
PRESSURE MONITORING DEVICE
Place the blood pressure cuff on the extremity according
-
to the manufacturer’s guidelines.
Turn on the blood pressure switch -
If appropriate, set the device for the desired number of
-
minutes between the blood pressure determinations.
When the device has determined the blood pressure
-
reading, note the digital results.
10. Remove the cuff. 3
11. Wipe the cuff with an approved disinfectant. 3
12. Document and report pertinent assessment data
3
according to hospital policy.
TOTAL SCORE= 84

EVALUATED BY: CONFORME:

_____________________________ ____________________________________
Signature over Printed Name of the Faculty Signature over Printed Name of the Student
 EMILIO AGUINALDO COLLEGE
Gov. D. Mangubat Ave., Brgy. Burol Main, City of Dasmariñas, Cavite 4114, Philippines
Tel. Nos. (046) 416-4339/41 www.eac.edu.ph
ISO 9001:2015 CERTIFIED

SCHOOL OF NURSING QUALITY MANAGEMENT SYSTEM

• VIRTUE • EXCELLENCE • SERVICE