Checklist Delivery

Name of Student:
Year & Section:

DELIVERY ROOM
I. LABOR ROOM 5 4 3 2 1
A. Establish rapport with the client and family
B. Able to evaluate the mother's status based on:
1. Accurate history taking (LMP, EDC, AOG
2. Assess the physical and psychological condition of the mother (including FH, FHT)
3. Identifies possible risk factors
C. Able to monitor the client's condition and progress of labor:
1. Accurate taking and recording of vital signs
2. Monitoring progress of labor through uterine contraction (Duration, interval, frequency,
Intensity)
3. Monitoring FHT & records accurately
D. Shows patience and understanding of the mother's condition
E. Able to answer specific questions by the mother regarding labor and delivery
F. Provides comfort and safety measures like positioning, non-pharmacologic control of
pain, regular voiding, physical care, etc.
G. Maintaining hydration/nutritional needs
II. PREPARATION/SET-UP OF STERILE TABLE
A. Applies the principles and techniques of skin preparation sharing, perineal flushing, etc.)
B. Selects pertinent supplies/equipment/instruments pertinent to the care
C. Does skin preparation with minimum supervision ( ) Applicable ( ) N/A ( )
III. SKIN PREPARATION ( ) applicable ( ) N/A
A. Applies the principles of asepsis when opening items
B. Does skin preparation with minimum supervision
C. Maintains patient's comfort and privacy during the procedure
IV. DELIVERY ROOM
A. Applies the principles of asepsis throughout the delivery
B. Maintains a supportive and patient attitude towards mother
C. Attends to the normal delivery of the baby
1. Assists mother in proper position at the DR table
2.
3. Cleanse vulva and perineum
4. Actual handling of delivery of the baby:
4.1 Knowledge of the mechanism of labor
4.2 Proper handling of the baby after the delivery
4.3 Proper cord cutting
5. Actual placental delivery
5.1 Knowledge of the signs of placental separation
5.2 Actual delivery of the placenta
6. Vital signs monitoring
7. Proper technique in newborn care
7.1 Keeping airway clear
7.2 Keeping baby warm
7.3 Able to cord care aseptically
7.4 APGAR scoring vital signs
7.5 Taking anthropometric measurement
8. Initiation of latching-on
8.1 Knowledge of the reason for latching-on and able to explain it to mother
8.2 Proper teaching in latching-on
9. After care in the delivery room
V. WARD CARE
A. Rooming-in done properly
B. Health teaching done properly
C. Monitoring vital sign
D. Providing comfort to both mother and baby
(HIGHEST POSSIBLE SCORE) Total
(CATEGORY WITH N/A CHECKED) Total
Name of Student:
Year & Section:
CORE COMPETENCIES Score Remarks

A. SAFE AND QUALITY NURSING CARE
1. Establishes and maintains patent airway
2. Places baby in skin-skin contact on mother's abdomen or chest
3. Suctions mouth and nose of the newborn when necessary.
4. Dries newborn and keeps baby warm.
Places under droplight as necessary
5. Performs and interprets APGAR scoring correctly
Immediate after delivery
After 5 minutes
6. Clamps the umbilical cord after pulsations stops around 1-3 minutes
Disinfects area properly according to hospital policy
Clamps and cuts cord 1 inch from the abdomen
Checks for the presence of 2 arteries and 1 vein.
Dresses cord aseptically according to hospital policy.
7. Performs physical assessment.
8. Latches newborn to the mothers breast immediately after birth for at least 90
minutes.
9. Encourages breastfeeding.
10. Stimulates rooting and sucking reflex of baby.
11. Applies CREDE's prophylaxis on both eyes aseptically.
12. Takes anthropometric measurement including weight, head, chest and abdominal
circumference.
13. Take vital signs (temperature per rectum to check patency).
14. Apply credes prophylaxis on the eyes
15. Administers Vitamin K (1mg/IM) into the left lateral anterior vastus lateralis.
16. Administers Hep B vaccine (0.5ml/m) into the right lateral anterior vastus lateralis.
17. Performs bathing after 6 hours of age.
18. Keeps baby wrapped warmly under drop light or bedside mother according to
institutional policy until discharge.
19. Ensures proper identification of newborn (name tag: mother's name, date and time
of delivery, gender and baby's name, physician)
20. Record pertinent observations and nursing care done.
21. Reports any signs of deviation/ abnormality to the pediatrician
B. MANAGEMENT OF RESOURCES, ENVIRONMENT AND EQUIPMENT
1. Prepares instrument and equipment needed:
 Suction bulb, cord clamp, gauze, cotton balls, disinfectant, blanket, bonnet,
vitamin K, Ophthalmic ointment, rectal thermometer, tape measure, weighing
scale.
2. Ensure use of sterile equipment during immediate care of the newborn.
3. Maintains adequacy of supplies as newborn care is rendered
4. Maintains orderliness of the working area
5. Observes precautionary measures related to use of the electrical equipment
6. Ensures warm and quite environment
7. Uses supplies diligently
8. Ensured proper disposal of hospital waste
C. HEALTH EDUCATION
1. Provides instructions to the mother on daily cord care and prevention of cord
infection.
2 Provides discharge instructions to the mother on when to expect cord to fall off or to
report signs of cord infection.
3. Provides information regarding newborn screening, Immunization, feeding, etc.
4. Responds to questions of mothers and relatives regarding expectations.
D. LEGAL RESPONSIBILITIES
1. Identifies newborn by comparing ID Band with data in the chart.
2. Documents all permanent data correctly and completely
3. Reports accurately any deviations, abnormal findings and nursing Interventions
rendered
4. Ensures that birth certificate and other civil registration forms are accomplished/
filled out according to institutional policy.
E. ETHICO-MORAL RESPONSIBILITIES
1. Respects the religious, cultural and ethnic practices of the family of the newborn
2. Maintains privacy and confidentially of findings of the assessment
F. PERSONAL AND PROFESSIONAL DEVELOPMENT
1. Updates oneself with the latest trends and developments in newborn care
2. Projects a professional image of a pediatric nurse
3. Accepts criticisms and recommendation
4. Performs functions according to standards.
G. QUALITY IMPROVEMENT
1. Identifies deviation of practice from the standards.
2. Recommends corrective and preventive measures for the identified deviations.
H. RESEARCH
1. Identifies researchable problems related to labor and delivery
2. Initiates a research study on an identified researchable problem.

3. Participates as a member of research team in the conduction of a research study.
4. Utilizes findings or research studies in the immediate care of newborn]
I. RECORDS MANAGEMENT
1. Documents accurately relevant data about the newborn
2. Maintains an organized system of filling and keeping records
J. COMMUNICATION
1. Utilizes appropriately all forms of communication: verbal, non-verbal, electronic
2. Informs mother of relevant information about the newborn
3. Listens attentively to mother and family members' queries and requests
K. COLLABORATION
1. Functions effectively as a team player in the nursery
2. Communicates findings of assessment to all concerned
3. Establishes collaborative relationship with members of the health team and family of
the newborn.
Evaluated By:
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Checklist Delivery

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Name of Student:

Year & Section:

CORE COMPETENCIES Score Remarks

2. Initiates a research study on an identified researchable problem.

Signature over Printed Name Signature Over Printed Name

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