Professional Documents
Culture Documents
College of Nursing
PR bpm RR cpm
________________________
Name and Signature
Nurse on Duty
Patient (Initial): _______________________
___________________________________
___
HANDLED CASE # 1
Name of Hospital/Facility:
Assisted by:
Newborn Care by:
Evaluated by:
Concurred by:
_________________________________
Signature over Printed Name Date: ____________________
(Clinical Instructor)
Republic of the Philippines
Cebu Normal University
COLLEGE OF NURSING – UNDERGRADUATE & GRADUATE STUDIES
CENTER OF EXCELLENCE IN NURSING
Level III Re-Accredited Status (AACCUP)
Osmeña Boulevard, Cebu City, Philippines Contact
No. (032) 254-4837 (telefax)
E-mail Address: cnucollegeofnursing@#live.com.ph
DESIRED ACTUAL
INTRA-PARTAL COMPETENCIES RATING RATING
MCN Coordinator
Clinical Instructor License Number:
License Number: PRC Card – Validity Date:
PRC Card – Validity Date:
Name of Hospital/Facility:
Handled by:
Newborn Care by:
Evaluated by:
Concurred by:
125
PERFORMANCE RATING SCALE FOR ASSISTING DELIVERIES
Name: Date:
Area: Level:
Levels of Achievement
No. Procedure 4 3 2 1
1 Ascertains obstetric history of mother and nature of progress of labor
2 Does medical hand washing.
3 Positions patient on the delivery table, elevate patient’s legs simultaneously
and position in padded stirrups, adjusting to leg length.
4 Prepares sterile set, supplies, drapes and equipment needed in the delivery.
5 Assists in the cleaning of the perineal area and draping the patient.
6 Washes hands, dry with sterile towel then wear sterile gloves aseptically.
7 Supports the perineum by applying pressure using palm of the hands every time
the mother bears down until the baby’s head is out.
8 Releases perineal support when the baby is out then get OS and wipe mucus
from baby’s nose and mouth.
9 Notes the time of delivery and the status of the baby.
10 Assists in the delivery of the placenta.
11 Notes the time of the delivery of the placenta as well as its presentation and
completeness.
12 Assesses the status of the perineum.
13 Assists in the repair of the episiotomy or laceration if necessary.
14 Performs perineal care and provides clean diaper and changes soiled gown.
15 Cleans used instruments and packs thereafter
16 Cleans up used DR table, basins, and etc.
17 Assists in the completion of DR records.
____________________________
Student’s Name & Signature
Rating: _______________________
____________________________ Date: ________________________
Clinical Instructor’s Name & Signature
IMMEDIATE CARE OF THE NEWBORN CASE # 1
Anthropometric Measurements:
Length: _____________ cm Weight: ___________ grams
Attending Physician:
Name of Hospital/Facility:
Handled by:
Assisted by:
Evaluated by:
Concurred by:
Date: ___________________________
Signature over Printed Name
(Clinical Instructor)
Republic of the Philippines
Cebu Normal University
COLLEGE OF NURSING – UNDERGRADUATE & GRADUATE STUDIES
CENTER OF EXCELLENCE IN NURSING
Level III Re-Accredited Status (AACCUP)
Osmeña Boulevard, Cebu City, Philippines Contact
No. (032) 254-4837 (telefax)
E-mail Address: cnucollegeofnursing@#live.com.ph
__________________________________
(Student’s Signature over Printed Name)
MCN Coordinator
Clinical Instructor License Number:
License Number: PRC Card – Validity Date:
PRC Card – Validity Date: