CAPITOL UNIVERSITY

COLLEGE OF NURSING
RLE 6 List of Supervised Nursing Procedures
NAME: ALFREDO D. ANCOG, III GRP. NO. 2 SEM. 1st SY 2009-2010

 BASIC PROCEDURES Date Sig. Date Sig. Date Sig.

Basic Cleaning Procedure
Basic Perineal Care (1x)
Bed making : Closed bed (1x)
Bed making : Occupied Bed (1x)
Bedmaking: Open Bed (1x)
Cleansing Bed Bath (1x)
Gloving [Open Method] (3x)
Ice Cap Application (1x)
Medical Handwashing (3x)
Morning Care (3x)
Mouth Care (3x)
Offering & Removing Bedpan (1x)
Physical Assessment (3x)
Positioning & Draping (3x)
Shampoo in Bed (1x)
Special Mouth Care (optional)
Tepid Sponge Bath (1x)
Urine Specimen Collection (1x)
Vital Signs Blood Pressure (3x)
Vital Signs Pulse: Apical (3x)
Vital Signs Pulse: Radial (3x)
Vital Signs Respiration (3x)
Vital Signs Temperature (3x)
Wound Dressing (1x)

 CONCEPT Date Sig. Date Sig. Date Sig.

PROCEDURES
Administration of Medication
 Anal Suppository (optional)
 Intradermal (1x)
 Intramuscular (3x)
 Per Orem (3x)
 Subcutaneous (3x)
 Vaginal Suppository (optional)
Antepartal Exercises (3x)
Application of Abdominal Binder (1x)
Application of Ice Cap [ to fundus] (1x)
Assisting in Blood Transfusion (optional)
Assisting in IVF Insertion (2x)
Assisting in NGT Insertion (1x)
Bathing the Infant (1x)
Breast Care (1x)
Catheterization (1x)
Labor Watch (1x)
DR Circulating Nurse (1x)
Estimating Gestational Age (1x)
Eye Ointment Application (1x)
 RLE 6 List of Supervised Nursing Procedures

 CONCEPT Date Sig. Date Sig. Date Sig.

PROCEDURES
Enema (optional)
Handling Delivery (1x)
Cord Care (1x)
Newborn Assessment/APGAR score (1x)
IVF Follow-up (3x)
Leopold’s Maneuver (3x)
Measuring Intake & Output (3x)
Nasogastric Tube Feeding (1x)
Oxygen Administration (1x)
Perineal Shaving (optional)
Postpartum Exercises (1x)
Removal of Catheter (1x)
Termination of IVF (3x)
Urine Examination (optional)

REMINDERS:

 Bring this ALWAYS to the clinical area

 Inform your Clinical Instructor that you will be performing the procedures required of you per
year level
 Submit to your Clinical Instructor for signature and rating:
 Satisfactory Rating – blue or black pen
 Unsatisfactory Rating – red pen
 Accomplish the required number of satisfactory supervised performance of a particular
procedure
 This checklist needs to be accomplished within the semester and should be submitted to the 4th
Rotation Clinical Instructor and Level Coordinator for evaluation. Non-compliance will result
to an INC grade in the RLE.
 CAPITOL UNIVERSITY
COLLEGE OF NURSING

RLE 7 List of Supervised Nursing Procedures

NAME: _______________________________GRP. NO. ______ SEM. ______ SY __________

 BASIC PROCEDURES Date Sig. Date Sig. Date Sig.

