Portfolio

In
Elective
(NCM105)
Submitted by:
Domasig, Sinan Mernel G.
Group18

Submitted to:
Mr. Alfredo Yambao R.N. R.M. MAN
Ms. Joy Colindres R.N. MAN
 OLIVAREZ COLLEGE

PHILOSOPHY OF OLIVARIAN EDUCATION

Olivarian education endeavors to combine the best in human and Christian

tradition with awareness of, and involvement in the present day demands of national and
global development. The earnest striving for self realization is, therefore, directed to find
its fulfillment in responsible service that will significantly contribute to the common
effort towards national and global development.

GENERAL GOALS OF OLIVARIAN EDUCATION

In the fulfillment of the institution philosophy, Olivarian education commits itself

to the following goals and objectives:

1. Inculcate in the mind of students spiritual and moral values, thus, making them
responsible persons with a truly Christian outlook in life;

2. Produce academically excellent students who can find the truth through the proper
use of reasoning and can make right judgments and sounds decisions based on
facts and objectives evidences;

3. Produce cultured students who have elegance and who are well versed in the arts
and sciences;

4. Produce vocationally efficient men and women whose skills and training can
enable them to earn a decent living and to prepare them to render worthy services
to the community.

5. Develop the leadership potential in students so that they will become responsible
citizens and leaders both in the Philippines and abroad;

6. Instill in the life of students the authentic traditions and values of the Filipino
people, thus realizing their significance.

SCHOOL MOTTO

Olivarez College puts emphasis on the three domains of human development: the mind,
body, and soul. These words capsulate the Olivarian philosophy of education, “Educating
the Mind, Body, and Soul” – a holistic education committed to the development of the
critical mind capable of intelligent decision-making and analysis; a physically fit body
that is well-versed with the arts, skills and athletics since a sound mind and body make up
a total person with a spirit that is in communion with Christian ideals; and one who’s
dedicated in the service of God, country and man.

OLIVAREZ COLLEGE
COLLEGE OF HEALTH RELATED SCIENCES

PHILOSOPHY AND GOALS OF OLIVARIAN NURSING EDUCATION

The College of Nursing upholds the nursing statement of Olivarian education.

moreover, the College subscribe to the concept of man as a biopsychosocial and spiritual
being. Guided by this tenet, the college continuously strives to develop young men and
women to imbued with concern for man in his entirety, regardless of his race,
socioeconomic, political and religious affiliation.

Objectives:

Olivarian Nursing Education aims to produce nurses who shall:

1. Demonstrate critical thinking in the performance of the professional competencies

of a beginning nurse practitioner.
2. Utilize the nursing process in the performance of his/her role as a professional
nurse.
3. Participate actively in outreach program in the community to enhance the delivery
of health service to the people especially the less privileged.
4. Participate in the continuing education program through graduate studies and
research to uplift him/her self in the nursing profession.
5. Exhibit patronage to Filipino cultural heritage.
6. Manifest profound adherence to time-honored virtues of love, justice truth and
faith in God.

NURSE EDUCATOR

Background:

Nurse educators combine clinical expertise and a passion for teaching into rich and
rewarding careers. These professionals, who work in the classroom and the practice
setting, are responsible for preparing and mentoring current and future generations of
nurses. Nurse educators play a pivotal role in strengthening the nursing workforce,
serving as role models and providing the leadership needed to implement evidence-based
practice.

Nurse educators are responsible for designing, implementing, evaluating and revising
academic and continuing education programs for nurses. These include formal academic
programs that lead to a degree or certificate, or more informal continuing education
programs designed to meet individual learning needs.
Nurse educators are critical players in assuring quality educational experiences that
prepare the nursing workforce for a diverse, ever-changing health care environment.
They are the leaders who document the outcomes of educational programs and guide
students through the learning process.

Nurse educators are prepared at the master's or doctoral level and practice as faculty in
colleges, universities, hospital-based schools of nursing or technical schools, or as staff
development educators in health care facilities. They work with recent high school
graduates studying nursing for the first time, nurses pursuing advanced degrees and
practicing nurses interested in expanding their knowledge and skills related to care of
individuals, families and communities.

Nurse educators often express a high degree of satisfaction with their work. They
typically cite interaction with students and watching future nurses grow in confidence and
skill as the most rewarding aspects of their jobs. Other benefits of careers in nursing
education include access to cutting-edge knowledge and research, opportunities to
collaborate with health professionals, an intellectually stimulating workplace and flexible
work scheduling.

Given the growing shortage of nurse educators, the career outlook is strong for nurses
interested in teaching careers. Nursing schools nationwide are struggling to find new
faculty to accommodate the rising interest in nursing among new students. The shortage
of nurse educators may actually enhance career prospects since it affords a high level of
job securityand provides opportunities for nurses to maintain dual roles as educators and
direct patient care providers.

Roles:

A nurse educator is a registered nurse who has advanced education, including advanced
clinical training in a health care specialty. Nurse educators serve in a variety of roles that
range from adjunct (part-time) clinical faculty to dean of a college of nursing.
Professional titles include Instructional or Administrative Nurse Faculty, Clinical Nurse
Educator, Staff Development Officer and Continuing Education Specialist among others.

Nurse educators combine their clinical abilities with responsibilities related to:

• Designing curricula
• Developing courses/programs of study
• Teaching and guiding learners
• Evaluating learning
• Documenting the outcomes of the educational process.

Nurse educators also help students and practicing nurses identify their learning needs,
strengths and limitations, and they select learning opportunities that will build on
strengths and overcome limitations.
In addition to teaching, nurse educators who work in academic settings have
responsibilities consistent with faculty in other disciplines, including:

• Advising students
• Engaging in scholarly work (e.g., research)
• Participating in professional associations
• Speaking/presenting at nursing conferences
• Contributing to the academic community through leadership roles
• Engaging in peer review
• Maintaining clinical competence
• Writing grant proposals

A growing number of nurse educators teach part-time while working in a clinical setting.
This gives them the opportunity to maintain a high degree of clinical competence while
sharing their expertise with novice nurses. Nurse educators who work in practice settings
assess the abilities of nurses in practice and collaborate with them and their nurse
managers to design learning experiences that will continually strengthen those abilities.

Specialties:

In most instances, nurse educators teach clinical courses that correspond with their
area(s) of clinical expertise and the concentration area of their graduate nursing education
program. Those considering a teaching career may choose from dozens of specialty areas,
including acute care, cardiology, family health, oncology, pediatrics and
psychiatric/mental health.

In addition, nurse educators teach in areas that have evolved as "specialties" through
personal experience or personal study, such as leadership or assessment. The true
specialty of a nurse educator is his or her expertise in teaching/learning, outcomes
assessment, curriculum development and advisement/guidance of the learner.

