DON MARIANO MARCOS MEMORIAL STATE UNIVERSITY

South La Union Campus

COLLEGE OF COMMUNITY HEALTH AND ALLIED MEDICAL SCIENCES
Agoo, La Union
Tel. 072.682.0663
Embracing World Class Standards Care to learn, Learn
to care

BACHELOR OF SCIENCE IN NURSING

E S S E N T I A L I N T R A P A R T U M N E W B O R N C A R E ( E I N C ) Checklist

Name: Date: Score:

Course/Section:___________
Rubrics:

Score
2 P Performed Well the procedure
1 NI Needs Improvement
0 NP Did not perform the procedure
 PROCEDURES 2 1 0
Preparation Phase
1. Conduct a thorough review of the client's existing medical
records, if they are accessible.
2. Assesses the required scope of assessment. Prepare the
necessary things needed.
3. Do hand hygiene and put gloves, if necessary.
4. Introduce self. Verifies the client's identification / gather
data about the health history of the mother.
5. Explain the procedure to the patient.
6. Position patient comfortably and provides privacy.
7. Ensures that the mother is in her preferred position during
labor.
8. Ask the mother if she wants any food or beverage.
9. Engages in effective communication with the mother,
providing regular updates on the progress of the labor process
while offering reassurance and encouragement.
INSIDE THE DELIVERY ROOM
10. Checks DR temperature and air draft.
11. Put the patient in a semi-upright / lithotomy. Ask if she is
comfortable in this posture.
12. Remove jewelries and perform hand hygiene.
13. Put on strile gloves aseptically.
14. Organizes items in a sequential manner, including gloves,
dry linen, bonnet, oxytocin injection, plastic clamp, scissors /
blade.
15. Clean the perineum using an antiseptic solution.
16. Wash hands.
Rubric 17. Put on sterile gloves aseptically. If the same healthcare of
provider handles the perineum and cord, put on 2 pairs of
sterile gloves aseptically.
DELIVERY TIME
18. Encourages woman to push as desired. Place the sterile
and dry linen over the mother's abdomen in order to prepare
for drying the baby.
19. Provides perineal support and performs controlled delivery
of the head.
20. Announces the precise time of birth and reveals the gender
of the newborn.
21. Notifies the mother of the result.
22. Take the blood pressure before giving 1 amp oxytocin
(Should be done by the assisting nurse)
UPON DELIVERY
23. Dry the baby quickly. Keep the baby at the same level of
the mother’ uterus until the end of the cord stops pulsating. .
Place the baby on the mother abdomen. Cover the baby. Clamp
the cord and cut. Suction the baby’s mouth and nose.
24. Determine the APRGAR score of the baby. Get the Vital
signs.
25. Check for pulsations by palpating the umbilical cord.
26. Place the cord clamp one inch from the base of the cord.
Apply 2nd clamp 5cm from the base of the umbilicus then cut
1cm from the plastic clamp.
27. After stabilization of the baby, get the anthropometric data
of the baby. (Weight, height, head circumference, chest
circumference, abdominal circumference, mid-thigh
circumference). Get the footprints of the baby.
28. Inject Vitamin K, Hepatitis B and BCG intramascularly.
Apply tetracycline ointment.
29. Put back the baby in skin-to-skin position with the mother.

Encourage breastfeeding.
30. Continue monitoring the baby until stable. Document the
procedure and findings. Perform aftercare.
TOTAL
 Student’s Performance during Related Learning Experience (RLE) or Clinical Practicum
(CP) Return Demonstration

Scor
Criteria Levels of Achievement
e

1
5 3
Needs
Excellent Good
Improvement
Brings needed Almost always Often forgets
materials/ brings needed needed materials/
resources during materials/ resources and is
RLE and is resources during rarely ready to
Preparedness
always ready to RLE and is perform the
perform the sometimes ready procedure.
procedure. to perform the
procedure.
All content is in At least half of the Less than half of
the student's content is in the the content is in
own words and student's own the student's own
Mastery
is accurate. words and is words and/or is
accurate. accurate.

The student was The student The student

able to perform performed the performed the
the entire procedure with 2- procedure with
Orderliness procedure in the 3 omissions in the several omissions
correct steps and in the steps.
sequence. maintained the
sequence.
All statements, Most statements Statements,
body language, and responses responses and/or
Proper and responses were respectful body language
attitude in were respectful and in appropriate were consistently
assessing the and were in language, but not respectful.
client followed appropriate there was one
language. sarcastic remark.

The student can The student can The student is

accurately accurately answer unable to
answer almost a few questions accurately answer
Ability to
all questions posed by the questions posed
answer
posed by the clinical instructor by the clinical
questions
clinical instructor about the topic. instructor about
about the topic. the topic.

Stands or sits up Stands or sits up Slouches or

straight and straight. appears too
looks confident casual and
and relaxed. Establishes eye establishes little
contact with eye contact with
Establishes eye clinical instructor the clinical
contact with during return instructor during
Proper clinical instructor demonstration. return
reporting during return demonstration.
observed demonstration. Speaks clearly
and distinctly Does not speak
Speaks clearly most of the time clearly and
and distinctly all but distinctly most of
the time and mispronounces 1 - the time and/or
mispronounces 2 words. mispronounces
no words. more than 2
words.
TOTAL:
Student’s signature: __________________
Evaluator’s Signature: __________________

Comments:__________________________________________________________________________________
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