Far Eastern University Institute of Nursing NCM 101 First Semester SY: 2011-2012 Performance Evaluation Tool for

Intradermal Injection Name________________________________________ Score: _______ Section/Group:____________________ Date:________ Grade description: 2 procedure was comp ete ! and correct ! done 1 procedure was incomp ete ! and/or incorrect ! done 0 procedure was not done Preparation 1" !ssess" #ppearance o$ t%e in&ection site Speci$ic dru' action and t%e e(pected response C ient)s *now ed'e o$ t%e dru' action and response C%ec* a'enc! protoco a+out t%e sites to use $or s*in tests 2" !ssem#le e$uipment and supplies" ,ia or ampu e o$ t%e correct medication/-accine Steri e 1 m s!rin'e ca i+rated into %undredt%s o$ mi i iter .tu+ercu in s!rin'e/0 and a 1 to 2/3 inc% on' 22 to 24 'au'e need e # co%o swa+s/steri e water swa+s $or -accine 2 ( 2 steri e 'au5e s6uare .optiona / C ean ' o-es .accordin' to a'enc! protoco / 7pinep%rine 8" %&ec t&e '!R" C%ec* t%e a+e on t%e medication/-accine care$u ! a'ainst t%e M#9 to ma*e sure t%at t%e correct medication/-accine is +ein' prepared" Fo ow t%e t%ree c%ec*s $or administerin' medications" 9ead t%e a+e on t%e medication" :%en it is ta*en $rom t%e medication cart ;e$ore wit%drawin' t%e medication #$ter wit%drawin' t%e medication" <" (rgani)e t&e e$uipment* Procedure 1" Perform &and &ygiene+ and o#serve ot&er appropriate infection control procedures* 2" Prepare t&e medication from t&e vial or ampule for 2 1 0 Remar s

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drug ,it&dra,al Prepare t&e client E-plain to t&e client t&at t&e medication ,ill produce a small ,&eal+ sometimes called a #le# Provide for client privacy* .elect and clean t&e site* Se ect a site #-oid usin' sites t%at are tender0 in$ amed0 or swo en and t%ose t%at %a-e esions" >ut on ' o-es as indicated +! a'enc! po ic!" C eanse t%e s*in at t%e site usin' a $irm0 circu ar motion0 startin' at t%e center and widenin' t%e circ e outward" # ow t%e area to dr! t%orou'% !" Prepare t&e syringe for t&e injection* 9emo-e t%e need e cap w%i e waitin' $or t%e antiseptic to dr!" 7(pe an! air +u++ es $rom t%e s!rin'e .$or medications on !/" Grasp t%e s!rin'e in !our dominant %and0 %o din' it +etween t%um+ and $ore$in'er" ?o d t%e need e a most para e to t%e s*in sur$ace wit% t%e +e-e o$ t%e need e up" Inject t&e fluid* :it% t%e non-dominant %and0 pu t%e s*in at t%e site unti it is taut" @nsert t%e tip o$ t%e need e $ar enou'% to p ace t%e +e-e t%rou'% t%e epidermis" A%e out ine o$ t%e +e-e s%ou d +e -isi+ e under t%e s*in sur$ace" Sta+i i5e t%e s!rin'e and t%e need e0 and in&ect t%e medication care$u ! and s ow ! so t%at it produces a sma w%ea on t%e s*in" :it%draw t%e need e 6uic* ! at t%e same an' e it was inserted" #cti-ate t%e need e sa$et! de-ice" Do not massa'e t%e area" Dispose o$ t%e s!rin'e and need e in t%e s%arps container" 9emo-e ' o-es i$ used" Circ e t%e in&ection site wit% in* to o+ser-e $or redness or induration per a'enc! po ic!" /ocument all relevant information* 9ecord t%e testin' materia 'i-en0 t%e time0 t%e dosa'e0 route0 site and nursin' assessments" Total .core

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.ignature of Faculty .tudent Far Eastern University Institute of Nursing NCM101 First Semester SY: 2011 2012

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Performance Evaluation Tool for Intramuscular Injection Name________________________________________ Score: _______ Section/Group:____________________ Date:________ Grade Description: 2 procedure was comp ete ! and correct ! done 1 procedure was incomp ete ! and/or incorrect ! done 0 procedure was not done Preparation 1" !ssess C ient a er'ies to medication Speci$ic dru' action0 side e$$ects0 and ad-erse reactions C ient)s *now ed'e o$ and earnin' needs a+out t%e medication Aissue inte'rit! o$ t%e se ected site C ient)s a'e and wei'%t0 to determine site and need e si5e C ient)s a+i it! or wi in'ness to cooperate 2" /etermine" :%et%er t%e si5e o$ t%e musc e is appropriate to t%e amount o$ medication to +e in&ected" 8" !ssem#le e$uipment and supplies C ient)s M#9 Steri e medication .ampu e or -ia / S!rin'e and need e o$ si5e appropriate $or t%e amount o$ so ution to +e administered" #ntiseptic swa+/steri e water swa+s $or -accines C ean ' o-es <" %&ec t&e '!R* C%ec* t%e a+e on t%e medication care$u ! a'ainst t%e M#9 to ma*e sure t%at t%e correct medication is +ein' prepared" Fo ow t%e t%ree c%ec*s $or administerin' medications" 9ead t%e a+e on t%e medication: :%en it is ta*en $rom t%e medication cart 2 1 0 Remar s

