COLLEGE OF NURSING

Silliman University Dumaguete City

PRENATAL ASSESSMENT
Performance Checklist Unsatisfactory Satisfactory REMARKS

1. Wash your hands. 2. Establish rapport with patient. 3. Compute expected date of confinement accurately. 4. Obtain vital signs and records. 5. Perform assessment methodically. a. HEENT b. Neck c. Breasts d. Heart e. Lungs f. Abdomen g. Back h. Extremities 6. Refer abnormal findings to physician prn. 7. Record findings.

Remarks:

______________________
Students Name

_____________________________
Clinical Instructors Name and Signature

Date: ______________________

COLLEGE OF NURSING
Silliman University Dumaguete City

LEOPOLD MANEUVER AND FHT EVALUATION

Performance Checklist Unsatisfactory Satisfactory REMARKS

1. 2. 3. 4. 5.

Wash your hands. Explain procedure to patient. Ask patient to void. Provide privacy. Ask patient to assume dorsal recumbent position with knees bent. 6. Drape patient properly. 7. Perform first maneuver. 8. Perform second maneuver. 9. Perform third maneuver. 10. Perform fourth maneuver. 11. State rationale in performing each maneuver. 12. State the approximate age of gestation based on Bartholomews rule of four. 13. State the position of the fetus. 14. Locate the fetal heart tone. 15. Count FHT for one full minute. 16. Distinguish maneuver from funic souffl. 17. Record findings. 18. Identifies any abnormal findings.

Remarks:

______________________
Students Name

_____________________________
Clinical Instructors Name and Signature

Date: ______________________