Qualifications:

Nurse educators need to have excellent communication skills, be creative, have a solid
clinical background, be flexible and possess excellent critical thinking skills. They also
need to have a substantive knowledge base in their area(s) of instruction and have the
skills to convey that knowledge in a variety of ways to those who are less expert.

Nurse educators need to display a commitment to lifelong learning, exercise leadership

and be concerned with the scholarly development of the discipline. They should have a
strong knowledge base in theories of teaching, learning and evaluation; be able to design
curricula and programs that reflect sound educational principles; be able to assess learner
needs; be innovative; and enjoy teaching.

Those who practice in academic settings also need to be future-oriented so they can
anticipate the role of the nurse in the future and adapt curriculum and teaching methods
in response to innovations in nursing science and ongoing changes in the practice
environment. They need advisement and counseling skills, research and other scholarly
skills, and an ability to collaborate with other disciplines to plan and deliver a sound
educational program.

Nurse educators who practice in clinical settings need to anticipate changes and
expectations so they can design programs to prepare nurses to meet those challenges.
They need to be able to plan educational programs for staff with various levels of ability,
develop and manage budgets, and argue for resources and support in an environment
where education is not the primary mission.

Practice Settings:

While nurses who care for patients in any setting engage in patient teaching, nurse
educators typically practice in the following settings:

• Senior colleges and universities

• Junior or community colleges
• Hospital-based schools of nursing
• Technical colleges
• Hospitals
• Community health agencies
• Home care agencies
• Long-term care facilities
• Online using distance learning technology.

Within the school setting, there are as many options as there are schools. Educators may
teach on a rural, suburban or urban campus; at a major private university or local
community college; as part of a certificate program in a teaching hospital; or as a
research coordinator in a doctoral program.

Education:

At a minimum, nurse educators who work in academic settings must hold a master's
degree. In order to be promoted to the upper academic ranks (e.g., associate professor and
professor) and to be granted tenure, academic faculty typically must hold an earned
doctoral degree. Nurse educators who work in clinical settings must hold the minimum of
a baccalaureate degree in nursing, but more and more institutions are requiring the
master's degree for such appointments.
 NCM 100
Lesson Plan
(Lecture)
Day 1

I. Topic: Nursing as a Profession

Subtopic: Code of ethics

II. Objective:

General:
At the end of the discussion the students will gain knowledge about
nursing as a profession.

Specific: the students will be ale to:

- Enumerate the different nursing organization

- Define the four patterns of knowing
- Differentiate the level of proficiency
- Identify the roles and responsibilities of professional nurse
- Give examples of negligence, malpractice and incompetence

III. Methodology:

- lecture discussion
- nursing audit

IV. Evaluation:

The students were evaluated based on the quiz that was given to them by the
student nurse educator. Majority of the students passed the given examination.
Health and Nursing Organization

Philippine Nurses Association (PNA)

- Rosario Montenegro- first president

- Anastacia Tupas- first secretary

National League of Nurses

ADPCN

Asylum of San Jose Asylum of Looban

Hospicio de San Jose

First board Exam (1920)

- Held in Manila Presided by Dr. Cabarro assisted by A. Tupas Helen Del Rosario

Board exam was held outside manila- iloilo

First board top notcher

- Anna Dahigen- 93.5 %

Act 2493
Regulating the process of medicine and surgery

RA 539
Nurse’s week

RA 1060
1997 declared as Jubille Year of nNursing

Growth of Professionalism

Profession
- Calling that requires special knowledge, skills and preparation.

Specialized Education
-Historically, nurses were educated in hospital in modern times the trend has shifted
toward nursing education programs in college and university.

Body of knowledge
- As a profession, nursing is establishing a well-defined body of knowledge and
expertise, increasing research in nursing is contributing to his body of knowledge.
Ethics
- Nurses have traditionally placed a high value on the worth and dignity of others.
Nursing has developed its own codes of ethics and in most instances has set up
means to monitor the professional behavior of its member.

Autonomy
- A profession is autonomous if it regulates itself and sets standard for its member.
So if nursing is to have professional status, it must function autonomously in the
formation of policy and in the control of its activity.

Four Pattern of Knowing

(Types of nursing Knowledge)

Nursing science
- or Science knowledge is the “cognitive brain” of nursing and includes knowledge
obtained through nursing research done in other discipline.

Nursing Esthetics
- Is the way in which nursing knowledge is expressed. It is the “art” or “heart” of
nursing. Unlike scientific knowledge which requires research, esthetics involves
feelings gained by subjective experience. Esthetics involves attitudes, beliefs and
values.

Nursing Ethics
- Refers to the accepted professional standard of conduct. Concerned with matters
of obligation, or what ought to done. It consists of information about moral
principle and processes for determining “right” action.

Personal knowledge
-is concerned with knowing oneself, that is having a conscious awareness of one’s own
values, beliefs, attitudes and abilities. Further, it involves the knowing of self in relation
to another and interacting on a person rather a role to role basis.

Level of Proficiency

Novice
- Maybe nursing student or any nurse entering a clinical setting where that person
has no experience yet.

Advance beginner
- can demonstrate marginally accepted performance. They have had experience
with real situation.

Competent
- is manifested by the nurse who has been in the job in a similar situation for 2 to3
years.
Proficient
- the nurse perceived a situation as a whole rather than just its individual aspect.
The nurse focuses on long term goals and is oriented towards managing the
nursing care of a client rather than performing specific tasks.

Expert
- the expert no longer relies on rules, guidelines, or maxim to connect and
understanding of the situation to an appropriate action.

Roles and responsibilities of professional nurse

Care provider
- provision of care in meeting the needs of the patient physically, emotionally,
intellectually and spiritually.

Communicator
- thru the use of interpersonal and therapeutic communication skill to establish and
maintain helping relationship and maintain helping relationship with patient in all
ages and in any setting.

Teacher/ Educator
- use communication skills to assess, implant and evaluate individualized teaching
plan to meet learning needs of patient and their families.

Counselor
- the use of interpersonal communication skills to provide information, make appropriate
referrals and facilitates the patient’s problem solving and decision making skills.

Leader
- the assertive, self confident practice of nursing when providing care.

Researcher
- the participation in or conduct a research to increase knowledge in nursing and
improve nursing care.

Advocate
- the protection of human or legal rights and securing of care for all patient based
on the belief that patient have the right to make informed decisions about their
own health and lives.

Negligence
- refers to the commission or omission of an act, pursuant to a duty.

