Father Saturnino Urios University

NURSING PROGRAM
Butuan City

NCM 321 RLE

Name: ____________________________________________________________ Section: ____________

NURSING LECTURE RETURN GRADE

PROCEDURES DEMONSTRATION DEMONSTRATION
DATE CI’s DATE CI’s
SIGNATURE SIGNATURE
Nasogastric Tube

Insertion And Removal

Changing a Bowel

Diversion Ostomy

Appliance

Application of Roller

Elastic Bandage

Crutch walking

Remarks:

Checked by: ______________________________________________ Date: _______________________

FOR LABORATORY USE ONLY

Name:________________________________________________________ Section: _____________

Clinical Instructor: ____________________________________Date of Return Demo: _____________

NASO GASTRIC TUBE INSERTION AND REMOVAL

Basic Concept: A tube that is inserted through the nose, down the throat and esophagus, and into the
stomach. It can be used to give drugs, liquids, and liquid food, or used to remove substances from the
stomach. Giving food through a nasogastric tube is a type of enteral nutrition. Also called gastric feeding tube
and NG tube.
Objectives:
1. To remove section and Gaseous substances from the Gastro Intestinal Tract to prevent abdominal
distention
2. To instill nutritional supplement or feeding into the stomach for patient who are unable to swallow
fluids
3. To apply intestinal pressure by means of an inflated balloon to prevent internal hemorrhage
4. To irrigate the stomach in case of active bleeding
5. To obtain specimen for gastric content for laboratory studies.

Equipment:
A. Salem Sump or Naso Gastric Tube
B. Waterproof pad or towel
C. Two inches hypoallergenic tape
D. Water soluble or KY jelly
E. Penlight
F. Glass of water
G. Straw
H. Emesis Basin
I. Asepto Syringe
J. Stethoscope
K. Rubber Band
L. Safety Pins
M. Connecting Tube
N. Suction Apparatus (Optional)
O. Normal Saline Solution
P. Gloves
Planning
A. Explain the procedure to the patient. Tell the patient that he may feel discomfort in his nose and that
the procedure may cause him to gag or shed tears.
B. To facilitate easy insertion, have the patient practice panting, mouth breathing and swallowing.
C. Establish a hand signals technique, the patient can use when he needs to rest during the insertion.
D. Place in a high- fowlers position.
E. Place a towel or water proof pad in the chest,
F. Remove any dentures that do not fit well.

Implementation Rationale
1. Put on Gloves

2. Remove NGT from the packages

3. Measures the length of the NGT to be

inserted using the methods:
 A. Measure distance by holding the distal
end of the tube to the tip of the nose to
the earlobe and xiphoid process.

4. Place an adhesive tape/marker to indicate

total length you have measured.

5. Using the penlight examine the nostrils for

septal defect deviation.

6. Occlude one nostril and observe for

mechanical obstruction of the other nostril.
Assess the airflow

7. Curve end of the tube around fingers and hold

for a few seconds

8. Lubricate the first 2-3 inches of the tube with

a KY jelly never used a mineral oil

9. Have patient hold his head up straight. Then

carefully insert the tube into the nostril with
better flow

10. Aim the tube towards the ears and downward

angle position, gently passing in the
oropharynx

11. When the tube reaches the nasopharynx, you

will feel a resistance. Tell the patient to lower
his head slightly.

12. Rotate the tube about 10 degrees towards the

nostril

13. Put emesis Basin on the bedside or in front of

the patient

14. Hand the patient with a glass of water with

straw and tell the patient to swallow as you
slowly advance the tube

15. If the patient is in respiratory distress, the tube

maybe in the bronchus. Withdraw the tube
immediately.

16. Do not force the tube in faster than the

patient can swallow. Stop advancing the tube
when you reach the marked tape

17. Confirm Placement

A. Aspiration stomach contents with an

asepto syringe
B. Injecting 5-10 cc of air into the tube as
you auscultate for whoosing sound over
the epigastric region.
C. Submerging the distal end of the tube in
water
D. If the above measures do not confirm
proper placement request for an X-ray.
18. Remove gloves

19. Secure end of the tube with a tape or a clip

made for that purpose

20. To reduce discomfort from weight of the tube,

loop the rubber band around the tube and
attach it to the patient gown, using a pin.

21. Pin the end of the tube above the stomach

22. Attached the NGT to the connecting tubing or

clamp the tube.

23. Chart the procedure and reaction of the

patient.

NGT REMOVAL
a. Preparation
1. Verify the doctors order
2. Instruct the patient of the procedure

b. Equipment
1. Gloves
2. Clean Towel
3. Tissue
4. Asepto Syringe
5. Normal Saline

c. Planning
1. Assess for gastric drainage, bowel sound, flatus, nausea, vomiting and abdominal distention
2. Explain the procedure
3. Position Semi- Fowlers
4. Place a clean towel chest area of the patient and offer tissues for the patient.

Implementation Rationale
1. Check for the placement of the tube

2. Flush the tube with 10ml of normal saline

solution

3. Clamp the tube securely by holding and

folding the tube

4. Have patient take a deep breath and have

him hold it slowly as you remove the tube.

5. Place the removed tube in a plastic or

towel away from the patient

6. Do Mouth Care

7. Observe for the next 48 hours the patient

for: Nausea, Vomiting, Abdominal
Distention and Food Intolerance

8. Chart the procedure

Name:____________________________________________________________ Section: ____________

Clinical Instructor (Return Demo): ______________________________Date of Return Demo: __________

PERFORMANCE CHECKLIST

NASO GASTRIC TUBE INSERTION AND REMOVAL

Criteria for evaluation or rating of the student’s performance during Return Demonstration:

1 – Performs the step/procedure independently, correctly and appropriate. Shows excellent attitude and gives
the correct rationale of the step/procedure to be performed. Answers the questions/correctly and analyzes
situation on or before performing the procedure.

2 – Performs more independently with increasing consistency, occasionally needing assistance. Shows very
satisfactory attitude and gives the correct rationale of the step/procedure to be performed, occasionally
needing follow-up instructions and explanations.

3 – Performs expected step/procedure but needs supervision, follow-up instructions and explanations. Has
knowledge about the topic, step or procedure but needs reinforcement.

