Student ______________________________________________________ Instructor ____________________________________________________

PERFORMANCE CHECKLIST SKILL 17-2 ORAL HYGIENE

Date _________________________ Date _________________________

S
ASSESSMENT

NP

Comments

1. Performed hand hygiene. Applied gloves. 2. Assessed the oral cavity. 3. Identified presence of common oral problems. 4. Removed gloves and performed hand hygiene. 5. Assessed patients risk for oral hygiene problems. 6. Determined patients oral hygiene practices. 7. Assessed patients ability to grasp and manipulate toothbrush.
NURSING DIAGNOSIS

1. Developed appropriate nursing diagnoses based on assessment data.

PLANNING

1. Identified expected outcomes. 2. Prepared equipment at bedside. 3. Explained procedure to patient and discussed preferences.
IMPLEMENTATION

1. Arranged equipment on paper towels on bedside table. 2. Raised bed to comfortable working position, lowered side rail, and positioned patient on side near nurse in semi-Fowlers or side-lying position. 3. Placed towel over patients chest. Applied gloves. 4. Applied toothpaste to brush and moistened paste. 5. Held or had patient hold toothbrush at 45-degree angle to gum line and used short strokes to brush tooth surfaces from gum to crown; held brush parallel to teeth to clean biting surfaces; brushed sides of teeth, moving bristles back and forth.

Mosby items and derived items 2010 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published.

S 6. Held or had patient hold brush at 45-degree angle and lightly brushed tongue surface. 7. Provided water for patient to rinse mouth thoroughly. Offered mouthwash for gargling and rinsing. 8. Assisted in wiping patients mouth. 9. Allowed patient to floss. 10. Allowed patient to rinse mouth thoroughly with tepid water after flossing. 11. Repositioned procedure. patient comfortably after

NP

Comments

12. Disposed of equipment and soiled linen properly. 13. Performed hand hygiene.
EVALUATION

1. Assessed patients comfort level. 2. Applied gloves and inspected condition of oral cavity. 3. Asked patient to describe proper oral hygiene techniques. 4. Observed patient brushing. 5. Identified unexpected outcomes.
RECORDING AND REPORTING

1. Recorded procedure on flowsheet. Included condition of oral cavity. 2. Reported any unusual findings to nurse in charge or physician.

Mosby items and derived items 2010 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published.