Examples:
• Failure to report observation to attending physicians.
 • Failure to exercise the degree of diligence which the circumstances of a
particular case demands.
• Mistaken identity
• Wrong medicine, wrong concentration, wrong route, and wrong dose
• Defects in the equipment such as stretchers and wheelchairs may lead to
fall.
• Error due to family assistance
• Administration of medicine without a doctor’s prescription

Responsibility
- obligation to answer an act done or to repair a injury it may have caused

Accountability
- liability’s for one’s action

Malpractice
- professional misconduct; improper discharge of professional duties; or failure to
meet the standard of care of a professional which resulted in harm to another.

Incompetence
- lack of ability, legal qualification or fitness to discharge the required duty.

Doctrine of force Majeure

- irresistible force, one that is unforeseen or inevitable

Doctrine of Respondeat Superior

- let the master answer for the act of the subordinate.
Ex. Hosp liability (staff/ underboard)
Surgeon (left instruments/OS)
 NCM 100
Lesson Plan
(RLE)
Day 2

I. Topic: Vital Signs

Sub-topic: Body Temperature, Pulse Rate, Respiratory Rate, Blood Pressure

II. Objective:

General:

- at the end of the discussion the students will gain knowledge about taking vitals
signs.

Specific:
- define the concept of Vitals signs.
- enumerate the different factors affecting Vital signs
- determine the normal values and alteration in Vital signs.
- discuss the different medical terminologist involved in the concept of Vital signs.
- Demonstrate the method of taking vital signs.
- Perform the vital signs taking

III. Methodology:

- lecture discussion
- film showing of procedures on how to assess vital signs
- nursing audit

IV. Evaluation:

The students were evaluated based on the return demonstration on assessing vital
signs. They were also given an examination but only 8 students passed out of the 45
students.
VITAL OR CARDINAL SIGNS

-are body temperature, pulse, respirations and blood pressure.

- Recently some agencies have designated pain as the 5th vital sign.
- These signs need to be checked to monitor the functions of the body because these
signs reflect changes in body function that is otherwise might not be observed.

AGE TEMP PR RR BP

NEWBORN 36.8 C (98.2) 130 ( 80-180) 35 ( 30-80) 73/55

1 YR 36.8 C 120 ( 80-140) 30 ( 20-40) 90/55

5-8 37 C (98.6) 100 (75 – 20 ( 15-20) 95/57

100)

10 37 C 70 ( 50-90) 19 (15-25) 102/62

TEEN 37 C 75 ( 50-90) 18 (15-20) 120/80

ADULT 37 C 80 ( 60-100) 16(12-20) 120/80

>70 37 C 70(60-100) 16(15-20) Possible

YRS.OLD increase in
diastolic

BODY TEMPERATURE

- reflects the balance between the heat produced and the heat loss from the body.
- measured in heat units called degrees.

KINDS OF TEMPERATURE
1. CORE TEMPERATURE – is the temperature of the deep tissues of the body ( ex.
Abdominal cavity and pelvic cavity)

- remains constant as reflected on the table in previous slide

2. SURFACE TEMPERATURE – is the temp. Of the skin, the subcutaneous tissue
and fat.
- This usually rise and fall in response to the environment.

FACTORS THAT AFFECT THE BODY’S HEAT PRODUCTION:

 1. BASAL METABOLIC RATE (BMR) – is the rate of energy utilization in the
body required to maintain essential activities such as breathing.
- BMR decreases with age, the younger the person the higher the BMR.

2. MUSCLE ACTIVITY – including shivering increases BMR.

3. THYROXINE OUTPUT – increase thyroxine output increases the cellular

metabolism through out the body ( chemical thermogenesis)

4. EPINEPHRINE, NOREPINEPHRINE AND SYMPHATHETIC STIMULATION

– these hormones increase the rate of cellular metabolism in many body tissues.

5. FEVER- increases the cellular metabolic rate and thus increases the body
temperature.

HEAT IS LOST FROM THE BODY THROUGH:

1. RADIATION – is the transfer of heat from the surface of one object to the surface
of another without contact between the 2 objects. Mostly in form of infrared rays.

2. CONDUCTION – is the transfer of heat from one molecule to a molecule of

lower temperature.
- Conductive transfer cannot takes place without contact between the molecules.

3. CONVECTION – is the dispersion of heat by air currents.

4. VAPORIZATION – is the continuous evaporation of moisture from the

respiratory tract and from the mucosa of the mouth from the skin.

Insensible water loss – continuous and unnoticed water loss

Insensible heat loss – is the accompanying heat loss.

HYPOTHALAMIC REGULATOR
– is the center that controls the core temperature
- Located in the preoptic area of the hypothalamus.

FACTORS THAT AFFECTS BODY TEMPERATURE:

1. Age –

2. Diurnal variations ( circadian rhythms) – the point of highest body temperature is

usually reached between 8:00 pm – midnight)
- The lowest point is reached during sleep between 4:00 – 6:00 am

3. EXERCISE – can increase body temperature to as high as 38.3 – 40 c if measures

rectally.
 4. HORMONES – women usually experienced more hormone fluctuations than
men.
- Progesterone secretion at the time of ovulation raises body temperature.

5. STRESS – stimulation of the sympathetic nervous system can increase the

production of epinephrine and norepinephrine thereby increasing the metabolic
activity and heat production.

6. ENVIRONMENT

PRIMARY ALTERATIONS OF BODY TEMPERATURE:

1. PYREXIA – a body temperature that is above the usual range

- A.K.A hyperthermia or fever

FEBRILE – is a patient with fever

AFEBRILE – is a patient without fever

TYPES OF FEVER

A. INTERMITTENT FEVER – is a body temperature that alternates at regular

interval between periods of fever – periods of normal or subnormal

B. REMITTENT FEVER – is a wide range of fluctuations of temperature ( more

than 2C) that occurs over the 24-hour period of 1 to 2 days

C. RELAPSING FEVER – is a short febrile period interspersed with periods of 1 -2

days of normal temperature.

D. FEVER SPIKE - a temperature that rises to fever rapidly following a normal

temperature and then returns to normal level rapidly following a normal
temperature and then returns to normal within a few hours

CLINICAL SIGNS OF FEVER:

A. ONSET ( cold or chill stage)

• Increased heart rate
• Increased respiratory rate and depth
• Shivering
• Cold skin
• Complaints of feeling cold
• Cyanotic nail beds
• “gooseflesh” appearance of the skin
 • Cessation of sweating

B. COURSE
• Absence of chills
• Skin that feels warm
• Photosensitivity
• Glassy-eyed appearance
• Increase pulse and respiratory rate
• Increased thirst
• Mild to severe dehydration
• Drowsiness, restlessness, delirium, or convulsion
• Herpetic lesions of the mouth
• Loss of appetite
• Malaise, weakness and aching muscle
•
C. DEFERVESCENCE
• Skin that appears flushed and feels warm

• Sweating
• Decreased shivering
• Possible dehydration

2. HYPOTHERMIA – is core body temperature that is below the lower limit of

normal.

