ST. SCHOLASTICA’S COLLEGE TACLOBAN, INC.

Maharlika Highway, Brgy. Campetic, Palo, Leyte

COLLEGE OF NURSING

Name: _____________________________________ Year/Section_________

Date: ___________________ Score: ______________
PROCEDURE: ESSENTIAL INTRAPARTUM AND NEWBORN CARE (ASSIST)

PERFORMANCE POINTS
1 A. KNOWLEDGE 2 1 0 CI’s
REMARKS
1. Concept of EINC
2. Thermoregulation (Mechanism
of Heat loss)
3. APGAR Scoring
4. Ballard’s Scoring
5. Naegele’s Rule

B. SKILLS/ABILITY CORRECTLY INCORRECTLY NOT CI’s

DONE (2) DONE (1) DONE (0) REMARKS
2 ✓ Wash hands and wear
clean gloves.
3 ✓ Assessment of the
patient:
• Check the vital
signs of the
laboring mother.
• Assess for the
fetal heart tone
and fundal
height.
• Vaginal exam
(IE) by the
physician.
4 ✓ Assist for IV insertion
and administering
intravenous fluid to the
patient and other
procedures in the DR
(catheter insertion,
administering oxygen,
CTG monitoring, etc)
5 ✓ Prepare Oxytocin prior to
delivery and keep in the
fridge.
6 ✓ As soon as the newborn is
delivered, document the
 time of birth, seconds
included.
7 ✓ Inject 10 IU of Oxytocin
IM (deltoid) to the mother
after the newborn is
delivered.

8 ✓ As soon as the placenta is

delivered, document the
time the placenta is out.
9 ✓ Check the mother’s vital
signs (BP, HR, RR and
temperature) every 15
minutes for the 1st hour
then every 30 minutes for
the 2nd hour and
document in proper
records.
10 ✓ Assist in recording the
anthropometric
measurements and giving
injection to the newborn.
11 ✓ Tidy the work area after
the procedure is done.
12 ✓ Perform hand hygiene.
C. ATTITUDE
13 ✓ Demonstrate
preparedness, readiness
and confidence in the
performance of the
procedure.
✓ Answers questions
politely and tactfully.
✓ Observe proper decorum
and behave as a mature
student nurse.
✓ Accepts corrections /
suggestions and shows
willingness to improve
performance.

Score/ 26 x 50 + 50 = grade

Evaluated by: Conforme:

___________________________ _______________________________
Clinical Instructor Name and Signature of Student