4 – Performs with close supervision. The student needs repeated, specific or detailed guidance, and direction
to be able to perform the step/procedure correctly and appropriately. There is a need to improve performance.

5 – Performs with very close supervision. The student shows poor or no interest in the step/procedure to be
performed; cannot answer the questions raised by the supervising CI based on the step or procedure to be
performed; unable to grasp understanding of the topic or procedure; unable to perform the required step and
state the rationale after being instructed, guided or directed. Student’s behavior is improper and potentially
harmful to the client.

STEPS OF THE PROCEDURE 1 2 3 4 5

A. PLANNING
1. Explain the procedure to the patient. Tell the patient that
he may feel discomfort in his nose and that the procedure
may cause him to gag or shed tears.
2. To facilitate easy insertion, have the patient practice
panting, mouth breathing and swallowing.
3. Establish a hand signals technique, the patient can use
when he needs to rest during the insertion.
4. Place in a high- fowlers position.
5. Place a towel or water proof pad in the chest.
6. Remove any dentures that do not fit well.
B. IMPLEMENTATION
1. Put on Gloves
2. Remove NGT from the packages
3. Measures the length of the NGT to be inserted using the
methods:
A. Measure distance by holding the distal end of the tube to
the tip of the nose to the earlobe and xiphoid process.
4. Place an adhesive tape/marker to indicate total length
you have measured.
5. Using the penlight examine the nostrils for septal defect
deviation.
6. Occlude one nostril and observe for mechanical
obstruction of the other nostril. Assess the airflow
7. Curve end of the tube around fingers and hold for a few
seconds
8. Lubricate the first 2-3 inches of the tube with a KY jelly
never used a mineral oil
9. Have patient hold his head up straight. Then carefully
insert the tube into the nostril with better flow
 10. Aim the tube towards the ears and downward angle
position, gently passing in the oropharynx
11. When the tube reaches the nasopharynx, you will feel a
resistance. Tell the patient to lower his head slightly.
12. Rotate the tube about 10 degrees towards the nostril
13. Put emesis Basin on the bedside or in front of the patient
14. Hand the patient with a glass of water with straw and tell
the patient to swallow as you slowly advance the tube
15. If the patient is in respiratory distress, the tube maybe in
the bronchus. Withdraw the tube immediately.
16. Do not force the tube in faster than the patient can
swallow. Stop advancing the tube when you reach the
marked tape
17. Confirm Placement

A. Aspiration stomach contents with an asepto syringe

B. Injecting 5-10 cc of air into the tube as you auscultate for
whooshing sound over the epigastric region.
C. Submerging the distal end of the tube in water
D. If the above measures do not confirm proper placement
request for an X-ray.

18. Remove gloves.

19. Secure end of the tube with a tape or a clip made for that
purpose
20. To reduce discomfort from weight of the tube, loop the
rubber band around the tube and attach it to the patient
gown, using a pin.
21. Pin the end of the tube above the stomach
22. Attached the NGT to the connecting tubing or clamp the
tube.
23. Chart the procedure and reaction of the patient.
NGT Removal
PREPARATION
1. Verify the doctors order
2. Instruct the patient of the procedure
ASSESSMENT
1. Assess for gastric drainage, bowel sound, flatus,
nausea, vomiting and abdominal distention
PLANNING
1. Explain the procedure
2. Position Semi- Fowlers
3. Place a clean towel chest area of the patient and offer
tissues for the patient.
IMPLEMENTATION
1. Check for the placement of the tube
2. Flush the tube with 10ml of normal saline solution
3. Clamp the tube securely by holding and folding the tube
4. Have patient take a deep breath and have him hold it
slowly as you remove the tube.
5. Place the removed tube in a plastic or towel away from
the patient
6. Do Mouth Care
7. Observe for the next 48 hours the patient for: Nausea,
Vomiting, Abdominal Distention and Food Intolerance
8. Chart the procedure
C. EVALUATION
1. Applies relevant and related principles.
2. Maintains sterility of the supplies as indicated throughout
the performance of the procedure.
3. Performs the procedure with ease and deftness.
 4. Displays a positive and caring behavior throughout the
performance of the procedure.
5. Keeps the client safe and comfortable throughout the
performance of the procedure.
6. Maintains the working area clean and orderly.
7. Do after care of supplies or materials used.
8. Disposes wastes and soiled materials to appropriate bin.
9. Listens and accepts comments and suggestions
positively.
10. Applies learned information for the improvement of skill.

Comments:

Rating: ____________

________________________________________
Supervising CI’s Signature over Printed Name
Name: _____________________________________________________Section: ___________________
Clinical Instructor: ______________________________________Date of Return Demo: ______________

Changing a Bowel Diversion Ostomy Appliance

Basic Concept: Ostomy is the term used to describe an artificial opening into a body cavity. The site of the
opening on the skin is called a stoma. An ostomy in the digestive tract may be a gastrostomy, jejunostomy,
duodenostomy, ileostomy, or colostomy (Linton & Matteson, 2023).

Objectives:
1. To provide means of fecal evacuation.
2. To assess and care for the peristomal skin.
3. To collect stool for assessment of the amount and type of output.
4. To prevent lesions, ulceration, excoriation, and other skin breakdown caused by fecal
contaminants.
5. To minimize odors for the client’s comfort and self-esteem.

Equipment:
o Clean gloves
o Bedpan
o Moisture-proof bag (for disposable pouches)
o Cleaning materials including warm water), washcloth, towel.
o Tissue or gauze pad
o Skin barrier (optional)
o Stoma measuring guide.
o Pen or pencil and scissors
o New ostomy pouch with optional belt
o Tail closure/ pouch clamp
o Deodorant for pouch (optional)

ASSESSMENT
1. Determine the following:
a. The type of ostomy and its placement on the abdomen
b. The type and size of appliance currently used, and the special barrier substance applied to
the skin, according to the nursing care plan.
2. Assess the stoma color, stoma size and shape, stomal bleeding, status of peristomal skin, amount,
and type of feces.
3. Assess learning needs of the client and family members regarding the ostomy and self-care.
4. Assess the client’s emotional status, especially strategies used to cope with the body image
changes and the ostomy.

