Testicular Self Exam

OUR LADY OF FATIMA UNIVERSITY
College of Nursing – Valenzuela City
PROGRAM Bachelor of Science in Nursing STUDENT NAME
COURSE NCMB-312 YEAR & SECTION

Care of Clients with Problem in
Oxygenation, Fluids & INSTRUCTOR
Electrolytes, Infectious,
Inflammatory & Immunologic DATE
Response, Cellular Aberrations
(Acute & Chronic)
(SKILLS LABORATORY)
PROCEDURE :TESTICULAR SELF EXAMINATION

EXPECTED OUTCOME : The student should be able to testicular self examination correctly.
ASSESSMENT TASK : Return Demonstration
Assessment Exceptional Good Average Poor
SCORE
Dimension (4) (3) (2) (1)
Clearly verified Verified the Verified the Failed to
1. the presence of presence of doctors presence of verified the
Verify the doctor’s doctor’s written ritten order with doctors written presence of
order and secure orderand secured minimal order incorrectly doctors written
consent if error and and secured order.
consent if necessar
secured consent consent if
necessary.
necessary.
if necessary.
2. Performed Performed Performed Medical hand
Hand washing medical hand medical hand medical hand washing not
washing washing with washing with performed
properly. least error. most error
3. Gathered all With lacking of 1- With lacking of Failed to
Gather all the the necessary 2 materials. 3 or more gather
necessary materials materials materials. necessary
needed. (drape, ruler completely. materials
in centimeter, marker, (Drape, ruler completely.
gloves) in centimeter,
marker,
gloves)
4 Greeted and Performed at least Performed one (1) Failed to greet
Identify the patient identified patient two (2) ways of way of identifying and identify the
by asking his/her identifying the the patient. patient.
name and patient.
checking his/her
ID band and bed
tag.
5. Explained Explained procedure Explained Failed to explain
Explanation the procedure to the but lacks details. procedure but in procedure.
procedure patient clearly and an unclear
completely with manner.
patient’s approval.
6. Provided privacy Privacy and Provided privacy Failed to provide
Privacy and position and position positioning of the but unable to privacy and
Cover the pelvic are with appropriately and patient was not position patient position the
a sheet comfortably maintained all comfortably and patient.
throughout the throughout the appropriately or
procedure. procedure. vice versa.
7. Performed Performed Performed Performed
Perform testicular testicular incomplete incomplete incomplete
inspection. inspection testicular inspection testicular testicular
Inspect the scrotum for completely. Taking with at least 1-2 inspection with at inspection with at
appearance, general size note all its details. details missing. least 3-4 details least 5-6 details
and symmetry. missing. missing.
8. Performed cup Performed cup Performed cup Performed cup
Perform cup testicle testicle palpation testicle palpation testicle palpation testicle palpation
palpation. completely. Taking with at least 1-2 with at least 3-4 with at least 5-6
Ask the client to hold note all its details. details missing. details missing. details missing.
the penis out of the
way Its normal that
one is lower than the
other
and firm but not hard.
9. Performed Performed checking Performed Performed
Check one testicle at a checking the one the one testicle at a checking the one checking the one
time testicle at a time time with at least 1- testicle at a time testicle at a time
Hold the testicle between completely. Taking 2 details missing. with at least 3-4 with at least 5-6
the thumb and fingers note all its details. details missing. details missing.
Gently roll the testicle
between your index and
thumb
Feel for any lumps,
bumps or painful areas
Don’t squeeze too
hard At the back feel
the epididymis
Feel up the spermatic
cord
10. Documented the Some of the details Most of the details Failed to
Documentation information about of procedure were of procedure were document the
the procedure, not documented. not documented. procedure.
date and time
properly and
completely.
OVERALL SCORE:
FACULTY SIGNATURE OVER PRINTED NAME

Testicular Self Exam

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OUR LADY OF FATIMA UNIVERSITY

College of Nursing – Valenzuela City

PROGRAM Bachelor of Science in Nursing STUDENT NAME

COURSE NCMB-312 YEAR & SECTION

PROCEDURE :TESTICULAR SELF EXAMINATION

FACULTY SIGNATURE OVER PRINTED NAME

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