DE LA SALLE LIPA
COLLEGE OF NURSING
Nursing Care Management _101
Procedural Checklist in
Assessment of Nose, Mouth, Throat, and Sinuses
Name: Year/Sec: Rating:
General Objective:
Given simulated situations/conditions, the students will be able to systematically
assess, observe and perform the assessment of nose, mouth, throat, and sinuses.
Specific Objectives:
1. Perform a systematic assessment of the nose, mouth, throat, and sinuses.
2. Describe normal findings in the physical assessment of the nose, mouth,
throat, and sinuses.
3. Describe abnormal findings in the physical assessment of the nose, mouth,
throat, and sinuses.
4. Perform accurate documentation of the whole assessment.
CRITERIA:
Item Descriptors Verbal Interpretation
Weight
1.0 Excellent Performed the procedure with great ease and confidence,
observing work ethics (prudent, accepts criticisms and
suggestions), able to rationalize scientifically and shows
diligence in documenting observations at all times .
0.75 Satisfactory Performed the procedure with less confidence and requires
close supervision, observing work ethics (prudent, accepts
criticisms and suggestions), able to rationalize scientifically and
shows minimal diligence in documenting observations.
0.5 Needs Failed to perform the procedure, unable to function well and
Improvement needs repeated specific/ detailed guidance or direction.
Skills – 20 points 1.0 0.75 0.5 Remarks
1. Prepared all the materials/supplies to be used.
a. Gloves
b. Tongue Depressor
c. Nasal Speculum or Otoscope
d. Penlight
e. Gauze
COLLEGE OF NURSING
Nursing Care Management _101
Procedural Checklist in
Assessment of Nose, Mouth, Throat, and Sinuses
Name: Year/Sec: Rating:
General Objective:
Given simulated situations/conditions, the students will be able to systematically
assess, observe and perform the assessment of nose, mouth, throat, and sinuses.
Specific Objectives:
1. Perform a systematic assessment of the nose, mouth, throat, and sinuses.
2. Describe normal findings in the physical assessment of the nose, mouth,
throat, and sinuses.
3. Describe abnormal findings in the physical assessment of the nose, mouth,
throat, and sinuses.
4. Perform accurate documentation of the whole assessment.
CRITERIA:
Item Descriptors Verbal Interpretation
Weight
1.0 Excellent Performed the procedure with great ease and confidence,
observing work ethics (prudent, accepts criticisms and
suggestions), able to rationalize scientifically and shows
diligence in documenting observations at all times .
0.75 Satisfactory Performed the procedure with less confidence and requires
close supervision, observing work ethics (prudent, accepts
criticisms and suggestions), able to rationalize scientifically and
shows minimal diligence in documenting observations.
0.5 Needs Failed to perform the procedure, unable to function well and
Improvement needs repeated specific/ detailed guidance or direction.
Skills – 20 points 1.0 0.75 0.5 Remarks
1. Prepared all the materials/supplies to be used.
a. Gloves
b. Tongue Depressor
c. Nasal Speculum or Otoscope
d. Penlight
e. Gauze
