NAME: ______________________
COURSE/YR. & SEC.: __________
DATE PERFORMED: _____________
CHECKLIST ON TEMPERATURE TAKING
AXILLARY METHOD
Procedure
5 4 3 2 1
1. Assess client’s skin if warm to touch.
2. Assess for most appropriate site to check the temperature.
3. Wash hands.
4. Gather the equipment needed.
5. Identify the client and explain the procedure.
6. Wipe the thermometer from bulb to stem with a firm twisting motion.
7. Shake the thermometer with strong wrist motion until mercury is down to
lowest marking.
8. Assist the client in a supine or sitting position.
9. Raise the client’ arm away from the torso, insert bulb into center and
place across client’s chest.
10. Leave the thermometer in place for 5-10 minutes.
11. Remove thermometer and wipe off any secretion from stem toward the
bulb with a rotating motion.
12. Read the thermometer at eye level.
13. Wash the thermometer at eye with soap and water, dry and shake and
return to container.
14. Assist the client in replacing clothing or gown.
15. Wash hands.
16. Evaluate the temperature taken.
17. Record result in a graphing sheet.
Equivalent Grade: ______
Clinical Instructor
Student’s Signature
NAME: ______________________
COURSE/YR. & SEC.: __________
DATE PERFORMED: _____________
CHECKLIST ON PULSE TAKING
PROCEDURE
1. Assess client’s condition.
2. Check nature of pulse.
3. Wash hands.
4. Assemble the equipment.
5. Identify client and explain procedure.
6. Have the patient rest his arm alongside of his body with the
wrist extended and the palm of the hands downward.
5 4 3 2 1
7. Place the tips of your middle three fingers on the palm side of
the patient’s wrist. Rest thumb on the back of the patient wrist.
8. Apply enough pressure so that you can feel the pulse (not too
hard not too light).
9. Using a watch with second hand count the number of
pulsations felt on the patient’s pulse for one full minute.
10. If the pulse rate is abnormal repeat the counting in order to
determine accurately its rate, quality and rhythm.
11. Wash hands.
12. Evaluate nature of pulse.
13. Record result rhythm and force in graphing sheet.
Remarks:_________________________________________________________________________
__________________________________________________________________________________
______________________________________________________________________
Equivalent Grade: ________
Rating Scale
Excellent
Very Satisfactory
Very Good
Good
Fair
Poor
Clinical Instructor
:
:
:
:
:
:
96-100%
90-95%
85-89%
80-84%
75-79%
74 & below
Student’s Signature
NAME: ________________________
DATE PERFORMED: ________
COURSE/YR. & SEC.: ___________
CHECKLIST ON BLOOD PRESSURE TAKING
PROCEDURE
5 4 3 2 1
1. Assess the client’s physical condition.
2. Assess for factors that affect blood pressure.
3. Determine the client’s baseline blood pressure.
4. Wash hands
5. Gather the equipment needed.
6. Identify the client and explain the procedure.
7. Place the client in a comfortable position (lying or sitting) and
position the arm at the level heart.
8. Place the cuff at the center observing at 1 to 2 inches above the
inner aspect of the brachial artery.
9. Wrap cuff around the arm smoothly and snugly.
10. Feel the pulse beat over the inner aspect of the elbow with the
use of the fingertips.
11. Place the stethoscope earpiece and close screw valve on the
air pump.
12. Palpate brachial artery, close valve and compress bulb to
inflate cuff to 30 mm hg.
13. Release the valve ( deflating) on the cuff slowly so that the
pressure goes down at the rate of 2-3 mm hg /sec. Listen to the
sound (first distinct loud muffing sound is systolic)
14. Continue to release the air evenly and slowly (Last soft
muffling sound is diastolic pressure)
15. Deflate cuff rapidly and completely after the final sound has
disappeared.
16. Clean and store the equipment.
17. Wash hands.
18. Evaluate the nature of the blood pressure.
19. Evaluate the client condition
20. Record the result taken.
Remarks:__________________________________________________________________
__________________________________________________________________
Equivalent Grade: ______
Rating Scale
Excellent
Very Satisfactory
Very Good
Good
Fair
Poor
:
:
:
:
:
:
96-100%
90-95%
85-89%
80-84%
75-79%
74 & below
Clinical Instructor: ___________________
Student’s Signature: _________________
NAME: __________________________
DATE PERFORMED: ________
COURSE/YR. & SEC.: _____________
CHECKLIST ON RESPIRATION TAKING
PROCEDURE
5 4 3 2 1
1. Assess client’s condition.
2. Check nature of respiration.
3. Wash hands.
4. Identify client and explain procedure.
5. Hold the client’s wrists just as if you were taking his/her pulse.
6. Note the rise and fall of the client’s chest.
7. Using a watch with second hand, count the number of
respiration for one full minute.
8. Wash hands.
9. Evaluate the character of respiration.
10. Record the character and the depth the respiration.
Remarks:___________________________________________________________
___________________________________________________________________
_________________________________________________________
Equivalent Grade: _______
Rating Scale
Excellent
Very Satisfactory
Very Good
Good
Fair
Poor
_____________________
Clinical Instructor
:
:
:
:
:
:
96-100%
90-95%
85-89%
80-84%
75-79%
74 & below
_____________________
Student’s Signature