SOUTHWESTERNUNIVERSITY PHINMA Name: Year & Section: = Date: Score: TESTICULAR SELF-EXAMINATION criticism if found to be incorrect. ‘RUBRICS PROCEDURE CRITERIA PROFICIENT | APPROACHING | DEVELOPING | BEGINNING Independently PROFICIENCY Performs skills Performs skills performs ail skills | Performs skills | with assistance of | with assistance fluently and with assistance of faculty 3-4 of faculty greater without difficulty. | facutty 1 - 2 times during | than 4 times times during ‘simutation. during ‘simulation. ‘sirnulation. 7 4 3 2 1 ‘ATTITUDE. 1. Displays readiness in the performance of the procedure. 2. Shows spontaneity in the execution of each step. 3, Readily accepts constructing 4, Answers all questions readily. ‘Observes precautionary measures and neatness at all times. 6. Accomplishes the procedure on time. KNOWLEDGE & SKILLS 1. Cup the testicles with one hand to feel the weight. © One testis may be larger ower than the other. 2. Check one testide al a ime. ® Index and middle finger undemeath the scrotum and thumb on top. a. Gently roll the testicle between fingers and thumb. Do not squeeze too hard. Check for any lumps, bumps, or painful areas. Feel the epididymis Testicle should be round and smooth (like a hard-boiled egg) © Epididymis is not as smooth as the egg-shaped testicle. os or 3. Repeat to the other testicie. 4. Paloateffeel the snermatic cord‘© The Spermatic cord is firm and smooth. TOTAL POINTS: 40 I ee ‘Signature over Printed name of the Student OO Signature over Printed name of the Clinical Instructor Marie Christine N. Mercado, RN, MAN, Ed.D Level Il RLE Coordinator Noted: Jill Marie G, MAN, Ed.D iechonn Yuj fe Dean AssistantSOUTHWESTERNUNIVERSITY PHINMA Name: ne: Year & Section: ‘Score: Subject: rr BREAST SELF-EXAMINATION RUBRICS PROCEDURE a PROFICIENT | APPROACHING | DEVELOPING ‘GINNING Independently Performs skills PROFICIENCY | Performs skills Performs all skills | Performs skills | with assistance of fluently and | with assistance of | faculty 3-4 | of facuty greater without dificult, | facuty 1-2 times during | than 4 times times during simulation. during simulation. simulation. 4 3 2 1 ATTITUDE 1. Displays readiness in the Performance of the procedure. 2. Shows spontaneity in the \ execution of each step. 3. Readily accepts constructing Giiticism if found to be incorrect. 4. Answers all questions readily. 5. Observes precautionary measures and neatness at all times. 6. Accomplishes the procedure on = 1 KNOWLEDGE & SKILLS: ‘Standing Position: 7 4. Stands in front of 2 mirror and places arms at the sides: Checks for changes in the following: = Shape: Compare one to the other. One breast may normally be larger than the other, but sudden changes in size should not occur. = Skin: Check for rash, redness, puckering, dimpling, or orange-peel textured appearance. + Nipples: Check for any physical changes such as a ‘sudden inversion, scaling, redness, itching, swelling, or discharge. + Vein pattems: Look fora noticeable increase in size or number of veins compared to the other breast. 7, Places hands on the hips and presses hands firmly, Bows slightly toward the mirror as shoulders are pulled and elbowsPointed forward. Note any change in the contour of both breasts. ‘3. Raises arms behind the head, lasps hands and presses hands forward. Baws slightly forward. Note any change in the contour of both breasts, 4. Raises left arm over the head. Using the right hand (flat pads of the three middle fingers), Palpates left underarm for lumps in circular motion. 5. Begins palpating the left breast by moving finger pads of the right hand starting at the outer edge of the breast in small circles while applying pressure until reaching the nipple. Squeeze the nipple gently. Palpates the entire breast area. 6. Repeats on the right breast. Lying Position: 1. Lies fat with a folded towelipiiow under the left shoulder to check the left breast with the right hand. Z_ Begins palpating the left breast by moving finger pads of the right hand starting at the outer edge of the breast in small circles while applying pressure until reaching the nipple. Squeeze the nipple gently. Palpates the entire breast area. 3. Repeats on the right breast. ~ TOTAL POINTS: 60 Signature over Printed name of the Student ‘Signature over Printed name of the Clinical Instructor Prepared: Marie Christine N CRN, MAN, Ed.D Level Il - RLE CoordinatorSOUTHWESTERNUNIVERSITY PHINMA Year & Section: Score: INDWELLING CATHETER INSERTION RUBRICS PROCEDURE (CRITERIA PROFICIENT | APPROACHING | DEVELOPING | BEGINNING Independently PROFICIENCY Performs skills Performs skills. Performs all skills | Performs skills | with assistance of | with assistance fvently and | with assistance of | faculty3-4 | of faculty greater without difficulty. faauity 1-2 times during than 4 times times during ‘simulation. during simulation, ‘simulation. Lo. 3 2 1 [arrmuve 1. Displays readiness in performing the procedure 12. Accepts criticism by showing effort to correct mistakes | 3. Shows enthusiasm and interest in performing the procedure. 4. Employs professionalism, reliability, and confidence in performing the procedure. 5. Answer rationale questions correctly. KNOWLEDGE & SKILLS. 