Performance Checklist On Newborn Care

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PERFORMANCE CHECKLIST ON NEWBORN CARE

Name of Student: __________________ Date: ____________________________


Year & Section: ____________________ Rating: __________________________

Instructions: Please use the following scale in rating the performance of the students:

3 – Very Satisfactory (Performs Procedure Skillfully)


2 – Satisfactory (With Minor Mistakes, Needs Minimal Guidance and Assistance
1 – Needs Improvement (Standards Steps Not Done
0 – Not Observed

CARE OF THE EYES

Steps 3 2 1 0
 Purpose: It is part if the routine care of the newborn to give prophylactic
eye treatment against gonorrhea conjunctivitis. Neisseria gonorrhea, the
causative agent, may be passed on the fetus from the vaginal canal
during delivery.
 Materials Needed: Erythromycin or Tetracycline Ophthalmic Ointment.
1. Cleanse the infant’s eyes before application, as needed.
2. Hold the tube in a horizontal rather than a vertical position to prevent
injury to the eye from sudden movement.
3. Administer from the inner canthus to the outer canthus. Do not touch the
tip of the tube to any part of the eye, because this may spread infectious
material from one eye to the other.
4. Do not rinse.
5. Ointment may be wiped from outer eye after 1 minute.
6. Observe for irritation.
7. Use a new tube for each infant to prevent spread of infection.

TOTAL SCORE

Clinical Instructor/Evaluator

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