GRADED
TRIAL
# 1
GRADED
TRIAL
# 2
NOTES
1. ✦ Perform hand hygiene.
2. ✦ Review the physician’s order.
3. ✦ Assemble equipment.
4. ✶ Identify the patient and
introduce yourself.
5. ✶ Explain the procedure.
6. ✦ Have the patient assume a
comfortable position, and ask the
patient to keep both eyes open.
7. ✶ In a well-lit room, have the
patient identify, at a distance
of 30 inches, the number that
is formed by the colored dots
on each card or page within
three seconds per page or card.
8. ✦ If the patient is unable to
identify the numbers, have the
patient trace the number with a
finger.
9. ✶ Score each plate as it is read.
(Figure 38-3 is an example of
one color plate.) If the patient is
able to identify the number, then
record the number seen after the
plate number (e.g., Plate 1:7). If
the patient was unable to identify
a number on a plate, record the
plate number and mark an X next
to it.
POINT VALUE
✦ = 3–6 points
✶ = 7–9 points
Name: ________________________________________
Date: _________________________________________
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