CLINICAL SIGNS OF HYPOTHERMIA

• Decreased body temperature, pulse and respirations
• Severe shivering ( initially)
• Feeling of cold and chills
• Pale, cool, waxy skin
• Hypotension
• Decreased urinary output
• Lack of muscle coordination
• Disorientaion
• Drowsiness progressing to coma
•
ASSESING BODY TEMPERATURE:

COMMON SITES OF ASSESING BODY TEMPERATURE:

1. Oral
 2. Rectal

3. Axillary

4. Tympanic membrane

5. ORAL – this methods reflects changing body temperature more quickly than the
rectal

6. Rectal temperature – considered to be very accurate.

7. Axilla – preferred site for newborns because it is accessible and offers to

possibility of rectal perforations.

8. Tympanic membrane – this is used bec. This site has abundant arterial blood
supply, primarily from branches of the external carotid artery.
• Foreheads may also be used using chemical thermometer.

ADVANTAGES AND DISADVANTAGES OF THE 4 SITES

ORAL:

Advantages:
- Accessible and convenient

Disadvantages:
• Glass thermometer can break if bitten

• Inaccurate if the client has just ingested hot or cold food or fluid or smoked

RECTAL

Advantage:
• Reliable measurement

Disadvantages:
• Inconvenient and more unpleasant for clients
• Difficult for client who cannot tun to side
• Could injure the rectum prior to rectal surgery
• A rectal glass thermometer does not respond to changes in arterial temperatures as
quickly as an oral thermometer.
• Presence of stool may interfere with thermometer placement.
AXILLARY

Advantage:
• Safe and noninvasive
Disadvantages:
• The thermometer must be placed for a long time to obtain an accurate
measurement.

TYMPANIC MEMBRANE

Advantage:
• Readily accessible
• Reflects the core temperature very fast

Disadvantage:
Can be uncomfortable and involves risk of injuring the membrane if the probe is inserted
too far or too deep
• Repeated measurements may vary
• Right and left measurements may differ
• Presence of cerumen may affect the reading

TYPES OF THERMOMETERS:
1. Oral thermometers – have a long, short, slender or rounded tip.

2. Electronic thermometers – they can provide a reading in only 2 – 60 seconds.

3. Chemical disposable thermometers – are also used to measure body temperature

by using a liquid crystal dots or bars or heat-sensitive tape
Or patches applied to the forehead, they usually change color to indicate temperature.

4. Temperature-sensitive tape

5. Infrared thermometers – sense body heat in the form of infrared energy given off
by a heat source, which is the tympanic membrane.

THERMOMETER PLACEMENT:
Oral – Place the bulb on either side of the frenulum

Rectal – Apply clean gloves

- Instruct the client to take a slow deep breath during insertion.
- Never force the thermometer if resistance is felt ( 1 ½ inches)

Axillary - Pat the axilla DRY IF MOIST

- the bulb is placed in the center of the axilla
Tympanic – pull the pinna slightly upward and backward
- point the probe slightly anteriorly, towards the eardrum using a circular motion

CONSIDERATIONS:

INFANTS:
• The tympanic is fast and convenient
• Avoid the tympanic route in a child with acute ear infection or tympanic drainage
tubes.
• Rectal route is least desirable in infants

CHILDREN:
• Tympanic or axillary sites are commonly preferred
• Children over age of 3, pull the pinna straight back and upward.
• Children under the age of 3, pull the pinna back and down

ELDERS:
• Elders temperature tend to be lower than those of middle-age adults
• Elders can develop significant buildup of era cerumen that may intefer with
tympanic thermometer readings
• Elders are most likely to have hemorrhoids. Inspect the anus before using rectal
thermometer

PULSE

- is a wave of blood created by contraction of the left ventricle of the heart.

CARDIAC OUTPUT – is the volume of blood pumped into the arteries by the heart
equals the result of the stroke volume (SV) times the heart rate (HR) per minute.

PERIPHERAL PULSE – is a pulse located away from the heart Ex. In the foot, in the
wrist or neck.

CENTRAL PULSE – is a central pulse that is located at the apex of the heart.

FACTORS AFFECTING THE PULSE:

1. AGE – as age increase the PR decrease

2. GENDER – after puberty, the average male’s pulse rate is slightly lower than the
female’s.

3. EXERCISE – the PR normally increase with activity

 4. FEVER – the pulse rate increases
a. In response to the lowered blood pressure that results from peripheral vasodilation
associated with elevated body temperature
b. Increased metabolic rate

5. MEDICATIONS – Ex. Cardiotonics (digitalis preparations) decrease HR while

epinephrine increases it.

6. HYPOVOLEMIA – loss of blood from the vascular system normally increase the
PR.

7. STRESS – sympathetic nervous stimulation increase the overall activity of the

heart,
- Fear and anxiety as well perception of pain stimulate the sympathetic nervous
system.

8. POSITION CHANGES – when a person is sitting or standing blood usually pools

in dependent vessels of the venous system.

PATHOLOGY – certain diseases such as some heart conditions or those that has
impaired oxygenation can alter the PR.

PULSE SITES:
1. TEMPORAL – where the temporal artery passes over the temporal bone of the
head.

- superior and lateral the eye

2. CAROTID – located at the side of the neck where the carotid artery runs between
the trachea and sternocleidomastoid muscle.

3. Apical – at the apex of the heart.

- in adult, located at the left side of the chest about 3 inches to the left of the
sternum and at the 4th, 5th or 6th intercostals space.
- for a child 7-9, located at the 4th or 5th intercostals space.
- before 4 yrs. Of age, left of the midclavicular line
-between 4 and 6 yrs. Old it is at the MCL.

4. BRACHIAL – at the inner aspect of the biceps muscle of the arm or medially in
the antecubital space

5. RADIAL – where the radial artery runs along the radial bone, on the thumb side
of the inner aspect of the wrist.

6. FEMORAL – where the femoral artery passes along side the inguinal ligament.
 7. POPLITEAL – where the popliteal artery passes behind the knee.

8. POSTERIOR TIBIAL – on the medial surface of the ankle where the posterior
tibial artery passes behind the medial malleolus

9. PEDAL (DORSALIS PEDIS) – where the dorsalis pedis artery passes over the
bones of the foot.
- imaginary line is drawn from the middle of the ankle to the space between the
big and second toe.