1. Reviews doctor's order 2. Identifies the patient 3. Assesses for allergies to iodine and latex 4. Explains the procedure, the type and the purpose of catheterization 5. Washes hands and prepare materials needed 6. Provides privacy sl ey 8. Covers patient with bath towel 2] Places a waterproof pad under the patient's hip 10. Checks water temperature | 11. Wears disposable / clean gloves 12. Washes patient's perineal area with soap and water, pat dry14. Opens pack containing drainage system maintaining sterility 16. Places sterile dressing under the hips. 16. Drapes perineal area using sterile fenestrated sheet ‘7. Wears sterile gloves 18. Places sterile tray and contents on sterile dressing in between the Patient's thighs 19. Tests balloon by injecting fluid | (NSS) into the balloon port 20. Withdraws fluid content and leave the syringe in place 21. Lubricates the catheter 25-5 Gms (female); 12.5 — 17.5 cms (mate) 122. Female: Retracts labia and cleanses urethral meatus using iodine swab Male: Grasps and cleanses the glans penis using iodine swab 23. Female: With dominant hand, inserts catheter 5 cms into the meatus Male: a. Holds the penis Perpendicular to the body and gently pull up b- injects 10 ml sterile water-soluble lubricant into the urethra 7 ©. Steadily, inserts the catheter about 8 inches into the meatus Instructs patients to bear down. ‘24. As urine drains, advances the catheter further. 25. Holds the catheter and inflates: balloon 26. Tugs the catheter gently until resistance is felt 27. Secures catheter on patient's thigh using a leg strap or a plaster, makes sure it is not too tight/not too loose 2B. Places the drainage bag below ‘the level of the bladder ‘29, Disposes of materials, remove gloves, and wash hands ‘30. Repositions the patient ‘31, Assesses and documents: character, color, and amount of urineSOUTHWESTERNUNIVERSITY : _ PHINMA i Name: Year & Section: ‘Score: Subject: Date: NASOGASTRIC TUBE INTUBATION AND ADMINISTERING ENTERAL NUTRITION VIA NASOGASTRIC TUBE RUBRICS PROCEDURE (CRITERIA Independently | PROFICIENCY | Performs skills | Performs skills Performs all skills | Performs skills | with assistance of | with assistance fluently and | with assistance of | facutty3-4 | of facutty greater without difficulty. | facuy 1 - 2 times during than 4 times times during simulation, during simulation. simulation. if PROFICIENT | APPROACHING | DEVELOPING | BEGINNING 4 3 2 1 . a feadiness in performing the procedure 2. Accepts crilicism by showing 3 effort to correct mistakes ‘Shows enthusiasm and interest in | performing the procedure. 4. Employs professionalism, reliability, and confidence in performing the procedure. | 5. Answer rationale questions + correctly. KNOWLEDGE & SKILLS ‘A. NASOGASTRIC TUBE T ] INTUBATION ; | 1. Verifies the patient’s need for ‘| enteral tube feedings. 2 Assesses for presence of skin breakdown and patency of nostrils: Ask the patient to breathe, occluding one nostril at a time. 3. Reviews patient's medical history | (gag reflex, nostril surgery, unusual nostril bleeding, bowel sounds, mental status). ‘4. Explains the procedure to the | Patient. 5. Informs the patient on how to. ‘communicate during intubation (hand signal or raise index finger for discomfort), 6 Prepares the equipment. Y 7. Positions patient in sitting or TIf patient is comatose: ‘semi-Fowler’s position with head propped forward using pillow 8. Covers the patient's chest with a towel. ‘9. Washes hands and puts on clean gloves. 10. Determines the length of the tube to be inserted and mark with a 11. Lubricates the first4 inches of the lube with water-soluble lubricant. 12. Asks the patient to slightly flex the Neck backward, 13. Gently insert the tube into the naris. 14. Asks the patient to flex head forward once the tube reaches ‘asopharynx. the n: 15. Advances the tube several inches at a time as the client swallows. Withdraw the tube immediately if there are signs of respiratory distress, 16. Advances the tube until the taped mark is reached. 1T. Secure the tube to the nose with a tape. 18. Checks the placement of the tube: a. Injects 10 ce of air and auscultate. bb. Aspirates gastric content and measures pH. ¢. Prepares the patient for x-ray check-up, if prescribed. 19. Caps or clamps the distal end of the tube or connects to suction machine or drainage bag. 20. Fastens the tube to the patient's gown with a tape. ‘21. Removes gloves, disposes used materials appropriately, and washes hands. 22. Assists patients to @ comfortable position, 23. Documents procedure. B. ADMINISTERING ENTERAL, NUTRITION VIA NASOGASTRIC TUBE 1. Assesses patient's need for enteral tube feedings, foodp iscultates bowel sounds, Obtains baseline weight and y reviews laboratory values. Assesses patients for fluid * volume excess or deficit, ' electrolyte abnormalities and metabolic abnormalities such as hyperglycemia. oe health care provider’s ame tothe [ 6. Prepares feeding and the materials needed. 7. Positions patient in high-fowler’s position. @ Washes hands and applies gloves. @. Check tube placement. 7b. Check gastric residual volume. Measure residual volume if present, 11. Imigates tube. { 42. Start tube feeding. | [13. When feeding is done. iigate the | tube. | 74. Caps or clamps the distal end of | the tube. 15, Maintains patient in high-fowier's position for 30 minutes tot hour after feeding. 146. Documents procedure. EC TOTAL POINTS: 176 + Signature over Printed name of the Student ee | Signature over Printed name of the Clinical Instructor | hare cris eal ee RNC MAN, Ed.D Level ll - RLE Coordinator Noted: Jill Marie C, jagenes, JRN, MAN, Ed.D Michelle B. Yu, Pano Dean