Admitting Patient in the Unit (1x)
Basic Cleaning Procedure (3x)
Basic Perineal Care (3x)
Bed making : Closed Bed (3x)
Bed making : Occupied Bed (3x)
Bedmaking: Open Bed (3x)
Cleansing Bed Bath (3x)
Discharging of Patient (3x)
Gloving [Open Method] (3x)
Ice Cap Application (1x)
Medical Handwashing (3x)
Morning Care (3x)
Mouth Care (3x)
Offering & Removing Bedpan (3x)
Physical Assessment (3x)
Positioning & Draping (3x)
Shampoo in Bed (1x)
Special Mouth Care (optional)
Tepid Sponge Bath (3x)
Urine Specimen Collection (1x)
Vital Signs Blood Pressure (3x)
Vital Signs Pulse: Apical (3x)
Vital Signs Pulse: Radial (3x)
Vital Signs Respiration (3x)
Vital Signs Temperature (3x)
Wound Dressing (3x)
 CONCEPT PROCEDURES Date Sig. Date Sig. Date Sig.
Administration of Medication
 Anal Suppository (optional)
 Intradermal (3x)
 Intramuscular (3x)
 Intravenous (3x)
 Per Orem (3x)
 Subcutaneous (1x)
 Vaginal Suppository(optional)
Antepartal Exercises (3x)
Application of Abdominal Binder (1x)
Application of Ice Cap [ to fundus] (3x)
Blood Transfusion (1x)
Assisting in IVF Insertion (3x)
Assisting in NGT Insertion (1x)
Bathing the Infant (3x)
Breast Care (3x)
Catheterization (1x)
Chest Physiotherapy/Chest Tapping (3x)
Labor Watch (3x)
DR Circulating Nurse (3x)
Estimating Gestational Age (3x)
Ear Instillation (optional)
Ear Irrigation (optional)
Eye Instillation (optional)
 RLE 7 List of Supervised Nursing Procedures

 CONCEPT PROCEDURES Date Sig. Date Sig. Date Sig.

Eye Irrigation (optional)
Eye Ointment Application (3x)
Handling Delivery (3x)
Cast Care (1x)
Cane Walking (1x)
Crutch Walking (1x)
Traction Care (optional)
Colostomy Care (optional)
Cord Care (3x)
Enema (1x)
Hemoglucotest (1x)
Isolation Technique (1x)
IVF Follow-up (3x)
Leopold’s Maneuver (3x)
Measuring Intake & Output (3x)
Nasogastric Tube Feeding (1x)
Nebulization/Steam Inhalation (3x)
Newborn Assessment/APGAR score (3x)
Oxygen Administration (1x)
Perineal Shaving (optional)
Postpartum Exercises (3x)
Removal of Catheter (1x)
Sputum Collection (optional)
Suctioning of Mucus Secretions (1x)
Termination of IVF (3x)
Neurologic Assessment/Glasgow Coma
Scale (1x)
Post Mortem Care (optional)
Postural Drainage (optional)
Pulse Oximeter Application (1x)
Range of Motion Exercises (3x)
Reverse Isolation Technique (1x)
Tracheostomy Care (optional)
24-Hours Urine Collection (optional)

REMINDERS:

 Bring this ALWAYS to the clinical area

 Inform your Clinical Instructor that you will be performing the procedures required of you per
year level
 Submit to your Clinical Instructor for signature and rating:
 Satisfactory Rating – blue or black pen
 Unsatisfactory Rating – red pen
 Accomplish the required number of satisfactory supervised performance of a particular
procedure
 This checklist needs to be accomplished within the semester and should be submitted to the 4th
Rotation Clinical Instructor and Level Coordinator for evaluation. Non-compliance will result
to an INC grade in the RLE.
 CAPITOL UNIVERSITY
COLLEGE OF NURSING

RLE 8 List of Supervised Nursing Procedures

NAME: _______________________________GRP. NO. ______ SEM. ______ SY __________

BASIC PROCEDURES Date Sig. Date Sig. Date Sig.