PLANNING
1. Determine the need for an appliance change.
2. Select an appropriate time to change the appliance.
3. Review features of the appliance to ensure that all parts are present and functioning correctly.
4. Explain procedure to patient, encourage patient’s interaction and questions.
5. Assemble equipment and close room curtains or door for privacy.
 IMPLEMENTATION RATIONALE
1. Prior to performing the procedure, introduce self
and verify the client’s identity using agency
protocol.
2. Explain to the client what you are going to do,
why it is necessary, and how he or she can
participate.
3. Perform hand hygiene and observe other
appropriate infection prevention procedures.
4. Apply clean gloves.
5. Provide for client privacy preferably in the
bathroom, where clients can learn to deal with
the ostomy as they would at home.
6. Assist the client to a comfortable sitting or lying Lying or standing positions may facilitate
position in bed or preferably a sitting or standing smoother pouch application, that is, avoid
position in the bathroom. wrinkles.
7. Unfasten the belt if the client is wearing one.
8. Empty the pouch and remove the ostomy skin
barrier. Emptying before removing the pouch prevents
o Empty the contents of a drainable pouch spillage of stool on the client’s skin.
through the bottom opening into a
bedpan or toilet.
o If the pouch uses a clamp, do not throw
it away because it can be reused.
o Assess the consistency, color, and Holding the skin taut minimizes client
amount of stool. discomfort and prevents abrasion of the skin.
o Peel the skin barrier off slowly,
beginning at the top and working
downward, while holding the client’s skin
taut.
o Discard the disposable pouch in a
moisture-proof bag.
9. Clean and dry the peristomal skin and stoma.
o Use toilet tissue to remove excess stool.
o Use warm water, and a washcloth to
clean the skin and stoma.
o Dry the area thoroughly by patting with a
towel.
10. Assess the stoma and peristomal skin.
o Inspect the stoma for color, size, shape,
and bleeding.
o Inspect the peristomal skin for any
redness, ulceration, or irritation.
Transient redness after the removal of
adhesive is normal.
11. Place a piece of tissue or gauze over the stoma, This absorbs any seepage from the stoma
and change it as needed. while the ostomy appliance is being changed.
12. Prepare and apply the skin barrier (peristomal
seal).
13. Use the guide to measure the size of the stoma.
14. On the backing of the skin barrier, trace a circle
the same size as the stomal opening.
 15. Cut out the traced stoma pattern to make an This allows space for the stoma to expand
opening in the skin barrier. Make the opening no slightly when functioning and minimizes the
more than 1/8 inch larger than the stoma (Piras risk of stool contacting peristomal skin.
& Hurley, 2011).
16. Remove the backing to expose the sticky
adhesive side.
For a one-piece pouching system
o Center the one-piece skin barrier and pouch over The heat and pressure help activate the
the stoma and gently press it onto the client’s adhesives in the skin barrier.
skin for 30 seconds.
For a two-piece pouching system
o Center the skin barrier over the stoma and gently
press it onto the client’s skin for 30 seconds.
o Remove the tissue over the stoma before
applying the pouch.
o Snap the pouch onto the flange or skin barrier
wafer.
o For drainable pouches, close the pouch
according to the manufacturer’s directions.
17. Remove and discard gloves.
18. Perform hand hygiene.
19. Document the procedure in the client record.
o Type of pouch and skin barrier used,
amount and appearance of effluent in
pouch, size and appearance of stoma,
and condition of peristomal skin.
o Patient/ family level of participation,
teaching performed, and response to
teaching.
o Abnormal appearance of stoma, suture
line, peristomal skin, or character of
output and report to health care provider.
EVALUATION
1. Relate findings to previous data available.
2. Adjust the teaching plan and nursing care plan as
needed.
3. Reinforce the teaching each time the care is
performed.
4. Encourage and support self-care as soon as
possible because clients should be able to
perform self-care by discharge.
5. Perform detailed follow-up based on findings that
deviated from expected or normal for the client.
6. Report significant deviations from normal to the
primary care provider.
Adapted from: Berman, A., Snyder, S. J., Frandsen, G., & Kozier, B. (2022). Kozier & Erb’s fundamentals of
nursing: Concepts, process, and Practice. Pearson Education Limited.
Name:____________________________________________________________ Section: ____________

Clinical Instructor (Return Demo): ______________________________Date of Return Demo: __________

PERFORMANCE CHECKLIST

CHANGING A BOWEL DIVERSION OSTOMY APPLIANCE

Criteria for evaluation or rating of the student’s performance during Return Demonstration:

1 – Performs the step/procedure independently, correctly and appropriate. Shows excellent attitude and gives
the correct rationale of the step/procedure to be performed. Answers the questions/correctly and analyzes
situation on or before performing the procedure.

2 – Performs more independently with increasing consistency, occasionally needing assistance. Shows very
satisfactory attitude and gives the correct rationale of the step/procedure to be performed, occasionally
needing follow-up instructions and explanations.

3 – Performs expected step/procedure but needs supervision, follow-up instructions and explanations. Has
knowledge about the topic, step or procedure but needs reinforcement.

4 – Performs with close supervision. The student needs repeated, specific or detailed guidance, and direction
to be able to perform the step/procedure correctly and appropriately. There is a need to improve performance.

5 – Performs with very close supervision. The student shows poor or no interest in the step/procedure to be
performed; cannot answer the questions raised by the supervising CI based on the step or procedure to be
performed; unable to grasp understanding of the topic or procedure; unable to perform the required step and
state the rationale after being instructed, guided or directed. Student’s behavior is improper and potentially
harmful to the client.

STEPS OF THE PROCEDURE 1 2 3 4 5

ASSESSMENT
1. Determine the following:
a. The type of ostomy and its placement on the
abdomen

b. The type and size of appliance currently used, and

the special barrier substance applied to the skin,
according to the nursing care plan.

2. Assess the stoma color, stoma size and shape, stomal

bleeding, status of peristomal skin, amount, and type of
feces.

