MISSION
“MABINI        COLLEGES          provides     quality
                                                                                     instruction, research and extension service
       VISION                                                                        programs at all educational levels as its monumental
                                                                                     contribution to national and global growth and
 “MABINI COLLEGES shall                                                              development.
   cultivate aCULTUREof                      MABINI COLLEGES                                        Specifically, it transforms students
EXCELLENCE in Education.”                                                            into:
                                       College of Nursing and Midwifery                            God – fearing
                                                                                             
                                            DaetCamarines Norte                              
                                                                                                    Nation – loving
                                                                                                    Law abiding
                                                                                                   Earth caring
                                                                                                   Productive, and
                                                                                                   Locally and Globally competitive
                                                                                                    persons
                              CHECKLIST ON NEBULIZATION THERAPY
        Name: __________________________ Year/Section:___________ Rating: _______
        Instruction: Rate the following criteria after having satisfactorily practiced the skills. Check
        appropriate scale.
        Legend;        5– Excellent                  3 – Very Good         1- Fair
                       4 – Very Satisfactory         2 – Good
                     Performance Criteria                           5     4    3   2 1           Remarks
        I - ASSESSMENT
        1. Determine current vital signs, level of consciousness
        2. Assess breath sounds and sign and symptoms of
        respiratory distress
        3. Check Doctor’s order.
        II- PLANNING
        4. Wash hands
        5. Assemble equipment. Check equiptment if functional
        III- IMPLEMENTATION
        1. Place the compressor on a sturdy surface that will
            support its weight, such as a table or desk. Plug the
            compressor ' s cord into a properly,rounded (three-
            pronged) outlet.
        2. Wash your hands with soap and water and dry
            completely with a clean towel.
        3. Place your medication in the nebulizer cup.
        4. Attach the top portion of the nebulizer cup, and
            connect the mouthpiece or face mask to the cup.
        5. Connect the tubing to the nebulizer and compressor.
        6. Turn on the compressor with the on/off switch. Once
            you turn on the compressor, you should see a light
            mist
        7. SIT UP STRAIGHT ON A COMFORTABLE CHAIR.
            USING A MOUTHPIECE IS PREFERRED. WHEN
            USING A MOUTHPIECE, PLACE THE MOUTHPIECE
            BETWEEN YOUR TEETH AND SEAL YOUR LIPS
            AROUND IT.
        8. IF YOU ARE USING A MASK, POSITION IT
            COMFORTABLY AND SECURELY ON YOUR FACE.
        9. BREATHE NORMALLY THROUGH YOUR MOUTH. IF
            POSSIBLE, EVERY FIFTH BREATH, TAKE A SLOW DEEP
            BREATH AND HOLD THIS BREATH FOR 2 TO 3 SECONDS
            BEFORE BREATHING OUT. THIS ALLOWS THE MEDICATION
            TO SETTLE INTO THE AIRWAYS.
        10. CONTINUE       THE     TREATMENT        UNTIL    THE
            MEDICATION IS GONE (ABOUT 5 TO 15 MINUTES).
            USE ALL OF THE MEDICINE UNLESS YOU ARE
            DIRECTED OTHERWISE BY YOUR DOCTOR.
        IV- EVALUATION
16. Evaluate client’s immediate response to nebulization
17. Evaluate client’s comfort with nebulization use
18. Assess client’s vital signs.
DOCUMENTATION
19. Record date and time of nebulization and method of
delivery.
20. Record medicine used
21. record immediate response of nebulization therapy,
subjective and objective observation of client.
22. Record client’s comfort with nebulization use use.
Analysis of Data
1. Formulate nursing diagnoses (wellness, risk, actual)
2. Formulate collaborative problems
3. Make necessary referrals.
III – ATTITUDE
1. Demonstrate preparedness, readiness and confidence
in the performance of the procedure.
2. Accepts corrections/suggestions and shows willingness
to improve performance..
3. Answers questions politely and tactfully.
4. Shows respect and consideration of the recipient of
care.
5. Observe proper decorum and behave as a mature
student nurse.
______________________________                         ___________________________
         Student’s Signature                           Clinical Instructor’s Signature
 Date: ______________                                     Date: ______________