REASONS FOR USING SPECIFIC PULSE SITE:

1. Radial – readily accessible

2. Temporal – used when radial pulse is not accessible.

3. Carotid – Used on cases of cardiac arrest

- use to determine the circulation of the brain.

4. Apical – used on infants and children up to 3 yrs. Of age

- used to determine in discrepancies in radial pulse
- used in conjuction with some medicine

5. Brachial – Used to measure the blood vessel

- used in cardiac arrest for infants

6. Femoral – used on cases of cardiac arrest

- used for infants and children
- used to determine circulation to a leg
7. Popliteal – used to determine circulation on the lower leg

8. Posterior tibial – used to detrmine circulation on the foot

9. Pedal – used to determine circulation on the foot.

ASSESSING THE PULSE RATE:

- a pulse is commonly assessed by palpation ( feeling) or auscultation ( hearing).

- the middle three fingers are used to palpate all pulse site except for the apex of the
heart, stethoscope is used as well as for the fetal heart tones.

Doppler Ultrasound stethoscope (DUS) – is used for pulses that are difficult to assess.
- the pulse is normally palpated by applying moderate pressure
BEFORE ASSESING FOR THE PR THE NURSE SHOULD BE AWARE OF THE
FOLLOWING:

1. Any medication that can affect the HR

2. Whether the client has been physical active
- wait for 15 mins. Until the client has rested
3. Any baseline date about the normal HR for the client
4. Whether the client should assume a particular positions. ( sitting )

OTHER DATA TO COLLECT:

1. Rate

Tachycardia – excessively fast heart rate ( over 100 bpm)

Bradycardia – HR of 60 bpm or less.

2. Rhythm – is the pattern of the beats and the interval beatween the beats.
- there shld. Be an equal time elapse bet. beats

Dysrhythmia or arrythmia – is a pulse with irregular rhythm.

3. Pulse volume – also called as pulse strength or amplitude

- refers to the force of blood with each beat.

Full or bounding Pulse – is a forceful or full blood volume

Weak, feeble or thready – readily obliterated with pressure from fingers

Elasticity of the arterial wall – reflects the expansibility and deformity of the arteries.
- a healthy, normal artery feels straight, smooth, soft and pliable.
- older people have inelastic arteries that feel twisted and irregular upon palpation.

CONSIDERATIONS FOR TAKING THE PULSE RATE:

Infants
• Use the apical pulse for the HR of newborns, infants, and children 2-3 yrs. Old to
establish a baseline data for subsequent evaluation.
• Place the baby in supine position and offer a pacifier if the baby is crying or
restless
• Brahial, popliteal and femoral pulses may be palpated.
•
Children
• To take the peripheral pulse, position the child comfortably in adult’s arm or
have an adult remain close by
 • To assess for apical pulse assist a young child to a supine position or sitting
position
• Demonstrate the procedure to the child using a stuffed toy or doll and let the child
hold the stethoscope.
•
Elders
• If the client has severe hand and arm tremor, the radial pulse may be difficult to
count.
• Cardiac changes in elders such as decrease in cardiac output, sclerotic changes to
heart valves,
And dysrhythmias often indicate that obtaining an apical pulse will be more accurate.
• Elders often have decreased peripheral circulation so that pedal pulses should also
be checked for regularity, volume and symmetry.

RESPIRATION

– is the act of breathing

EXTERNAL RESPIRATION – interchange of oxygen and carbon dioxide between the

alveoli of the lungs and the pulmonary blood.

INTERNAL RESPIRATION – takes place throughout the body.

INHALATION OR INSPIRATION – refers to the intake of the air in the lungs.

EXHALATION OR EXPIRATION – refers to the breathing out or movement of gases

from the lungs to the atmosphere

VENTILATION – refers to the movement of air in and out of the lungs

TYPES OF BREATHING

A. COSTAL ( THORACIC) BREATHING – involves the external intercostal

muscles and other accessory muscle such as the sternocleidomastoid muscles.

B. DIAPHRAGMATIC BREATHING – involves the contraction and relaxation of

the diaphragm

MECHANICS AND REGULATION OF BREATHING:

 During inhalation – the diaphragm contracts ( flatten ) , the ribs move upward
and outward and the sternum moves outward thus enlarging the thorax and
permitting the lungs to expand
  During exhalation – the diaphragm relaxes, the ribs move downward and inward
and the sternum moves inward, decreasing the size of the thorax as the lungs are
compressed.

Normal adult inspiration – 1 – 1.5 seconds

Normal adult exhalation – 2 -3 seconds

Respiration is controlled by:

1. Respiratory centers in the medulla oblongata and the pons of the brain

2. Chemoreceptors located centrally in the medulla and peripherally in the carotid

and aortic bodies.

BEFORE ASSESSING A CLIENT’S RESPIRATION A NURSE SHOULD BE

AWARE OF THE FOLLOWING:

1. The clients normal breathing pattern

2. The influence of client’s health problems on respirations
3. Any medications or therapies that might affect respiration
4. The relationship client’s respiration

Cardiovascular function

The following should also be assessed:

A. Respiratory rate – describe as the breaths per minute

Eupnea – breathing that is in noramal rate and depth

Bradypnea – abnormally slow respirations

Tachypnea or polypnea – abnormally fast respiration

Apnea – absence of breathing

2. Depth – can be established by watching the chest

 During normal inhalation and exhalation an adult takes in about 500 ml. of air and
this called as the Tidal volume.

HYPERVENTILATION – overexpansion of the lungs characterized by rapid and deep

breaths

HYPOVENTILATION – underexpansion of the lungs, characterized by shallow

respirations

3. Respiratory rhythm – refers to the regularity of the inhalation and exhalation.

 - can be regular and irregular

Cheyne-stroke breathing – rhythmic waxing and waning of respirations

- from very deep to very shallow breathing and temporary apnea

4. Respiratory quality or character – refers to the aspect of breathing that are
different from the normal, effortless breathing.

LABORED BREATHING – is breathing with a decided effort.

DYSPNEA – difficult and labored breathing during which the individual has a persistent,
unsatisfied need for air and feels distress

ORTHOPNEA- ability to breath only in upright sitting or standing position.

ALTERED BREATHING SOUNDS:

1. Stridor – a shrill, harsh sound heard during inspiration with laryngeal obstruction

2. Stertor – snoring or sonorous respiration usually due to partial obstruction of the

upper airway.

3. Wheeze – continuous, high-pitched musical squeak or whistling sound occurring

on expiration and sometimes on inspiration when air moves through a narrowed
or partially obstructed airway.