3. Assess learning needs of the client and family members

regarding the ostomy and self-care.
4. Assess the client’s emotional status, especially strategies
used to cope with the body image changes and the ostomy.
PLANNING
1. Determine the need for an appliance change.
2. Select an appropriate time to change the appliance.
3. Review features of the appliance to ensure that all parts are
present and functioning correctly.
4. Explain procedure to patient, encourage patient’s interaction
and questions.
5. Assemble equipment and close room curtains or door for
privacy.
IMPLEMENTATION
1. Prior to performing the procedure, introduce self and verify
the client’s identity using agency protocol.
2. Explain to the client what you are going to do, why it is
necessary, and how he or she can participate.
 3. Perform hand hygiene and observe other appropriate
infection prevention procedures.
4. Apply clean gloves.
5. Provide for client privacy preferably in the bathroom, where
clients can learn to deal with the ostomy as they would at
home.
6. Assist the client to a comfortable sitting or lying position in
bed or preferably a sitting or standing position in the
bathroom.
7. Unfasten the belt if the client is wearing one.
8. Empty the pouch and remove the ostomy skin barrier.
a. Empty the contents of a drainable pouch through the
bottom opening into a bedpan or toilet.
b. If the pouch uses a clamp, do not throw it away
because it can be reused.
c. Assess the consistency, color, and amount of stool.
d. Peel the skin barrier off slowly, beginning at the top
and working downward, while holding the client’s
skin taut.
e. Discard the disposable pouch in a moisture-proof
bag.
9. Clean and dry the peristomal skin and stoma.
a. Use toilet tissue to remove excess stool.
b. Use warm water, and a washcloth to clean the skin
and stoma.
c. Dry the area thoroughly by patting with a towel.
10. Assess the stoma and peristomal skin.
a. Inspect the stoma for color, size, shape, and
bleeding.
b. Inspect the peristomal skin for any redness, ulceration,
or irritation. Transient redness after the removal of
adhesive is normal.
11. Place a piece of tissue or gauze over the stoma, and change
it as needed.
12. Prepare and apply the skin barrier (peristomal seal).
13. Use the guide to measure the size of the stoma.
14. On the backing of the skin barrier, trace a circle the same
size as the stomal opening.
15. Cut out the traced stoma pattern to make an opening in the
skin barrier. Make the opening no more than 1/8 inch larger
than the stoma (Piras & Hurley, 2011).
16. Remove the backing to expose the sticky adhesive side
For a one-piece pouching system
a. Center the one-piece skin barrier and pouch over the stoma
and gently press it onto the client’s skin for 30 seconds.
For a two-piece pouching system
a. Center the skin barrier over the stoma and gently press it onto
the client’s skin for 30 seconds.
b. Remove the tissue over the stoma before applying the pouch.
c. Snap the pouch onto the flange or skin barrier wafer.
d. For drainable pouches, close the pouch according to the
manufacturer’s directions.
17. Remove and discard gloves.
18. Perform hand hygiene.
19. Document the procedure in the client record.
a. Type of pouch and skin barrier used, amount and
appearance of effluent in pouch, size and appearance of
stoma, and condition of peristomal skin.
b. Patient/ family level of participation, teaching performed,
and response to teaching.
c. Abnormal appearance of stoma, suture line, peristomal
skin, or character of output and report to health care
provider.
EVALUATION
1. Relate findings to previous data available.
2. Adjust the teaching plan and nursing care plan as needed.
 3. Reinforce the teaching each time the care is performed.
4. Encourage and support self-care as soon as possible
because clients should be able to perform self-care by
discharge.
5. Perform detailed follow-up based on findings that deviated
from expected or normal for the client.
6. Report significant deviations from normal to the primary care
provider.

Comments:

Rating: ____________

________________________________________
Supervising CI’s Signature over Printed Name
Name: ___________________________________________________________ ____ Section _______
Clinical Instructor: ________________________ ___________ Date of Return Demo: _____________

Blood Glucose Monitoring

Basic Concept: Blood glucose monitoring is also known as finger stick glucose. A capillary blood specimen
is taken to measure the current blood glucose level when frequent tests are required or when a venipuncture
cannot be performed. This technique is less painful than a venipuncture and easily performed. It provides
accurate indication of how the body is controlling glucose metabolism and provides feedback to guide
clinicians and patients about their treatment adjustments to achieve optimal glucose control (Berman,
Frandsen & Synder, 2020).

Objectives:
1. To maintain the patient’s blood glucose level within normal limits by balancing food intake with
medication and activity.
2. To aid in assessment control and diabetes management.
3. To help in decision making regarding treatment titration and changes.

Equipment:

• Alcohol or cotton swab

• Lancet device or mechanical blood-letting devices/ single patient use pricking device.
• Blood glucose meter (e.g. Accu-Chek III, OneTouch)
• Blood glucose test strips appropriate for meter brand
• Clean gloves
• Sharps bin
• Paper towel

Assessment:
1. Checks doctor’s order for monitoring schedule.
2. Assesses patient’s understanding of procedure and purpose.
3. Determines if specific conditions need to be meet before and after sample collection.
4. Determines if risks exist for performing the skin puncture.
5. Assesses skin area for puncture.

Planning:
1. Reviews the general guidelines for insulin administration.
2. Prepares or gathers necessary materials and brought materials to bedside.
3. Arranges supplies according to usage and ensures orderly working area.
4. Provides privacy.

IMPLEMENTATION Rationale
1. Performs hand hygiene.
2. Explains the procedure to the patient and family/
SO.
3. Offers the patient and family opportunity to
practice testing the procedure.
4. Positions the patient comfortably.
5. Prepares the lancet aseptically.
6. Removes test strips from the vial and places it in
a towel or any clean and dry
surface with test pad facing up.
7.Recaps the container of the reagent strips.
8. Turns on the monitor and checks the code
number of the strip.
9. Inserts strip to glucose meter and sets the code.
10. Wears clean gloves.
11. Massages the side of the finger toward the
puncture site.
12. Chooses the correct puncture site.
13. Cleans skin with alcohol swab and allows it to
dry completely.
14. Holds lancet perpendicular to the skin and
pierces site with lancet.
15. Wipes away first drop of blood with gauze
square or cotton ball.
16. Lowers hand to encourage bleeding until
enough blood has formed to cover the strip.
17. Gently touches the drop of blood to the test strip
without smearing it.
18. Applies pressure to puncture site.
19. Reads the blood test result and record it.
20. Turns off the meter, removes the strip, and
disposes the strip to appropriate container.
21. Removes the lancet from the lancet holder and
discards it to appropriate container.
22. Removes the gloves and performs hand
hygiene.
23. Documents care rendered, the time blood
glucose test done, the result, assessment findings,
etc.
24. Reinspects the puncture site for bleeding and
tissue injury.
Name: ___________________________________________________________ ____ Section _______
Clinical Instructor: ________________________ ___________ Date of Return Demo: _____________

PERFORMANCE CHECKLIST
Blood Glucose Monitoring

Criteria for evaluation or rating the student’s performance:

1.0 – Performs the step/procedure independently, correctly and appropriately. Shows excellent attitude and
gives the correct rationale of the step/procedure to be performed. Answers the question/s correctly
and analyzes situation on or before performing the procedure.

