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Appraisal Form Tepid Sponge Bath

The document provides an assessment form for performing a tepid sponge bath procedure. It lists 18 specific steps of the procedure and provides scoring criteria for evaluation. The form also includes sections to record the learner's attitude, start and end times of the procedure, and vital sign measurements before and after. The high-level purpose is to evaluate a learner's performance of a full tepid sponge bath procedure from preparing supplies to recording outcomes.

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CARRAO, Samuel Jr.
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273 views2 pages

Appraisal Form Tepid Sponge Bath

The document provides an assessment form for performing a tepid sponge bath procedure. It lists 18 specific steps of the procedure and provides scoring criteria for evaluation. The form also includes sections to record the learner's attitude, start and end times of the procedure, and vital sign measurements before and after. The high-level purpose is to evaluate a learner's performance of a full tepid sponge bath procedure from preparing supplies to recording outcomes.

Uploaded by

CARRAO, Samuel Jr.
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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APPRAISAL FORM IN Code Number:


Effectivity
PERFORMING TEPID SPONGE BATH

Name: __________________________________________ Date: ___________


Year and Section: _________________________________ Group: __________

Scoring: 2 – the learner performed the step correctly without the supervision of the instructor.
1 – the learner needs more practice in performing the step. Needs minimal assistance in performing the step.
0 – the learner did not perform the step.

STEPS 2 1 0

1. Assess client’s body temperature and pulse rate.


Provides baseline for evaluating response to therapy.
2. Explain purpose and procedure to client.
Procedure can be uncomfortable because of the cool application. Anxiety over procedure can increase body
temperature.
3. Wash hands; put on gloves.
Deters spread of microorganisms.
4. Assemble equipment and bring to client’s unit.
Saves time and energy.
5. Close room door and windows or draw curtain around client’s bed.
This provides privacy and prevent drafts.
6. Remove and fold top linens. Drape client with bath blanket. Refer to Procedure 16: Bathing A Client in
Bed, step #9 (Place bath blanket over the top sheet. Ask client to grasp the top of the bath blanket or tuck
it under the client’s shoulder. Remove the top sheet from under the blanket starting at the client’s
shoulders and moving linen down toward the foot of the bed).
Prevents top linens from getting wet. Bath blanket will keep client from chilling.
7. Place rubber sheet under the client and remove gown.
Rubber sheet will protect the bed from soiling. Removing gown provides access to all skin surfaces.
8. Immerse washcloths in water and apply these wet but not dripping to the axillae and groins. Reapply
washcloths to axillae and groins as needed.
Axillae and groins contain large superficial blood vessels. Application of washcloths promotes cooler
temperature pf body’s core of conduction.
9. Sponge the client’s face, forehead and neck.
10. Place a towel under the far arm. Gently and slowly, sponge upward for 3-5 minutes. Do the same with
the other arm and legs. Expose only the part you are sponging and keep the rest of the body covered with
the bath blanket.
Rubbing may increase heat production. Bath blanket will prevent chilling.
11. Pat dry extremity/extremities.
Prevents chilling.
12. Change water and reapply washcloths to the axillae and groins.
Water temperature rises as a result of exposure to client’s body surface.
13. Assist client to turn to his/her side. Place the bath towel behind the patient. Continue sponging back
and buttocks for 3-5 minutes. Pat dry. Return patient back to supine position.
14. Remove washcloths from the axillae and groins and dry these areas. Cover client with light blanket or
sheet.
Prevents chilling. Excessively thick covering may increase body temperature.
15. Check the client’s temperature and pulse after 15 minutes. Discontinue the bath when body
temperature falls to slightly above normal.
To evaluate effect of bath on the client. Prevents temperature drift to subnormal because the body
continues to cool off even after the bath.
16. Clean/dispose equipment used and change bed linens and client’s gown if soiled. Wash hands.
Promote client comfort. Controls transmission of infection.
17. Record the time the procedure was started and terminated, changes in vital signs and client’s
response to therapy.
Recording communicates care rendered in accurate and timely fashion.
18. Check and record the client’s temperature, pulse and respiration 30 minutes after the procedure.
Vital signs indicates response to therapy.
ATTITUDE
19. Engages the client in a therapeutic conversation.
20. Polite (courteous and respectful).
21. Methodical (thorough, precise, uses proper body mechanics).
22. Punctual in reporting to class.
TOTAL
/4423

FINAL GRADE FOR THIS ROTATION (SCORE X 60/# + 40)

Note: The contents of this material are adapted from the Manual of Basic Nursing Procedures by Carol Ruth L. Valles and Manual and Checklists on
Health Care Procedures by Diana R. Adion and Ederlinda C. Dizon.

IMPORTANT: By signing this form, I acknowledge that this was shown and discussed to me by the clinical facilitator
whose name and signature appears below.

_____________________________ _____________________________
NURSE LEARNER CLINICAL FACILITATOR
Signature above printed name Signature above printed name
Date Signed: _________________________ Date Signed: _________________________

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