OUR LADY OF FATIMA UNIVERSITY

College of Nursing – Pampanga Campus

PROGRAM Bachelor of Science in Nursing STUDENT NAME

NCMA 219 RLE YEAR & SECTION
Care of Mother and Child at Risk or Problems
COURSE (Acute and Chronic) INSTRUCTOR
SKILLS LABORATORY
DATE

PROCEDURE : Nursing Care of the Infant Receiving Phototherapy

EXPECTED OUTCOME : The student should be able to perform nursing care to infants receiving phototherapy. ASSESSMENT
TASK : Return Demonstration

Exceptional Good Average Poor

Assessment Dimension SCORE
(4) (3) (2) (1)
Ensure Effective Irradiance
Position phototherapy units no Performed the Performed all the Performed all the Failed to more than 30.5cm from
the procedures with ease. procedures with procedures with perform the patient. Refer to specific
minimal supervision. maximal supervision. procedures. phototherapy units manufacturing
guidelines for more details Assess Skin Exposure
Neonates should be nursed naked Performed the Performed all the Performed all the Failed to apart from a diaper under
procedures with ease. procedures with procedures with perform the
phototherapy and will need to be minimal supervision. maximal supervision. procedures.

nursed in an Isolette to maintain an appropriate neutral thermal environment.

Expose as much of the skin Performed the Performed all the Performed all the Failed to surface as possible to the
procedures with ease. procedures with procedures with perform the phototherapy light. To maximize
minimal supervision. maximal supervision. procedures. skin exposure, dress the baby in a diaper and their
protective eye covers only.
Provide Eye Protection
Performed the Performed all the Performed all the Failed to
Cover the eyes with appropriate procedures with ease. procedures with procedures with perform the opaque eye covers
minimal supervision. maximal supervision. procedures.
Ensure eye covers are removed 4- Performed the Performed all the Performed all the Failed to 6 hourly for eye care
during infant procedures with ease. procedures with procedures with perform the cares or feeding. Observe
for minimal supervision. maximal supervision. procedures. discharge/infection/damage and
document any changes.
Hydration
Daily fluid requirements should be Performed the Performed all the Performed all the Failed to reviewed and
individualized for procedures with ease. procedures with procedures with perform the gestational and
postnatal age. minimal supervision. maximal supervision. procedures.
Maintain a strict fluid balance chart.
Breast feeds may need to be Performed the Performed all the Performed all the Failed to limited to 20 minutes if
bilirubin procedures with ease. procedures with procedures with perform the level is high to minimize
amount minimal supervision. maximal supervision. procedures. of time out of the lights
Promoting Elimination and Skin Integrity
Monitor vital signs and Performed the Performed all the Performed all the Failed to temperature at least 4 hourlies,
procedures with ease. procedures with procedures with perform the more often if needed minimal
supervision. maximal supervision. procedures.
Monitoring Bilirubin Levels
Cover lipid lines with light Performed the Performed all the Performed all the Failed to
resistant, reflective tape to avoid procedures with ease. procedures with procedures with perform the peroxidation
minimal supervision. maximal supervision. procedures.
Ensure that phototherapy unit is Performed the Performed all the Performed all the Failed to turned off during
collection of procedures with ease. procedures with procedures with perform the blood for TSB/SBR levels, as
both minimal supervision. maximal supervision. procedures. conjugated and unconjugated bilirubin are photo-
oxidized when

COLLEGE OF NURSING – VALENZUELA CAMPUS 1

exposed to white or ultraviolet

light.
 Can state at least 3 Can state at least 2 Can state at least 1 Failed to state
Observe for signs of potential side
potential side effects potential side effects potential side effects potential side
effects.
effects

SCALE:
3 – (EXCEPTIONAL) Works competently and independently at all times
2 – (GOOD) Requires minimum guidance and supervision
1 – (AVERAGE) Requires frequent guidance and supervision
0 – (POOR) Requires close guidance and supervision most of the time

OVERALL SCORE: ______________

Total Raw Score: 33 out of 44 points. If the raw score is less than 33, repeat the return demonstration.

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FACULTY SIGNATURE OVER PRINTED NAME STUDENT NURSE SIGNATURE OVER PRINTED NAME
COLLEGE OF NURSING – VALENZUELA CAMPUS 2