2.0 - Performs more independently with increasing consistency, occasionally needing assistance. Shows
very satisfactory attitude and gives the correct rationale of the step/procedure to be performed,
occasionally needing follow-up instructions and explanations.

3.0- Performs expected step/ procedure but needs supervision, follow-up instructions and explanations.
Has knowledge about the topic, step or procedure but needs reinforcement.

4.0- Performs with close supervision. The student needs repeated, specific or detailed guidance, and
direction to be able to perform the step/ procedure correctly and appropriately. There is a need to
improve performance.

5.0 - Performs with very close supervision. The student shows poor or no interest in the step/ procedure to
be performed; cannot answer the question raised by the supervising clinical instructor based on the
step or procedure to be performed; unable to grasp understanding of the topic or procedure; unable to
perform the required step and state the rationale after being instructed, guided or directed. Student’s
behavior is improper and potentially harmful to the client.

1 2 3 4 5
ASSESSMENT
1. Checks doctor’s order for monitoring schedule.
2. Assesses patient’s understanding of procedure and purpose.
3. Determines if specific conditions need to be meet before and after sample
collection.
4. Determines if risks exist for performing the skin puncture.
5. Assesses skin area for puncture.
PLANNING
1. Reviews the general guidelines for insulin administration
2. Prepares or gathers necessary materials and brought materials to bedside.
3. Arranges supplies according to usage and ensures orderly working area.
4. Provides privacy.
IMPLEMENTATION
1. Performs hand hygiene.
2. Explains the procedure to the patient and family/ SO.
3. Offers the patient and family opportunity to practice testing the procedure.
4. Positions the patient comfortably.
5. Prepares the lancet aseptically.
6. Removes test strips from the vial and places it in a towel or any clean and
dry
surface with test pad facing up.
7.Recaps the container of the reagent strips.
8. Turns on the monitor and checks the code number of the strip.
9. Inserts strip to glucose meter and sets the code.
10. Wears clean gloves.
11. Massages the side of the finger toward the puncture site.
12. Chooses the correct puncture site.
13. Cleans skin with alcohol swab and allows it to dry completely.
14. Holds lancet perpendicular to the skin and pierces site with lancet.
15. Wipes away first drop of blood with gauze square or cotton ball.
 16. Lowers hand to encourage bleeding until enough blood has formed to
cover
the strip.
17. Gently touches the drop of blood to the test strip without smearing it.
18. Applies pressure to puncture site.
19. Reads the blood test result and record it.
20. Turns off the meter, removes the strip, and disposes the strip to
appropriate
container.
21. Removes the lancet from the lancet holder and discards it to appropriate
container.
22. Removes the gloves and performs hand hygiene.
23. Documents care rendered, the time blood glucose test done, the result,
assessment findings, etc..
24. Reinspects the puncture site for bleeding and tissue injury.
EVALUATION
1. Applies relevant and related principles or concepts.
2. Keeps the patient safe and free of harm/ injury while performing the
procedure.
3. Performs the procedure with ease and deftness.
4. Observes asepsis or sterility throughout the performance of the procedure.
5. Keeps the area clean and orderly throughout the performance of the
procedure.
6. Displays a positive and caring behavior throughout the performance of the
procedure.
7. Does after care of supplies or materials used.
8. Disposes wastes and soiled materials to appropriate bin/ area.
9. Listens and accepts comments and suggestions positively.
10. Applies learned information for the improvement of skill.

Remarks:

Rating:

CI’s Signature:
Name:_____________________________________________________Section:____________________
Clinical Instructor:__________________________________Date of Return Demosntration:____________
Application of roller elastic bandage
Basic Concept: Bandage is a material used to provide support either to a medical dressing or a injured part
of the body. Bandaging is the application of a continuous strip of woven material to a body part.
Objectives:
1. Create pressure over body part
2. To immobilize a body part
3. To secure a splint
4. To support a wound
5. To reduce or prevent edema
6. To secure dressing

Types of bandages: (Look for a picture on the different types of bandages and provide a short description
and its uses.)

A. Fingertip Bandage

B. Knuckle Bandage

C. Large Plastic Bandage

D. Plastic Bandage Strip

E. Butterfly Bandage

F. Wound Closure Tape

G. Self-Adherent Compression Bandage

 H. Elastic Bandage

I. Triangular Bandage

Materials:
A clean bandage of the appropriate material with the width of bandage depends on the size of the body part
to be bandaged, the larger the circumference, the wider the bandage.
Pads
Tape
Metal clips
Safety Pins

Preparation:
1. Review medical record and NCP to determine the needed care
2. Identify the patient and explain the procedure to the patient
3. Assess the area to be bandaged and identify the purpose of the particular bandage for the patient
4. Plan for specific technique to be used
5. Recall related principles
6. Plan for modifications
7. Gather equipment needed
8. Provide privacy
9. Wash hands

Procedure Rationale
1. Assess the following before application of
bandage:
A. Inspect and palpate area for swelling,
presence of and status of wounds
B. Note the presence of drainage
(amount, color, odor, viscosity)
C. Inspect and palpate for adequacy of
circulation (skin temperature, color,
and sensation)
D. Ask client about any pain
experienced(location, intensity, onset, quality)
2. Assess the ability of the client to reapply
the bandage or binder when needed.

3. Assess the capabilities of the client

regarding activities of daily living (eating,
dressing, combing hair, bathing) assess
the degree of assistance required
convalescence period.

