Name: _____________________________________________________Date: ________________
Course: _______________________________________ ____ Grade:_______________
COMPETENCY CHECKLIST
OXYGENATION
Expected Outcome: Patient’s signs and symptoms of hypoxia is reduced or eliminated
Rate the student as follows:
1 - Needs Practice 3 - Very Satisfactory
2 - Satisfactory 4 - Excellent
4 3 2 1
1. Verify the physicians order
2. Perform hand hygiene
3. Prepare needed supplies and equipment
4. Establish Rapport
5. Verify the patient’s identity using two patient identifiers.
6. Explain procedure to patient and/or significant others and
encourage patient’s interaction and questions.
7. Eliminate safety hazards that may lead to fire/explosion; discuss
with patient the oxygen safety guidelines
8. Secure the oxygen tank
9. Install the pressure regulator to valve outlet of the oxygen tank
10. Turn the valve clockwise and check the pressure regulator
11. Fill humidifier with distilled water to the level indicated (about 2/3
full)
12. Attach humidifier to oxygen flow meter
13. Assist patient in high Fowler’s position
14. Attach oxygen delivery device (nasal cannula / face mask) to the
flow meter
15. Check that oxygen is flowing out of the prongs
16. Place prongs in patient’s nostrils with tube over and behind ear
adjusted comfortably; face mask must fit over nose and mouth
comfortable
17. Regulate oxygen flow rate as ordered
18. Encourage to breathe normally through nose
20. Insert the appropriate color-coded valve or dial the prescribed
percentage if Venturi mask is used
21. Start the flow of oxygen as ordered. For those with reservoir,
partially inflate bag with oxygen
22. Position face mask over patient’s nose and mouth. Adjust the
elastic strap so that mask fits snugly but comfortably over face
23. Adjust flow rate as prescribed
24. Remove the mask and dry the skin every 2-3 hours if the oxygen
is running continuously
25. Turn off the oxygen flow from the cylinder by turning the cylinder
key clockwise until it is tight
26. Drain any tubing that collects condensation
27. Provide skin, oral and nasal hygiene every 4-8 hours.
28. Dispose used materials according to infection control policies
29. Perform hand hygiene
30. Document assessment data, percentage or liter flow of oxygen
administration, type of delivery device, length of time use, client’s
response to oxygen therapy
TOTAL