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;e$ore wit%drawin' t%e medication #$ter wit%drawin' t%e medication Con$irm t%at t%e dose is correct" (rgani)e t&e e$uipment* Procedure Perform &and &ygiene+ and o#serve ot&er appropriate infection control procedures* Prepare t&e medication from t&e ampule or vial for drug ,it&dra,al* :%ene-er $easi+ e c%an'e t%e need e on t%e s!rin'e +e$ore t%e in&ection" @n-ert t%e s!rin'e need e uppermost0 and e(pe a e(cess air" Provide for client privacy* Prepare t&e client* C%ec* t%e c ient)s identi$ication +and" #ssist t%e c ient to a supine0 atera 0 prone or sittin' position dependin' on t%e c%osen site C+tain assistance in %o din' an uncooperati-e c ient" E-plain t&e purpose of t&e medication and &o, it ,ill &elp+ using t&e language t&at t&e client can understand* Include relevant information a#out effects of t&e medication* .elect+ locate and clean t&e site* Se ect a site $ree o$ s*in esions0 tenderness0 swe in'0 %ardness or oca i5ed in$ ammation and one t%at %as not +een used $re6uent ! @$ in&ections are to +e $re6uent00 a ternate sites" #-oid usin' t%e same site twice in a row" Docate t%e e(act site $or t%e in&ection" >ut on c ean ' o-es" C ean t%e site wit% an antiseptic swa+" Esin' a circu ar motion0 start at t%e center and mo-e outward a+out 2cm" Arans$er and %o d t%e swa+ +etween t%e t%ird and $ourt% $in'ers o$ !our non dominant %and in readiness $or need e wit%drawa 0 or position t%e swa+ on t%e c ient)s s*in a+o-e t%e intended site" # ow t%e s*in to dr! prior to in&ectin' medication" Prepare t&e syringe for injection" 9emo-e t%e need e co-er and discard wit%out contaminatin' t%e need e" Inject t&e medication* Ese t%e u nar side o$ t%e non dominant %and to pu t%e s*in appro(imate ! to t%e side or pinc% t%e musc e i$ t%e c ient is emaciated or an in$ant" ?o din' t%e s!rin'e +etween t%e t%um+ and $ore$in'er0 pierce t%e s*in 6uic* ! and smoot% ! at a B0-de'ree an' e0 and insert t%e need e into t%e musc e"

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?o d t%e +arre o$ t%e s!rin'e stead! wit% !our non dominant %and0 and aspirate +! pu in' +ac* on t%e p un'er wit% t%e dominant %and" #spirate $or 2 to 10 seconds" @$ + ood appears in t%e s!rin'e0 wit%draw t%e need e0 discard t%e s!rin'e0 and prepare a new in&ection" @$ + ood does not appear0 in&ect t%e medication steadi ! and s ow ! w%i e %o din' t%e s!rin'e stead!" #$ter in&ection0 wait $or 10 seconds" 0it&dra, t&e needle* :it%draw t%e need e smoot% ! at t%e same an' e o$ insertion" 9e ease t%e s*in" #pp ! 'ent e pressure at t%e site wit% a dr! spon'e0 do not massa'e t%e site @$ + eedin' occurs0 app ! pressure wit% a dr! steri e 'au5e unti it stops !ctivate t&e needle device+ or discard t&e uncapped needle and attac&ed syringe into t&e proper receptacle* Remove gloves* Perform &and &ygiene* /ocument all relevant information* @nc ude t%e time o$ administration0 dru' name0 dose0 route0 and t%e c ient)s reaction" !ssess effectiveness of t&e medication at t&e time it is e-pected to act* Total .core