4. Position the patient.

5. Provide the client with chair or bed and

arrange support for the area to be
bandaged, like if the affected part is the
elbow, you ask the client to place the
elbow on the table so that the hand does
not have to bend up unsupported.

6. Align the part of the body to be bandaged

with slight flexion of the joints unless this
is contraindicated.

7. Start bandaging from base to the indicated

bandaging type.

Circular Turn:
1. Hold the bandage in your dominant
hand, keeping the roll uppermost, and
unroll the bandage about 8cm (3 in.)
2. Apply the end of the bandage to the
part of the body to be bandaged.
3. Hold the end down with the thumb of
the other hand.
4. Encircle the body part a few times or as
often as needed, making sure that
each layer overlaps, one-half to two-
thirds of the previous layer.
5. Ensure that the bandage is firm but not
too tight.
6. Ask the client if the bandage feels
comfortable.
7. Secure the end of the bandage with
tape or a safety pin over an uninjured
area.

Spiral Turn:
1. Make two circular turn
2. Continue spiral at about 30 degrees
angle. Each turn overlapping the
preceding one by two-thirds the width
of the bandage.
3. The thumb will hold the bandage while
it is folded on itself.
4. Terminate the bandage with two
circular turns and secure.

Spiral Reverse Turn:

1. Anchor the bandage with two
circular turns, and bring the
bandage upward at about a
30 degree angle.
2. Place the thumb of your free
 hand on the upper edge of
the bandage
3. Unroll the bandage about 15
cm (6in), and then turn your
hand so that the bandage
falls over itself.
4. Continue the bandage over the
limb, overlapping each
previous turn by two-thirds
the width of the bandage.
Make each bandage turn the
same position on the limb so
that the turns of the bandage
will be aligned.
5. Terminate the bandage with
two circular turns, and secure
the end as described by
circular turns.

Recurrent Turn:
1. Anchor the bandage with two
circular turns.
2. Fold the bandage back on
itself, and bring it centrally
over the distal end to be
bandaged.
3. Holding it with the other hand,
bring the bandage back over
to the right of the center
bandage but overlapping it by
two-thirds of the width of the
bandage.
4. Bring the bandage back on the
left side, also overlapping the
first turn by two-thirds the
width of the bandage.
5. Continue this pattern of
alternating right and left until
the area is covered. Overlap
the preceding turns by two-
thirds the bandage with each
turn.
6. Terminate the bandage with
two circular turns
7. Secure end appropriately.

Figure of Eight Turn:

1. Anchor the bandage with two
circular turns
2. Carry the bandage above the joint,
around it and then below it,
making a figure-eight.
3. Continue above and below the
joint, overlapping the previous
turn two-thirds the width of the
bandage.
4. Terminate the bandage above the
joint with two circular turn, and
then secure the end
appropriately.

After applying bandage:

 1. Assess for signs that bandage is too
tight:
A. The skin around the bandage becomes
pale or bluish in color
B. Complains of pain
C. The skin beyond the bandage is cold,
tingling or numb
D. Unable to move his or her fingers or toes

2. Keep patient comfortable

Name:____________________________________________________________ Section: ____________

Clinical Instructor (Return Demo): ______________________________Date of Return Demo: __________

PERFORMANCE CHECKLIST

APPLICATION OF ROLLER ELASTIC BANDAGE

Criteria for evaluation or rating of the student’s performance during Return Demonstration:

1 – Performs the step/procedure independently, correctly and appropriate. Shows excellent attitude and gives
the correct rationale of the step/procedure to be performed. Answers the questions/correctly and analyzes
situation on or before performing the procedure.

2 – Performs more independently with increasing consistency, occasionally needing assistance. Shows very
satisfactory attitude and gives the correct rationale of the step/procedure to be performed, occasionally
needing follow-up instructions and explanations.

3 – Performs expected step/procedure but needs supervision, follow-up instructions and explanations. Has
knowledge about the topic, step or procedure but needs reinforcement.

4 – Performs with close supervision. The student needs repeated, specific or detailed guidance, and direction
to be able to perform the step/procedure correctly and appropriately. There is a need to improve performance.

5 – Performs with very close supervision. The student shows poor or no interest in the step/procedure to be
performed; cannot answer the questions raised by the supervising CI based on the step or procedure to be
performed; unable to grasp understanding of the topic or procedure; unable to perform the required step and
state the rationale after being instructed, guided or directed. Student’s behavior is improper and potentially
harmful to the client.

STEPS OF THE PROCEDURE 1 2 3 4 5

A. PREPARATION
1. Review medical record and NCP to
determine the needed care
2. Identify the patient and explain the
procedure to the patient
3. Assess the area to be bandaged and
identify the purpose of the particular
bandage for the patient
4. Plan for specific technique to be used
5. Recall related principles
6. Plan for modifications
7. Gather equipment needed
8. Provide privacy
9. Wash hands
B. IMPLEMENTATION
1. Assess the following before application of
bandage:
A. Inspect and palpate area for swelling,
presence of and status of wounds
B. Note the presence of drainage (amount,
color, odor, viscosity)
C. Inspect and palpate for adequacy of
circulation (skin temperature, color, and
sensation)
D. Ask client about any pain experienced(location,
intensity, onset, quality)
2. Assess the ability of the client to reapply
the bandage or binder when needed.

3. Assess the capabilities of the client

 regarding activities of daily living (eating,
dressing, combing hair, bathing) assess
the degree of assistance required
convalescence period.
4. Position the patient.
5. Provide the client with chair or bed and
arrange support for the area to be
bandaged, like if the affected part is the
elbow, you ask the client to place the
elbow on the table so that the hand does
not have to bend up unsupported.
6. Align the part of the body to be bandaged
with slight flexion of the joints unless this is
contraindicated.
7. Start bandaging from base to the indicated
bandaging type.
Circular Turn:
1. Hold the bandage in your dominant hand,
keeping the roll uppermost, and unroll the
bandage about 8cm (3 in.)
2. Apply the end of the bandage to the part of
the body to be bandaged.
3. Hold the end down with the thumb of the
other hand.
4. Encircle the body part a few times or as
often as needed, making sure that each
layer overlaps, one-half to two-thirds of the
previous layer.
5. Ensure that the bandage is firm but not too
tight.
6. Ask the client if the bandage feels
comfortable.
7. Secure the end of the bandage with tape or
a safety pin over an uninjured area.