Administration of Medication
 Intradermal (3x)
 Intramuscular (3x)
 Intravenous (3x)
 Per Orem (3x)
 Subcutaneous (3x)
Admitting Patient in the Unit (3x)
Assisting in IVF Insertion (3x)
Assisting in NGT Insertion (1x)
Basic cleaning procedure (3x)
Basic perineal care (optional)
Bedmaking : Closed bed (1x)
Bedmaking : Occupied Bed (3x)
Bedmaking: Open Bed (3x)
Blood Transfusion
Catheterization (1x)
Cleansing Bed Bath (3x)
Discharge of Patient (3x)
Gloving [Open Method] (3x)
Ice Cap Application (1x)
IVF Follow-up (3x)
Measuring Intake & Output (3x)
Medical Handwashing (3x)
Morning Care (3x)
Mouth Care (3x)
Offering & Removing Bedpan (3x)
Oxygen Administration (1x)
Physical Assessment (3x)
Positioning & Draping (3x)
Removal of Catheter (1x)
Shampoo in Bed (1x)
Special Mouth Care (1x)
Stool Specimen Collection (1x)
Tepid Sponge Bath (3x)
Termination of IVF (3x)
Urine Specimen Collection (3x)
Vital Signs: Blood Pressure (3x)
Vital Signs Pulse: Apical (3x)
Vital Signs Pulse: Radial (3x)
Vital Signs Respiration (3x)
Vital Signs Temperature (3x)
Wound Dressing (3x)
 RLE 8 List of Supervised Nursing Procedures
 CONCEPT PROCEDURES Date Sig. Date Sig. Date Sig.
Ambubagging (1x)
Anesthetic Bed (3x)
Assisting in Abdominal Paracentesis
(optional)
Assisting in Lumbar Puncture (1x)
Assisting in Thoracentesis (optional)
Assisting in Thoracostomy (optional)
Assisting in Dialysis (Hemo &
Peritoneal) (1x)
Cardiac Monitoring (3x)
Care of the Patient with
Respirator/Ventilator (optional)
Cardiopulmonary Resuscitation-Advance
Life Support (optional)
Central Venous Pressure Reading (1x)
Chest Physiotherapy/Chest Tapping (3x)
Ear Instillation (optional)
Ear Irrigation (optional)
ECG Taking (1x)
Enema (1x)
Eye Instillation (optional)
Eye Irrigation (optional)
Hemoglucotest (1x)
Isolation Technique (1x)
Nebulization/Steam Inhalation (3x)
Sputum Collection (optional)
Suctioning of Mucus Secretions (1x)
Nasogastric Tube Feeding (3x)
NGT Lavage (optional)
Neurologic Assessment/Glasgow Coma
Scale (3x)
Post Mortem Care (optional)
Postural Drainage (optional)
Pulse Oximeter Application (3x)
Range of Motion Exercises (3x)
Reverse Isolation Technique (1x)
Tracheostomy Care (optional)
24-Hours Urine Collection (1x)
 OPERATING ROOM
PROCEDURES
Gowning (2x)
Instrumentation (2x)
Surgical Gloving [Close Method] (2x)
Surgical Scrub (2x)
Surgical Shaving (2x)
Skin Preparation & Draping (2x)
REMINDERS:
 Bring this ALWAYS to the clinical area
 Inform your Clinical Instructor that you will be performing the procedures required of you per
year level
 Submit to your Clinical Instructor for signature and rating:
 Satisfactory Rating – blue or black pen
 Unsatisfactory Rating – red pen
 Accomplish the required number of satisfactory supervised performance of a particular
procedure
 This checklist needs to be accomplished within the semester and should be submitted to the 4th
Rotation Clinical Instructor and Level Coordinator for evaluation. Non-compliance will result
to an INC grade in the RLE.
 CAPITOL UNIVERSITY
COLLEGE OF NURSING
RLE 9 List of Supervised Nursing Procedures
NAME: _______________________________GRP. NO. ______ SEM. ______ SY __________

 BASIC PROCEDURES Date Sig. Date Sig. Date Sig.

