RETURN DEMONSTRATION EVALUATION TOOL FOR:
Assessing the Thorax and Lungs
  Name: _____________________________________                            Grade: _____________
  Time started:____________ Time ended:____________         Date of RD:________________________
       AREA FOR EVALUATION                              RATING                  COMMENTS
             SKILLS (35%)                       5   4   3   2    1   0
ASSESSMENT /PLANNING
   1. Check doctor’s order.
   2. Assemble equipments:
            Stethoscope
            Skin marker/pencil
            Centimeter ruler
IMPLEMENTATION
   3. Identifies client.
   4. Explains to the client what you are
       going to do, why it is necessary,
       and how he or she can cooperate.
   5. Washes hands and observes
       other appropriate infection control
       procedures.
   6. Provides for client’s privacy.
    7. Determines client’s history of the
        following:
       Family history of illness, including
         cancer
       Allergies
       Tuberculosis
       Smoking         and    occupational
         hazards
       Any medications being taken
       Current problems such as
         swellings, coughs, wheezing,pain
            Posterior Thorax
    8. Inspects the shape and symmetry
        of the thorax from posterior and
        lateral views..
    9. Inspects the spinal alignment for
        deformities.
      a. Have the client stand. From a
      lateral position, observe the three
      normal       curvatures:      cervical,
      thoracic, and lumbar.
    b. To assess for lateral deviation of
        spine (scoliosis), observe the
        standing client from the rear.
        Have the client bend forward at
        the waist and observe from
        behind.
    10. Palpates the posterior thorax.
    11. Palpates the posterior chest for
        respiratory excursion.
    12. Palpates the chest for vocal
        (tactile) fremitus.
    13. Percusses the thorax.
    14.       Percuss for diaphragmatic
          excursion.
    15.    Ausculatates the chest using the
          flat-disc   diaphragm     of  the
          stethoscope.
                  Anterior Thorax
    16.   Inspects breathing patterns.
    17.   Inspects the costal angle and the
          angle at which the ribs enter the
          spine.
    18.   Palpates the anterior chest.
    19. Palpates the anterior chest for
        respiratory excursion.
    20. Palpates the tactile fremitus in the
        same manner as for the posterior
        chest.
    21. Percusses the anterior chest
        systematically.
    22. Auscultates the trachea.
    23. Auscultates the anterior chest.
EVALUATION/DOCUMENTATION
   1. Documents findings in the client’s
      record.
KNOWLEDGE: (15%)
   1. Gives rationale of the procedure.
    2. Explains the elements and
       mechanics of the procedure.
     3. Knows the elements of nursing
         process as applied.
     4. States principles applied in the
         procedure.
ATTITUDE: (10%)
1. Is well groomed.
2. Wears prescribed, neat, and clean
uniform.
3. Arrives on time for the RD.
4. Speaks to CI and client tactfully.
5. Minimizes use of energy, time, and
effort
6. Utilizes supplies efficiently.
7. Considers client’s safety, privacy, and
comfort.
8. Is well organized.
9. Keeps working area clean at all times.
10. Gives high value for aesthetics.
   Comments:        _______________________________________________________________
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   Clinical Instructor’s signature:    ____________________________________