4. Bubbling – gurgling sounds heard as air passes through moist secretions in the
respiratory tract.

Chest movements

1. Intercostal retractions – indrawing between the ribs

2. Substernal retraction - indrawing beneath the breastbone

3. Suprasternal retraction – indrawing above the clavicles

Secretions and coughing

1. Hemoptysis – presence of blood in the sputum

2. Productive cough – a cough accompanied by expectorated secretions

3. Nonproductive cough – a dry, harsh cough without secretions

Consideration:
Children
- Young children are diaphragmatic breathers, observe for the rise and fall of the
abdomen.

ARTERIAL BLOOD PRESSURE

– is a measure of pressure exerted by the blood as it flows through the arteries.

- measured in millimeters of mercury (mm/Hg) and recorded as fraction.

SYSTOLIC PRESSURE – is the pressure of the blood as result of the contraction of the
ventricles
- pressure of the height of the wave

DIASTOLIC PRESSURE – is the pressure when the ventricles are at rest.

PULSE PRESSURE – is the difference between the systolic and diastolic pressure.a

DETERMINANTS OF BLOOD PRESSURE

1. Pumping action of the heart
2. Peripheral vascular resistance
3. Blood volume
4. Blood viscosity
5.
FACTORS AFFECTING THE BLOOD PRESSURE:
1. Age
2. Exercise
3. Stress
4. Race
5. Gender
6. Medications
7. Diurnal variations
8. Obesity
9. Disease process

HYPERTENSION – is a persistently above normal

PRIMARY HYPERTENSION – elevated BP of unknown cause

SECONDARY HYPERTENSION – elevated BP of known cause

FACTORS ASSOCIATED WITH HYPERTENSION

1. Thickening of the Arterial wall
2. Lifestyle factors – cigarette smoking, obesity and heavy alcohol consumption
3. High cholesterol level
4. stress
HYPOTENSION
– is a blood pressure that is below normal.
- a systolic pressure between 85 – 110 mm Hg
- can be caused by analgesics such as meperidine hydrochloride (Demerol), bleeding,
severe burn & dehydration
ORTHOSTATIC HYPOTENSION – a blood pressure that falls when the client sits or
stands.

ASSESSING BLOOD PRESSURE

• A blood pressure is measured by a BP apparatus and stethoscope.

BP apparatus – consist of blood pressure cuff and sphygmomanometer ( indicates the

pressure of air in the bladder)

Bladder – is a rubber bag in the cuff that can be inflated with air

TYPES OF SPHYGMOMANOMETER
1. Aneroid – is a calibrated dial with a needle that points on the calibration

2. Mercury – is a calibrated cylinder filled with mercury.

3. Electronic – eliminates the need to listen to the client’s systolic and diastolic
pressure
• Blood pressure is usually assessed in the clients arm using the brachial artery and
a stethoscope.

Blood pressure in the thigh is used on the following conditions:

a. The blood pressure cannot be measured on the either arm such as on the cases of
burns and other trauma
b. The blood pressure in one thigh is to be compared with the blood pressure on the
other thigh

BP cannot be measured on the arm and thigh on the following situations:

a. The shoulder, arm and thigh are injured

b. A cast or bulky bandage is in any part of the limb
c. The client has had a removal of axilla lymph nodes on that side
d. The client has intravenous infusion on that side
e. The client has arteriovenous fistula

METHODS OF ASSESSING THE BP:

1. Direct – ( invasive monitoring) – involves the insertion of the catheter into the
brachial, radial or femoral artery
 2. Noninvasive indirect measurement
a. Auscultatory – is the most frequently used.

Korotkoff’s sounds – sounds that the nurse hears as one deflates the bladder

Phase 1 – the pressure at which the first faint, clear tapping sounds are heard
- this is the systolic pressure
- sharp

Phase 2 – the sounds are swishing or whooshing sound

Phase 3 – a sound or thump softer than the phase 1

- the blood is freely moving in an open artery

Phase 4 – a softer blowing muffled sound that fades

Phase 5 – The pressure where the last sound is heard

- this is the diastolic pressure

b. Palpatory method – is used when the korotkoffs sound cannot be heard, prevent
the misdirection from the presence of auscultatory gap.

auscultatory gap – occurs on hypertensive clients

- is the temporary disappearance of the sounds that is normally heard over the
brachial artery when the cuff pressure is high followed by the reappearance of
sound at a lower level.

COMMON ERRORS IN BP ASSESSMENT

BLADDER CUFF TOO NARROW HIGH

BLADDER CUFF TOO WIDE LOW

ARM UNSUPPORTED HIGH
INSUFFICIENT REST BEFORE HIGH
ASSESSMENT
REPEATING ASSESSMENT TOO HIGH SYSTOLIC AND LOW
QUICKLY DIASTOLIC
CUFF WRAPPED LOOSELY OR HIGH
UNEVENLY
DEFLATING CUFF TOO QUICKLY LOW SYSTOLIC AND HIGH
DIASTOLIC
ASSESSING IMMEDIATELY AFTER A HIGH
MEAL OR SMOKES OR IN PAIN
DEFLATING TOO SLOWLY HIGH DIASTOLIC PRESSURE
ARM ABOVE THE LEVEL OF THE LOW
HEART
FAILURE TO IDENTIFY LOW SYSTOLIC
AUSCULTATORY GAP AND LOW DIASTOLIC

Considerations:

Infants
- The lower edge of the blood pressure cuff can be closer to the antecubital space
- Arm and thigh pressure are equivalent in children under 1 year of age

Children
- The thigh pressure is about 10 mm Hg higher than the arm

Elders
- Determine if the client is taking an antihypertensive drugs, if so when was the last dose
 NCM 100
Lesson Plan
(RLE)
Day 3

I. Topic: Asepsis and infection control

Sub topic: Putting on Sterile Gloves

II. Objective:

General:
- at the end of the discussion the students will gain knowledge about putting on
sterile gloves.
Specific: at the end of the discussion the students will be:

- Demonstrate the proper method on putting sterile gloves in open method.

