Objective Data Collection: 27.47 of 28 (98.11%)
Correct Incorrect
Partially correct Missed
Assessed Vitals 1 of 1 point
Temperature (1/5 point) Blood Pressure (1/5 point)
Normothermic Normotensive
Hyperthermic Hypertensive
Hypothermic Hypotensive
Heart Rate (1/5 point) Respiratory Rate (1/5 point)
No abnormal findings No abnormal findings
Tachycardic Tachypnea
Bradycardic Bradypnea
Oxygen Saturation (1/5 point)
No abnormal findings
Hypoxemia
Assessed IV Bag 1 of 1 point
Appropriate Fluid (1/3 point) Appropriate Label (1/3 point)
Bag is normal saline Name and dosage are correct
Bag is not normal saline Name is incorrect
Bag is not labeled Dosage is incorrect
Infuse rate is incorrect
Bag is not labeled
Fluid Appearance (1/3 point)
No visible abnormal appearance
Cloudy
Inappropriate color
Crystallization
Assessed IV Pump 1 of 1 point
Observations (1/1 point)
, IV pump is infusing IV fluid at the ordered rate
IV pump is infusing IV fluid at a slower than the
ordered rate
IV pump is infusing IV fluid at a faster than the
ordered rate
Inspected IV Site 1 of 1 point
Insertion Site (1/2 point) Dressing (1/2 point)
No visible abnormal signs Dry and intact
Erytherma Moist dressing
Infiltration
Inspected Head and Face 1 of 1 point
Skull Symmetry (1/3 point) Facial Feature Symmetry (1/3 point)
Symmetric Symmetric
Asymmetric Asymmetric
Appearance (1/3 point)
No visible abnormal findings
Rash
Papules, pustules, or comedones
Skin growths (freckles, moles, or birth mark)
Excessive hair growth
Evidence of skin trauma (scar, laceration, or
bruising)
Drooping eye
Drooping mouth
Inspected Eyes 1 of 1 point
Eyelids (1/3 point) Conjunctiva And Lens (1/3 point)
No visible abnormal findings No visible abnormal findings
Ptosis Sclera - injection
Swelling Sclera - icterus
Lesion Lens opacification
Allergic shiners
Pupillary Reaction (1/3 point)
No visible abnormal findings (PERRL)
Unequal
Irregular
Miosis
Correct Incorrect
Partially correct Missed
Assessed Vitals 1 of 1 point
Temperature (1/5 point) Blood Pressure (1/5 point)
Normothermic Normotensive
Hyperthermic Hypertensive
Hypothermic Hypotensive
Heart Rate (1/5 point) Respiratory Rate (1/5 point)
No abnormal findings No abnormal findings
Tachycardic Tachypnea
Bradycardic Bradypnea
Oxygen Saturation (1/5 point)
No abnormal findings
Hypoxemia
Assessed IV Bag 1 of 1 point
Appropriate Fluid (1/3 point) Appropriate Label (1/3 point)
Bag is normal saline Name and dosage are correct
Bag is not normal saline Name is incorrect
Bag is not labeled Dosage is incorrect
Infuse rate is incorrect
Bag is not labeled
Fluid Appearance (1/3 point)
No visible abnormal appearance
Cloudy
Inappropriate color
Crystallization
Assessed IV Pump 1 of 1 point
Observations (1/1 point)
, IV pump is infusing IV fluid at the ordered rate
IV pump is infusing IV fluid at a slower than the
ordered rate
IV pump is infusing IV fluid at a faster than the
ordered rate
Inspected IV Site 1 of 1 point
Insertion Site (1/2 point) Dressing (1/2 point)
No visible abnormal signs Dry and intact
Erytherma Moist dressing
Infiltration
Inspected Head and Face 1 of 1 point
Skull Symmetry (1/3 point) Facial Feature Symmetry (1/3 point)
Symmetric Symmetric
Asymmetric Asymmetric
Appearance (1/3 point)
No visible abnormal findings
Rash
Papules, pustules, or comedones
Skin growths (freckles, moles, or birth mark)
Excessive hair growth
Evidence of skin trauma (scar, laceration, or
bruising)
Drooping eye
Drooping mouth
Inspected Eyes 1 of 1 point
Eyelids (1/3 point) Conjunctiva And Lens (1/3 point)
No visible abnormal findings No visible abnormal findings
Ptosis Sclera - injection
Swelling Sclera - icterus
Lesion Lens opacification
Allergic shiners
Pupillary Reaction (1/3 point)
No visible abnormal findings (PERRL)
Unequal
Irregular
Miosis