Spiral Turn:
1. Make two circular turn
2. Continue spiral at about 30 degrees angle.
Each turn overlapping the preceding one
by two-thirds the width of the bandage.
3. The thumb will hold the bandage while it is
folded on itself.
4. Terminate the bandage with two circular
turns and secure.

Spiral Reverse Turn:

1. Anchor the bandage with two circular turns,
and bring the bandage upward at about a
30 degree angle.
2. Place the thumb of your free hand on the
upper edge of the bandage
3. Unroll the bandage about 15 cm (6in), and
then turn your hand so that the bandage
falls over itself.
4. Continue the bandage over the limb,
overlapping each previous turn by two-
thirds the width of the bandage. Make
each bandage turn the same position on
the limb so that the turns of the bandage
will be aligned.
5. Terminate the bandage with two circular turns,
and secure the end as described by circular turns.
 Recurrent Turn:
1. Anchor the bandage with two circular
turns.
2. Fold the bandage back on itself, and bring
it centrally over the distal end to be
bandaged.
3. Holding it with the other hand, bring the
bandage back over to the right of the
center bandage but overlapping it by two-
thirds of the width of the bandage.
4. Bring the bandage back on the left side,
also overlapping the first turn by two-thirds
the width of the bandage.
5. Continue this pattern of alternating right
and left until the area is covered. Overlap
the preceding turns by two-thirds the
bandage with each turn.
6. Terminate the bandage with two circular
turns
7. Secure end appropriately.
Figure of Eight Turn:
1. Anchor the bandage with two circular turns
2. Carry the bandage above the joint, around it
and then below it, making a figure-eight.
3. Continue above and below the joint,
overlapping the previous turn two-thirds
the width of the bandage.
4. Terminate the bandage above the joint
with two circular turn, and then secure the
end appropriately.
After applying bandage:
1. Assess for signs that bandage is too tight:
A. The skin around the bandage becomes pale
or bluish in color
B. Complains of pain
C. The skin beyond the bandage is cold,
tingling or numb
D. Unable to move his or her fingers or toes
2. Keep patient comfortable.
C. EVALUATION
1. Keeps the patient safe and comfortable
throughout the performance of the
procedure.
2. Applies related and relevant principles or
concepts.
3. Performs procedure with ease and
deftness.
4. Displays a positive and caring behavior
throughout the performance of the
procedure.
5. Listens and accepts comments and
suggestions positively.
6. Applies learned information for the
improvement of skill.

Comments: Rating: ____________

________________________________________
Supervising CI’s Signature over Printed Name
 Name:_____________________________________________________Section:____________________
Clinical Instructor:_________________________________Date of Return Demonstration:_____________
Crutch Walking
Basic Concept: Crutches are walk8ing aids made of wood or metal wood or metal in the form of a shaft. It is
used to improve the balance and to relieve weight-bearing fully or partially on lower extremity.
Crutch walking is a method of support and balance for transferring or walking employed by a person who is
lame , weak ,or injured. Instruction in proper crutch walking technique is essential in many orthopedic
disorders.
Objectives:
1. To ensure proper support and balance.
2. To prevent injury.
3. To assist client who cannot bear any weight on one leg.
4. To assist client who have full weight bearing on both legs.

Equipment:
Crutches
Measuring tape

The Different Types of Crutch:

(Attach picture and describe the different types of crutch.)

A. Axillary Crutch

B. Forearm Crutch

C. Platform Crutch
D. Strutters

E. Leg Support

Draw a crutch and label its parts.

Preparation:
1. Review doctor’s order , plan of nursing care and determine which gait is best for the client.
2. Remove trip hazards such as rugs, toys, etc. From the walking environment.
3. Instruct patient to wear sturdy or well-fitting shoes.
4. Rationalize the intervention of teaching to the client to gain cooperation.
5. Prepare the client for maintaining balance by asking him or her to stand on the unaffected leg by a chair.
Holding the patient near the waist or using a transfer belt would be helpful in promoting balance.

PROCEDURE RATIONALE
1. Measure the client for crutch length.
If standing: Set crutch length approximately
5cm (2 inches) below the axilla.
If lying: measure from anterior fold of axilla to
sole of the foot and add 5 cm.

2. Adjust crutches based on measurements.

3. Measure for hand piece:

A. Have the client position crutch under
axilla and grasp hand piece. Arm rest should
be 1 to 2 inches below the axilla. Elbow
should be flexed 20 to 30 degrees.
B. Use foam rubber pad on the underarm.
C. Adjust crutches to fit the client’s
measurements.
4. Demonstrate the following:
A. Exercise for crutch walking.
1. Flexion and extension of arms in several
directions.
2. Moving from a supine position by flexing
the elbows and pushing the hands against
bed surfaces.
3. Lifting the body off the bed surface by
pushing down with the hands and
extending the elbows.
4. Squeezing a rubber ball or a gripper with
the hand.

B. Tripod Position
1. The crutches are placed about 15 cm (6
inches) in front of the feet and out laterally
about 15cm (6 inches) creating a wide base
of support.
2. The feet are slightly apart.

C. Crutch Gaits
1. Four-point gait
Place the patient in tripod position and
instruct him/her to do the following:
A. Move the right crutch forward
B. Move the left foot forward
C. Move the left crutch forward
D. Move the right foot forward
E. Repeat this sequence of crutch-foot-crutch-
foot for desired ambulation.

2. Three -point gait

Place the patient in tripod position and
instruct him/her to do the following:
A. Move the affected (non-weight bearing)
leg and both crutches forward
together.
B. Move the unaffected (weight bearing)
leg forward.
C. Repeat this sequence for desired
ambulation.

3. Two-point gait
Place the patient in tripod position and
instruct him/her to do the following:
A. Move the right leg and left crutch forward
together.
B. Move the left leg and the right crutch forward
together.
C. Repeat this sequence for desired
ambulation.