- Enumerate the uses and importance of using sterile gloves

IV. Methodology:

- lecture discussion
- film showing on donning sterile gloves
- nursing audit

IV.Evaluation:

The students will be evaluated base on the return demonstration on donning sterile
gloves.
 Putting on Sterile Gloves
Action
1. perform hand hygiene
2. check that the sterile glove package is
dry and unopened. Also note date, making
sure that the date is still valid.
3.Place the sterile gloves on clean dry
surface or at above your waist
4. open the outside wrapper by carefully
peeling the top layer back. Remove inner
package touching only the outside of it.
5. place the inner package on the work
surface with the side labeled “cuff end”
closest to the body.
6. carefully open the inner package. Folds
open the top flap, then the bottom and
sides. Take care not to touch the inner
surface of the package or the gloves
7. with the thumb and forefinger of the non
dominant hand, grasp the folded cuff of the
glove for dominant hand, touching only the
exposed inside of the glove
8. Keeping the hand above the waistline,
lift and hold the glove up and off the inner
package with fingers down.
9. Carefully insert dominant hand palm up
into glove and pull glove on. Leave the cuff
folded until the opposite hand is gloved.
10. Hold the thumb of the gloved hand
outward. Place the fingers of the gloved
hand inside the cuff of the remaining glove.
Lift it from the wrapper, taking care not to
touch anything with the glove or hand
11. carefully insert non dominant hand into
glove. Pull the glove on, taking care that
the skin does not touch any of the outer
surface of the gloves.
Rationale
Hand hygiene deters the spread of
microorganism
Moisture contaminates a sterile package.
Expiration date indicates period tat package
remains sterile.
Moisture could contaminate the sterile
gloves. Any sterile object held below the
waist is considered contaminated.
This maintains the sterility of gloves in
inner packet.
Allows for ease of gloves application
The inner surface of the package is
considered sterile. The outer 1” border of
the inner package is considered
contaminated. The sterile gloves are
exposed with the cuff and closest to the
nurse.
Unsterile hand touches inside of glove.
Outside remains sterile.
Glove is contaminated if it touches
unsterile object
Attempting to turn upward with unsterile
hand may result in contamination of sterile
gloves.
Thumb is less likely to become
contaminated if held outward. Sterile
surface touching sterile surface prevents
contamination.
Sterile surface touching sterile surface
prevents contamination.
12. slide the fingers of the one hand under Sterile surface touching sterile surface
the cuff of the other and fully extend the prevents contamination.
cuff down the arm, touching only the
sterile outside of the glove. Repeat on the
remaining hand.
13. adjust gloves on both hands if Sterile surface touching sterile surface
necessary, touching only sterile areas with prevents contamination.
other sterile areas.
 Skills checklist
Putting on sterile gloves

Legend:

5- performed without supervision

4- performed with minimal supervision
3- performed with supervision
2- needs improvement
1- not performed

Procudures 5 4 3 2 1
1. perform hand hygiene
2. check that the sterile glove package is dry and unopened.
Also note date, making sure that the date is still valid.
3.Place the sterile gloves on clean dry surface or at above
your waist
4. open the outside wrapper by carefully peeling the top
layer back. Remove inner package touching only the outside
of it.
5. place the inner package on the work surface with the side
labeled “cuff end” closest to the body.
6. carefully open the inner package. Folds open the top flap,
then the bottom and sides. Take care not to touch the inner
surface of the package or the gloves
7. with the thumb and forefinger of the non dominant hand,
grasp the folded cuff of the glove for dominant hand,
touching only the exposed inside of the glove
8. Keeping the hand above the waistline, lift and hold the
glove up and off the inner package with fingers down.
9. Carefully insert dominant hand palm up into glove and
pull glove on. Leave the cuff folded until the opposite hand
is gloved.
10. Hold the thumb of the gloved hand outward. Place the
fingers of the gloved hand inside the cuff of the remaining
glove. Lift it from the wrapper, taking care not to touch
anything with the glove or hand
11. carefully insert non dominant hand into glove. Pull the
glove on, taking care that the skin does not touch any of the
outer surface of the gloves.
12. slide the fingers of the one hand under the cuff of the
other and fully extend the cuff down the arm, touching only
the sterile outside of the glove. Repeat on the remaining
hand.
13. adjust gloves on both hands if necessary, touching only
sterile areas with other sterile areas.
NCM 100
Lesson Plan
(RLE)
Day 3

I. Topic: Asepsis and infection control

Sub topic: Removing soiled gloves

II. Objective:

General:

- at the end of the discussion the students will gain knowledge about removing
soiled gloves.

Specific: the students will be able to:

- demonstrate the proper method on removing soiled gloves.

III. Methodology:

- lecture discussion
- film showing of procedures on removing soiled gloves
- nursing audit

IV. Evaluation:

The students were evaluated based on the return demonstration on how to remove
soiled gloves.
 Removing Soiled Gloves

Action Rationale
1.use dominant hand to grasp the opposite Contaminated area does not come in
glove near cuff end on the outside exposed contact with hands or wrists.
area. Remove it by pulling it off, inverting
it as it is pulled, keeping the contaminated
area on the inside. Hold the removed glove
in the remaining glove hand
2.slide fingers of ungloved hand between Contaminated area does not come in
the remaining glove and the wrists. Take contact with hands or wrists.
care to avoid touching the outside surface
of the glove. Remove it by pulling it off,
inverting it, as it is pulled, keeping the
contaminated area on the inside, and
securing the first glove inside the second.
3. discard gloves in appropriate container Prevent transmission of microorganism.
and perform hand hygiene. Hand hygiene deters the spread of
microorganism.
 Skills checklist
Removing soiled gloves

Legend:

5- performed without supervision

4- performed with minimal supervision
3- performed with supervision
2- needs improvement
1- not performed

Procedures 5 4 3 2 1
1.use dominant hand to grasp the opposite glove near cuff end
on the outside exposed area. Remove it by pulling it off,
inverting it as it is pulled, keeping the contaminated area on
the inside. Hold the removed glove in the remaining glove
hand
2.slide fingers of ungloved hand between the remaining glove
and the wrists. Take care to avoid touching the outside surface
of the glove. Remove it by pulling it off, inverting it, as it is
pulled, keeping the contaminated area on the inside, and
securing the first glove inside the second.
3. discard gloves in appropriate container and perform hand
hygiene.
 NCM 100
Lesson Plan
(RLE)
Day 3

I. Topic: Asepsis and infection control

Sub topic: Hand washing

II. Objective:

General:
- at the end of the discussion the students will gain knowledge about hand washing

Specific: at the end of the discussion the students will be:

- Demonstrate the proper procedure on hand washing

- Enumerate the importance of hand washing
- Identify situation in which hand washing is indicated.