Administration of Medication
 Intradermal (3x)
 Intramuscular (3x)
 Intravenous (3x)
 Per Orem (3x)
 Subcutaneous (3x)
Admitting Patient in the Unit (3x)
Ambubagging (1x)
Anesthetic Bed (3x)
Assisting in Abdominal Paracentesis
(optional)
Blood Transfusion (1x)
Assisting in IVF Insertion (3x)
Assisting in Lumber Puncture (1x)
Assisting in NGT Insertion (1x)
Assisting in Thoracentesis (optional)
Assisting in Thoracostomy (optional)
Basic cleaning procedure (3x)
Basic Perineal care (1x)
Bedmaking : Closed bed (3x)
Bedmaking : Occupied Bed (3x)
Bedmaking: Open Bed (3x)
Catheterization (1x)
Central Venous Pressure Reading (1x)
Chest Physiotherapy/ Chest Tapping (3x)
Cleansing Bed Bath (3x)
Discharging of Patient (3x)
Ear Instillation (optional)
Ear Irrigation (optional)
ECG Taking (1x)
Enema (1x)
Eye Instillation (optional)
Eye Irrigation (optional)
Gloving [Open Method] (3x)
Hemoglucotest (1x)
Ice Cap Application (1x)
Isolation Technique (3x)
IVF Follow-up (3x)
Measuring Intake & Output (3x)
Medical Handwashing (3x)
Morning Care (3x)
Mouth Care (3x)
Nasogastric Tube Feeding (3x)
NGT Lavage (1x)
Nebulization/Steam Ihalation (3x)
Neuro Assessment/Glasgow Coma Scale (3x)
Offering & Removing Bedpan (3x)
Oxygen Administration (3x)
Physical Assessment (3x)
Positioning & Draping (3x)
Post Mortem Care (optional)
Postural Drainage (optional)
Pulse Oximeter Application (3x)
 RLE 9 List of Supervised Nursing Procedures

 BASIC PROCEDURES Date Sig. Date Sig. Date Sig.

Range of Motion Exercises (3x)
Removal of Catheter (1x)
Reverse Isolation (1x)
Shampoo in Bed (1x)
Special Mouth Care (1x)
Sputum Collection (optional)
Stool Specimen Collection (1x)
Suctioning of Mucus Secretions (3x)
Tepid Sponge Bath (3x)
Termination of IVF (3x)
Tracheostomy Care (optional)
Urine Specimen Collection (3x)
Vital Signs Blood Pressure (3x)
Vital Signs Pulse: Apical (3x)
Vital Signs Pulse: Radial (3x)
Vital Signs Respiration (3x)
Vital Signs Temperature (3x)
Wound Dressing (3x)
24-Hours Urine Collection (1x)

 CONCEPT PROCEDURES Date Sig. Date Sig. Date Sig.

Assisting in Bone Marrow Aspiration
(optional)
Assisting in Liver Biopsy (optional)
Assisting in Dialysis (Hemo & Pertoneal)
(1x)
Bladder Irrigation (optional)
Cardiac Monitoring (3x)
Care of the Patient with
Respirator/Ventilator (1x)
Cardiopulmonary Resuscitation-Advance
Life Support (optional)
Defibrillation/Cardioversion (1x)
Post-mastectomy Exercises (optional)
Self-Breast Exam (1x)
Testicular Exam (optional)
 OPERATING ROOM
PROCEDURES
Gowning (3x)
Instrumentation (3x)
Surgical Gloving [Close Method] (3x)
Surgical Scrub (3x)
Surgical Shaving (3x)
Skin Preparation & Draping (3x)
REMINDERS:

 Bring this ALWAYS to the clinical area

 Inform your Clinical Instructor that you will be performing the procedures required of you per
year level
 Submit to your Clinical Instructor for signature and rating:
 Satisfactory Rating – blue or black pen
 Unsatisfactory Rating – red pen
 Accomplish the required number of satisfactory supervised performance of a particular
procedure
 This checklist needs to be accomplished within the semester and should be submitted to the 4th
Rotation Clinical Instructor and Level Coordinator for evaluation. Non-compliance will result
to an INC grade in the RLE.