4. Swing -to-gait
Place the patient in tripod position and
instruct him/her to do the following:
A. Move both crutches ahead together
B. Lift body weight by the arms and swing to the
crutches (level of crutches).
C. Repeat the sequence in the rhythm for
desired ambulation.
 5. Swing-through gait
Place the patient in tripod position and
instruct him/her to do the following:
A. Move both crutches forward together about
6 inches
B. Move both legs forward together about 6
inches
C. Repeat the sequence in the rhythm for
desired ambulation.

D. Sitting
Instruct patient to:
A. Grasp hand piece for control.
B. Bend forward slightly while assuming
sitting position.
C. Place affected leg forward to prevent
weight bearing and flexion while sitting.

E. Standing
Instruct patient to:
A. Move forward to edge of chair, keep
unaffected leg slightly under seat.
B. Place both crutches on side of affected
extremity.
C. Push down on hand piece while rising to
standing position.

F. Climbing and descending stairs with

crutches
Climbing:
A. Step up with your unaffected leg
B. Follow with crutches and your affected
leg.

Descending:
A. Step down with the crutches and your
affected leg
B. Follow with your unaffected leg.

Documents the findings.

Name:____________________________________________________________ Section: ____________

Clinical Instructor (Return Demo): ______________________________Date of Return Demo: __________

PERFORMANCE CHECKLIST

CRUTCHWALKING

Criteria for evaluation or rating of the student’s performance during Return Demonstration:

1 – Performs the step/procedure independently, correctly and appropriate. Shows excellent attitude and gives
the correct rationale of the step/procedure to be performed. Answers the questions/correctly and analyzes
situation on or before performing the procedure.

2 – Performs more independently with increasing consistency, occasionally needing assistance. Shows very
satisfactory attitude and gives the correct rationale of the step/procedure to be performed, occasionally
needing follow-up instructions and explanations.

3 – Performs expected step/procedure but needs supervision, follow-up instructions and explanations. Has
knowledge about the topic, step or procedure but needs reinforcement.

4 – Performs with close supervision. The student needs repeated, specific or detailed guidance, and direction
to be able to perform the step/procedure correctly and appropriately. There is a need to improve performance.

5 – Performs with very close supervision. The student shows poor or no interest in the step/procedure to be
performed; cannot answer the questions raised by the supervising CI based on the step or procedure to be
performed; unable to grasp understanding of the topic or procedure; unable to perform the required step and
state the rationale after being instructed, guided or directed. Student’s behavior is improper and potentially
harmful to the client.

STEPS OF THE PROCEDURE 1 2 3 4 5

A. PREPARATION
1. Review doctor’s order , plan of nursing
care and determine which gait is best for
the client.
2. Remove trip hazards such as rugs, toys,
etc. From the walking environment.
3. Instruct patient to wear sturdy or well-
fitting shoes.
4. Rationalize the intervention of teaching
to the client to gain cooperation.
5. Prepare the client for maintaining
balance by asking him or her to stand on
the unaffected leg by a chair. Holding the
patient near the waist or using a transfer
belt would be helpful in promoting
balance.
B. IMPLEMENTATION
1. Measure the client for crutch length.

If standing: Set crutch length approximately

5cm (2 inches) below the axilla.

If lying: measure from anterior fold of axilla to

sole of the foot and add 5 cm.
2. Adjust crutches based on measurements.
3. Measure for hand piece:
A. Have the client position crutch under axilla
and grasp hand piece. Arm rest should be 1 to
2 inches below the axilla. Elbow should be
flexed 20 to 30 degrees.
B. Use foam rubber pad on the underarm.
 C. Adjust crutches to fit the client’s
measurements.
5. Demonstrate the following:
A. Exercise for crutch walking.
1. Flexion and extension of arms in several
directions.
2. Moving from a supine position by flexing the
elbows and pushing the hands against bed
surfaces.
3. Lifting the body off the bed surface by
pushing down with the hands and extending
the elbows.
4. Squeezing a rubber ball or a gripper with the
hand.
B. Tripod Position
1. The crutches are placed about 15 cm (6
inches) in front of the feet and out laterally
about 15cm (6 inches) creating a wide base of
support.
2. The feet are slightly apart.
C. Crutch Gaits
Four-point gait
Place the patient in tripod position and instruct
him/her to do the following:
1. Move the right crutch forward
2. Move the left foot forward
3. Move the left crutch forward
4. Move the right foot forward
5. Repeat this sequence of crutch-foot-
crutch-foot for desired ambulation.
Three -point gait
Place the patient in tripod position and instruct
him/her to do the following:
1. Move the affected (non-weight bearing) leg
and both crutches forward together.
2. Move the unaffected (weight bearing) leg
forward.
3. Repeat this sequence for desired
ambulation.
Two-point gait
Place the patient in tripod position and instruct
him/her to do the following:
1. Move the right leg and left crutch forward
together.
2. Move the left leg and the right crutch
forward together.
3. Repeat this sequence for desired
ambulation.
Swing -to-gait
Place the patient in tripod position and instruct
him/her to do the following:
1. Move both crutches ahead together
2. Lift body weight by the arms and swing to
the crutches (level of crutches).
3. Repeat the sequence in the rhythm for
desired ambulation.
Swing-through gait
Place the patient in tripod position and instruct
him/her to do the following:
1. Move both crutches forward together
about 6 inches
2. Move both legs forward together about 6
 inches
3. Repeat the sequence in the rhythm for
desired ambulation.
Sitting
Instruct patient to:
1. Grasp hand piece for control.
2. Bend forward slightly while assuming
sitting position.
3. Place affected leg forward to prevent
weight bearing and flexion while sitting.
Standing
Instruct patient to:
1. Move forward to edge of chair, keep
unaffected leg slightly under seat.
2. Place both crutches on side of affected
extremity.
3. Push down on hand piece while rising to
standing position.
Climbing and descending stairs with crutches
Climbing:
1. Step up with your unaffected leg
2. Follow with crutches and your affected
leg.
Descending:
1. Step down with the crutches and your
affected leg
2. Follow with your unaffected leg.
6. Documents the findings.
D. EVALUATION
1. Applies related and relevant principles or
concepts
2. Performs procedure with ease and
deftness.
3. Listens and accepts comments and
suggestions positively.
4. Applies learned information for the
improvement of skill.

Comments:

Rating: ____________

________________________________________
Supervising CI’s Signature over Printed Name