III. Methodology:

- lecture discussion
- film showing of procedures on how to do hand washing
- nursing audit

IV.Evaluation:

The students were evaluated based on the return demonstration on proper hand
washing.
 Hand washing

Action Rationale
1. stand in front of the sink. Do not allow The sink considered contaminated.
your clothing to touch the sink during the Clothing may carry organism from place to
washing procedure. place.
2. remove jewelry, if possible, and secure Removal of jewelry facilitates proper
in a safe place and allow plain wedding cleansing. Microorganism may accumulate
band to remain in place. in settings of jewelry. If jewelry was worn
during care, it should be left on during hand
washing.
3. . turn on water and adjust force. Regulate Water splashed from contaminated sink
the temperature until the water is warm. may contaminate your clothing. Warm
water is more comfortable and has less
tendency to open pores and remove oils
from the sink. Organism can lodge in
roughened and broken areas of chopped
skin.
4. wet the hand and wrist area. Keep hands Water should flow from the cleaner toward
lower than elbows to allow water to flow the more contaminated area. Hands are
toward fingers. more contaminated than forearms.
5. Use about 1 teaspoon liquid soap from Rinsing the soap before and after use
dispenser or rinse bar of soap and lather removes the lather that may contain
thoroughly. Cover all areas of hand with microorganism.
soap product. Rinse soap bar again and
return to soap dish.
6. with firm rubbing and circular motion, Friction caused by firm rubbing and
wash the palm and back of the hand, each circular motion helps to loosen dirt and
finger, the areas between the fingers, the organism that can lodge between the
knuckles, wrist and forearms. Wash at least fingers, in skin crevices of knuckles, on
1 inch above area of contamination. If palms and backs of the hands, and on the
hands are not visibly soiled, wash to1inch wrist and forearms. Cleaning less
above the wrist. contaminated areas (forearms and wrist)
after hands are clean prevents spreading
organism from the hands to the forearms
and wrist.
7. continue this friction motion for at least Length of hand washing is determined by
15 seconds. degree of contamination.
8. use fingernails of the other hand or a Area under nails has a high microorganism
clean orangewood stick to clean under count, and organisms may remain under the
fingernails.
9. rinse thoroughly.
10. dry hands, beginning with the fingers
and moving upward toward forearm, with a
paper towel and discard it immediately.
Use another clean towel to turn off the
faucet. Discard towel immediately without
touching the clean hand.
11. use lotion in hand if desired.
nails where they can grow and be spread to
others.
running water rinses organism and dirt into
the disk.
Drying the skin well prevents chapping.
Dry hands first because they are the
cleanest and least contaminated area.
Turning the faucet off with a clean paper
towel protects the clean hands from contact
with a soiled surface.
Oil-free lotion helps to keep the skin soft
and prevent chapping. It is best applied
after patient care is complete and from
small, personal containers. Oil-based lotion
should be avoided because they can cause
deterioration of gloves.
 Skills checklist
Hand washing

Legend:

5- performed without supervision

4- performed with minimal supervision
3- performed with supervision
2- needs improvement
1- not performed

Procedures 5 4 3 2 1
1. stand in front of the sink. Do not allow your clothing to
touch the sink during the washing procedure.
2. remove jewelry, if possible, and secure in a safe place and
allow plain wedding band to remain in place.
3. . turn on water and adjust force. Regulate the temperature
until the water is warm.
4. wet the hand and wrist area. Keep hands lower than
elbows to allow water to flow toward fingers.
5. Use about 1 teaspoon liquid soap from dispenser or rinse
bar of soap and lather thoroughly. Cover all areas of hand
with soap product. Rinse soap bar again and return to soap
dish.
6. with firm rubbing and circular motion, wash the palm and
back of the hand, each finger, the areas between the fingers,
the knuckles, wrist and forearms. Wash at least 1 inch above
area of contamination. If hands are not visibly soiled, wash
to1inch above the wrist.
7. continue this friction motion for at least 15 seconds.
8. use fingernails of the other hand or a clean orangewood
stick to clean under fingernails.
9. rinse thoroughly.
10. dry hands, beginning with the fingers and moving
upward toward forearm, with a paper towel and discard it
immediately. Use another clean towel to turn off the faucet.
Discard towel immediately without touching the clean hand.
11. use lotion in hand if desired.
 NCM 100
Lesson Plan
(RLE)
Day 3

I. Topic: Asepsis and infection control

Sub topic: Sterile Gown Application

II. Objective:

General:

- at the end of the discussion and demonstration the students will gain knowledge
about sterile gown application

Specific: the students will be able to:

- demonstrate the proper method on application of sterile gown

III. Methodology:

- lecture discussion
- film showing of procedures on application of sterile gown.
- nursing audit

IV. Evaluation:

The students were evaluated based on the return demonstration on proper wearing
of sterile gown.
 Sterile Gown Application

Action Rationale
1. Wash hands and organize equipment; Reduces microorganism transfer
apply mask, if needed; enlist assistant to tie Promotes efficiency
gown
2. Remove sterile gown package from Maintains sterility of gown
outer cover and open inner covering to
expose sterile gown; place on bedside Provides sterile field places gloves in
table, touching only outsides of covering. convenient location and on sterile field
Spread covering over table; open outer
glove package and slide inside glove cover
onto sterile field.
3. Remove gown from the field by moving Prepares gown for application
one step backward, grasping at the crease
near the neck, hold it away from you inside
of gown and gently shaken to loosen folds
without touching anything including the
uniform; hold gown with inside facing you.
4.Locate the shoulders or arm sleeve, place Preserves the sterility of the gown
both arms inside the arm sleeve at the same
time and stretch outward or partway until
hands reach edge of sleeves; don sterile
gloves

5. If donning Sterile gloves by using the

closed method. Work the hands down the
sleeves only to the proximal edge of the
cuff or if donning sterile gloves by using
the open method, work the hands down the
sleeves and through the cuffs.
6. Have assistant pull tie from back of
gown and fasten to inside tie; have assistant Secures gown without contamination of
pull outside tie around with sterile tongs or outer portion.
sterile gloves. Make three-quarter turn,
then take the tie and secure it at the back. Secures gown
 Skills checklists
Sterile Gown Application

Legend:

5- performed without supervision

4- performed with minimal supervision
3- performed with supervision
2- needs improvement
1- not performed

Procedures 5 4 3 2 1
1. Wash hands and organize equipment; apply mask, if
needed; enlist assistant to tie gown
2. Remove sterile gown package from outer cover and open
inner covering to expose sterile gown; place on bedside table,
touching only outsides of covering. Spread covering over
table; open outer glove package and slide inside glove cover
onto sterile field.
3. Remove gown from the field by moving one step backward,
grasping at the crease near the neck, hold it away from you
inside of gown and gently shaken to loosen folds without
touching anything including the uniform; hold gown with
inside facing you.
4.Locate the shoulders or arm sleeve, place both arms inside
the arm sleeve at the same time and stretch outward or
partway until hands reach edge of sleeves; don sterile gloves

5. If donning Sterile gloves by using the closed method. Work

the hands down the sleeves only to the proximal edge of the
cuff or if donning sterile gloves by using the open method,
work the hands down the sleeves and through the cuffs.
6. Have assistant pull tie from back of gown and fasten to
inside tie; have assistant pull outside tie around with sterile
tongs or sterile gloves. Make three-quarter turn, then take the
tie and secure it at the back.