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Far Eastern University Institute of Nursing NCM101 First Semester SY: 2011 2012 Performance Evaluation Tool for .u#cutaneous Injection Name________________________________________ Score: _______ Section/Group:____________________ Date:________ Grade description: 2 procedure was comp ete ! and correct ! done 1 procedure was incomp ete ! and/or incorrect ! done 0 procedure was not done 1" Preparation 2 !ssess" # er'ies to medication Speci$ic dru' action0 side e$$ects0 and ad-erse reactions C ient)s *now ed'e and earnin' needs a+out t%e medication Status and appearance o$ su+cutaneous site $or esions0 er!t%ema0 swe in'0 ecc%!mosis0 in$ ammation and tissue dama'e $rom pre-ious in&ections" #+i it! o$ t%e c ient to cooperate durin' t%e in&ection >re-ious in&ection sites used !ssem#le e$uipment and supplies" M#9 or computer print out ,ia or ampu e o$ t%e correct medication Steri e s!rin'e and need e #ntiseptic swa+s . steri e water swa+s $or -accine/ 2(2 dr! steri e 'au5e s6uare $or openin' an ampu e .optiona / C ean ' o-es .accordin' to a'enc! protoco / %&ec t&e '!R" C%ec* t%e a+e on t%e medication care$u ! a'ainst t%e M#9 to ma*e sure t%at t%e correct medication is +ein' prepared" Fo ow t%e t%ree c%ec*s $or administerin' medications" 9ead t%e a+e on t%e medication" :%en it is ta*en $rom t%e medication cart ;e$ore wit%drawin' t%e medication 1 0 %omments

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#$ter wit%drawin' t%e medication" (rgani)e t&e e$uipment* Procedure Perform &and &ygiene+ and o#serve ot&er appropriate infection control procedures* Prepare t&e medication from t&e vial or ampule for drug ,it&dra,al Provide for client privacy Prepare t&e client @ntroduce !ourse $0 and -eri$! c ient)s identit!" #ssist c ient to a position in w%ic% t%e arm0 e'0 and a+domen can +e re a(ed0 dependin' on t%e site to +e used" C+tain assistance in %o din' an uncooperati-e c ient" E-plain t&e purpose of t&e medication1vaccine and &o, it ,ill &elp+ using language t&at t&e client can understand* Include relevant information a#out effects of t&e medication* .elect and clean t&e site* Se ect a site $ree o$ tenderness0 %ardness0 swe in'0 scarrin'0 itc%in'0 +urnin'0 and oca i5ed in$ ammation" Se ect a site t%at %as not +een used $re6uent !" >ut on c ean ' o-es .optiona / #s a'enc! protoco indicates0 c ean t%e site wit% an antiseptic swa+ .steri e water swa+ $or -accine/" Start at t%e center o$ t%e site and c ean in a widenin' circ e to appro(imate ! 2 cm .2inc%es/" # ow t%e area to dr! t%orou'% !" > ace and %o d t%e swa+ +etween t%e t%ird and $ourt% $in'ers o$ t%e non-dominant %and0 or position t%e swa+ on t%e c ient)s s*in a+o-e t%e intended site" Prepare t&e syringe for injection 9emo-e t%e need e cap w%i e waitin' $or t%e site to dr!" >u t%e cap strai'%t o$$ to a-oid contaminatin' t%e need e +! t%e outside ed'e o$ t%e cap" Dispose o$$ t%e need e cap" @n&ect t%e medication" Grasp t%e s!rin'e in !our dominant %and +! %o din' it +etween !our t%um+ and $in'ers" :it% pa m $acin' to t%e side or upward $or a <2-de'ree an' e insertion or t%e pa m downward $or a B0-de'ree an' e insertion0 prepare to in&ect" Esin' t%e non-dominant %and0 pinc% or spread t%e s*in at t%e site0 insert t%e need e usin' t%e dominant %and and a $irm stead! pus%" :%en t%e need e is inserted0 mo-e !our non-dominant %and to t%e end o$ t%e p un'er" @n&ect t%e medication +! %o din' t%e s!rin'e stead! and depressin' t%e p un'er wit% s ow0 e-en pressure" :it% man! su+cutaneous in&ections0 t%e need e s%ou d +e im+edded wit%in t%e s*in $or $i-e seconds a$ter comp ete depression +! p un'er to ensure comp ete de i-er! o$ t%e

dose" B" Remove t&e needle* 9emo-e t%e need e s ow ! and smoot% !0 pu in' a on' t%e ine o$ insertion w%i e depressin' t%e s*in wit% t%e nondominant %and" @$ + eedin' occurs0 app ! pressure to t%e site wit% dr!0 steri e 'au5e unti it stops" 1 /ispose supplies appropriately*
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#cti-ate t%e need e sa$et! de-ice0 or discard t%e uncapped need e and attac% s!rin'e into desi'nated receptac es" 9emo-e ' o-es" >er$orm %and %!'iene" /ocument all relevant information* Document t%e medication 'i-en0 dosa'e0 time0 route0 and an! assessments" Man! a'encies pre$er t%at medication administration +e recorded on t%e medication record" #ssess t%e e$$ecti-eness o$ t%e medication at t%e time it is e(pected to act" Total .core

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