Republic of the Philippines TARLACSTATEUNIVERSITY COLLEGE OF NURSING Lucinda Campus, Brgy. Ungot, Tarlac CityPhilippines 2300 Tel. No.

: (045) 493-1865 Fax: (045) 982-0110 website: www/tsu.edu.ph

Performance Evaluation Checklist Adult Basic Life Support CPR Skills Competency Name of Student: _______________________________________ Year/Clinical Group: ___________________________________ School Year: ____________________ Term: ___First Semester ____Second Semester ___ Summer Inclusive Dates of Clinical Rotation: __________________ Instructor: _____________________________________________

Core Competency A. Safe and quality nursing care 1. Check the surroundings for safety and make sure any bystander and you are safe 2. Check the victim for a response. Gently shake his shoulders and ask loudly, Are you all right? 3. If he responds: y Leave him in the position in which you find him provided there is no further danger. y Try to find out what is wrong with him and get help if needed. y Reassess him regularly 4. If he does not respond: y Shout for help. y With your fingertips under the point of the victim's chin, lift the chinto open the airway. 5. Turn thevictim onto his back and then open the airway using head tilt andchin lift: head back.

SCORE 2 1

REMARKS 0

6. Place your hand on his forehead and gently tilt his head back

7. Keeping the airway open, look, listen, and feel for normal breathing. 8. Look for chest movement. 9. Listen at the victim's mouth for breath sounds. 10. Feel for air on your cheek. 11. In the first few minutes after cardiac arrest, a victim may be barely breathing, or taking infrequent, noisy, gasps. This is often termed agonal breathing and must not be confused with normal breathing. 12. Look, listen, and feel for no more than 10 seconds to determine if the victim is breathingnormally. If you have any doubt whether breathing is normal, act as if it is not normal. 13. If he is breathing normally: Turn him into the recovery position. 14. Summon help from the ambulance service by mobile phone. If this is notpossible, send a bystander. Leave the victim only if no other way of obtaininghelp is possible. 15. Continue to assess that breathing remains normal. If there is any doubtabout the presence of normal breathing, start CPR B. Management of Resources ,Environment and Equipments If he is not breathing normally:

1. Ask someone to call for an ambulance and bring an AED if available. If you are on your own, use your mobile phone to call for an ambulance. Leave the victim only when no other option exists for getting help. 2. Start chest compression as follows:

3. Kneel by the side of the victim.

4. Place the heel of your other hand on top of the first hand.And place the heel of one hand in the centre of the victims chest(which is the lower half of the victims sternum (breastbone)).

5. Interlock the fingers of your hands and ensure that pressure is notapplied over the victim's ribs. Do not apply any pressure over theupper abdomen or the bottom end of the sternum. 6. Position yourself vertically above the victim's chest and, with yourarms straight, press down on the sternum 5 - 6 cm. 7. After each compression, release all the pressure on the chestwithout losing contact between your hands and the sternum. Repeat at a rate of 100 120 min8. Compression and release should take an equal amount of time. 9. After 30 compressions open the airway again using head tilt and chin lift. 10. Pinch the soft part of the victims nose closed, using the index finger and thumb of your hand on his forehead. 11. Allow his mouth to open, but maintain chin lift 12. Take a normal breath and place your lips around his mouth, making sure

that you have a good seal. 13. Blow steadily into his mouth whilst watching for his chest to rise; take about one second to make his chest rise as in normal breathing; this is an effective rescue breath. 14. Maintaining head tilt and chin lift, take your mouth away from the victim and watch for his chest to fall as air comes out. 15. Take another normal breath and blow into the victims mouth once more to give a total of two effective rescue breaths. The two breaths should not take more than 5 s. Then return your hands without delay to the correct position on the sternum and give a further 30 chest compressions. 16. Continue with chest compressions and rescue breaths in a ratio of 30:2. Note :For Infant :Locate the brachial pulse in the

manikins upper arm closer to you, using the fi ngers to feel the pulse between the biceps muscle and the humerus. Feel pulse with gentle touch for at least 5 seconds but no more than 10 seconds.Place 2 fingers on the sternum just below
the nipple line.Give 30 compressions in less than 23 seconds. Push hard, push fast; allow chest to return to normal between compressions 17. Stop to recheck the victim only if he starts to show signs of regaining consciousness, such as coughing, opening his eyes, speaking, or moving purposefully AND starts to breathe normally; otherwise do not interruptresuscitation.

18. If the initial rescue breath of each sequence does not make the chest rise as in normal breathing, then, before your next attempt:

19. Check the victim's mouth and remove any visible obstruction. 20. Recheck that there is adequate head tilt and chin lift. 21. Do not attempt more than two breaths each time before returning to chest compressions. If there is more than one rescuer present, another should take 22. Do not attempt more than two breaths each time before returning to chest compressions. 23. Ensure the minimum of delay during the changeover of rescuers, and do not interrupt chest compressions.

IV.HEALTH EDUCATION Compression-only CPR 1. If you are not trained to, or are unwilling to give rescue breaths, give chest compressions only.purposefully AND starts to breathe normally; otherwise do not interruptresuscitation. 2. If chest compressions only are given, these should be continuous at a rate of100 - 120 min-1. 3. Stop to recheck the victim only if he starts to show signs of regainingconsciousness, such as coughing, opening his eyes, speaking, or moving V.LEGAL RESPONSIBLITIES 1. Secures informed consent if relative is present 2. Reports accurately and honesty the gender, time of the actual incidence 3. Ensures proper identification of the client 4. Documents all pertinent data correctly and completely

VI. ETHICO-MORAL RESPONSIBILITY Continue resuscitation until: 1. Qualified help arrives and takes over,

2. The victim starts to show signs of regaining consciousness, such ascoughing, opening his eyes, speaking, or moving purposefully AND starts to breathe normally, ORyou become exhausted 3. Promotes emotional security by supporting needs 4. Ensures privacy and confidentiality VII. PERSONAL AND PROFESSIONAL DEVELOPMENT 1. Updates oneself with the latest trends and development in Basic Life Support 2. Maintain professionalism ethics in administering CPR 3. Accepts criticism and recommendation VIII. QUALITY IMPROVEMENT 1. Identifies deviation of practice from the standards 2. Participates in audit practices in emergency Basic life support 3. Recommends corrective and preventive measures for the identified deviations IX. RESEARCH 1. Identifies researchable problems related to basic life support 2. Initiates a research study on an identified researchable problems 3. Participates as a member of a research team in the conduction of a research study. 4. Ulitize findings of research studies in Basic life

support X.RECORD MANAGEMENT 1.Documents accurately relevant data about the clients 2.. Maintain an organized system of filing and keeping records of the client XI. COMMUNICATION 1. Utilizes appropriately all forms of communication, verbal. Non-verbal, electronic 2. Informs clients significant other of the progress. 3. Listen attentively to clients and families queries and request XII. COLLABORATION AND TEAMWORK 1. Functions effectively as a team player in the delivery room/lying in. 2. Communicates the progress of the CPR to significant others or to the health team 3.Establishes collaborative relationship with the members of the health team and family members TOTAL SCORE:

Evaluated by:

________________________________ Signature over Printed Name Clinical Instructor

________________________________ Signature over Printed Name Student