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: ______________