BREAST CARE

EVALUATION TOOL

NAME:
YEAR & SECTION: SCORE:

INSTRUCTION:
1 0 REMARKS
Mark the appropriate column
1. Wash hands.

2. Bring equipment at bedside.

3. Screen the patient,

4. Explains the procedure and its purposes.

5. Places the patient in semi-fowler’s position.

6. Exposes the farther breast and places the rolled towel around it.
(Cleans breast using the following sequence)
7. Uses sterile cotton ball wet in sterile water, clean breast from nipple going outward in
rotary motion.
Uses sterile cotton ball soaked in soapsuds solution, cleans breast from the areola going
8.
outward in rotary motion.
9. Able to give rationale why soapsuds solution is not used to clean the nipple.
Uses sterile cotton ball soaked in sterile water, rinses the breast from the nipple going
10.
outward in rotary motion (may use several cotton balls).
Cleans breast going outward in rotary motion. Identify the rationale on the manner of
11.
cleaning the breast.
12. Observes aseptic technique in handling pick-up and sterile forceps.

13. Avoids wetting patient's clothing and bed sheets with cleansing solutions.
Dries breast with sterile cotton ball from the areola to surrounding area in rotary
14.
motion.
15. Dries breast by using the patting motion.

16. Applies sterile OS or clean layette over the nipple or breast.

17. Repeats Steps No. 6 - 16 to the nearer breast.

18. Removes towel, adjusts gown and make patient comfortable.

19. Cares for the equipment after the procedure.

20. Washes hands.
TOTAL
PERFECT SCORE: 20 = 100%

___________________________________
CI’s Signature over printed name
LEGEND:
1 SKILLED
0 UNSKILLED

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