PERFORMANCE CHECKLIST

LEOPOLD’S MANEUVER

Name: _______________________________________ Grade: ________________

Year and Sec.: ________________ Date: _________________

Legend: 5 – Excellent; 4 – Very Good; 3 – Good; 2 – Fair; 1 – Poor

Rating
1 2 3 4 5
1. Wash hands.
2. Explain the procedure to the patient.
3. Let the patient empty her bladder deviate before the
procedure.
4. Position the patient on supine with one while pillow
under her head and with knees slightly flexed.
5. If right handed, stand at women’s right, facing the
patient.
6. First maneuver – Face the patient and palpate the
uterine fundus to determine what part of the fetus lies
in the upperpart of the fetus.
7. Second maneuver – Palpate in a downward direction
on the sides of the abdomen of applying gentle but
deep pressure to determine the position of the fetal
extremities, fetal back and anterior shoulder.
8. Third maneuver – Place one hand over the symphysis
pubis and grasp the lower uterine at segment between
the thumb and fingers feel the presenting part.
9. Fourth maneuver – Turn and face the woman’s the
feet to confirm the findings of the third maneuver and
determine the flexion of the fingers into the pelvis.
10. Locate again the back of the fetus and place the
stethoscope over it and listen to the fetal heart tone for
one full minute.
11. Note the location, rate and character of FHT.
12. Make the patient comfortable.
13. Document the observation made; the fetal findings
presentation, position, attitude and whether engaged or
floating.
14. Maintains body mechanics throughout the
performance of the procedures
15. Manifests neatness in the performed procedure.
16. Receptive to criticisms.
17. Observes courtesy.
18. Shows calmness while performing the procedure.
19. Uses correct English.
20. Shows mastery of the procedure.
Comments:

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Criteria: I. Knowledge (quiz) 30%

II. Skills/ Performance 60%
III. Attitude 10%
100%

_______________________________ _______________________
Student’s Printed Name and Signature Date

_______________________________ _______________________
Instructor’s Printed Name and Signature Date
 PERFORMANCE CHECKLIST
IMMEDIATE NEWBORN CARE

Name: _______________________________________ Grade: ________________

Year and Sec.: ________________ Date: _________________

Legend: 5 – Excellent; 4 – Very Good; 3 – Good; 2 – Fair; 1 – Poor

Rating
1 2 3 4 5
1. Provide additional warmth with droplight.
2. Wash hands & Don Gloves.
3. Skin to Skin (30mins) tap dry the newborn.
Assess Newborn’s condition;
a. Color lip & feet for cyanosis/jaundice
b. CR baby’s back=bell Steth
c. Suction 1st Mouth then Nose (mouth breather)
d. RR (1=rise & fall)
e. Apgar Scoring & Identification band.
f. Go to Crib with baby
4. Restrain Upper & Lower Extremities.
5. Apply Crede’s Prophylaxis from inner cantus to outer
repeat to the other eye on slanting position to prevent
injury. Eye prophylaxis to prevent gonococcal & eye
infections.
6. Prepare Vitamin K (aquamephyton) to prevent
bleeding. [Term 0.1mg & Preterm 0.5] disinfect
w/alcohol = 90 degree injects middle 3rd lateral
aspect of thigh vastus lateralis.
Additional:
Hbsag = 0.5 Vastus Lateralis = disinfect
w/sterileH2O.
BCG = 0.1 disinfect with sterileH2O
• Boy-upper arm
• Girl-upper buttock (aesthetic purposes prevent scar)
7. Prepare:
a. 2 sterile forceps & 1 surgical scissors in sterilized
hypodermic tray.
b. 8 pus of dry CB on kidney basin.
c. 4 CB with alcohol & 4 CB betadine.
d. Put sterilized OS on sterilized lining.
e. Open 1 cord dressing pack & drop on lining.
f. Slip rubber ring on the tip of forceps & place it
back securely under the hypotowel.
8. Disinfect the cord with 4 CB of alcohol from base
going outward. 1 at a time in circular motion.
9. Disinfect the cord with 4 CB of betadine from base
going outward. 1 at a time in circular motion.
10. Place sterilized OS at the base of the cord.
11. Measure the cord 1 ½ inches from basic & used
forceps (stump).
12. Used cord clamp (base) on cord again about 1 inch.
13. Cut the cord with sterilized surgical scissors.
14. Express out remaining blood from the cord stamp
with OS place on base of cord.
15. Disinfect the stump with 4 CB of alcohol & disinfect
the stump with 4 CB of betadine.
16. Take anthropometric measurement: record on
notebook;
a. Head Circumference: 33-35cm (eyebrow)
b. Chest Circumference: 31-33cm (nipple)
c. Abdominal Circumference: 32-37cm (umbilical)
d. Length: 48.5 – 53.75cm (crown head to heel)
17. Take the rectal temperature
(AGA-36.5-37. 5°C; Premature- 35.5-36.5° C)
18. Wrap the Newborn with clean baby’s blanket.
19. Hold the baby in football grip manner/folding ear
close.
20. Put shirt, diaper, mittens & wrap with blanket.
21. Wrap baby surely with clean blanket exposing the
hand with wrist band.
22. Position the baby appropriately to facilitate drainage:
a. Trendelenburg (\) – to facilitate drainage/
secretions using suction bulb (normal).
b. Semi-Fowler (⁄) – prevent the increase intracranial
pressure (vacuum extraction, forceps extraction &
CS.)
23. Provide drop light over the crib
24. Attach crib tag
25. Document pertinent observations.
26. Manifests neatness in the performed procedure.
27. Receptive to criticisms.
28. Observes courtesy.
29. Shows calmness while performing the procedure.
30. Uses correct English.
31. Shows mastery of the procedure.
Comments:

_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

Criteria: I. Knowledge (quiz) 30%

II. Skills/ Performance 60%
III. Attitude 10%
100%

_______________________________ _______________________
Student’s Printed Name and Signature Date

_______________________________ _______________________
Instructor’s Printed Name and Signature Date