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
(ACTUAL DELIVERY)

PERFORMANCE POINTS
A. KNOWLEDGE 2 1 0 CI’s
REMARKS
1 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 ✓ Perform hand hygiene
3 ✓ As per hospital’s
protocol, arrange needed
supplies/instruments in
linear fashion on the
Mayo table.
-gauze/ cherry
-umbilical cord clamp (1)
-clamp forceps (1)
-umbilical cord scissors/surgical
scissors (1)
-needle holder (1)
-tissue forceps (1)
-suture (chromic 2.0) (1)
-5 cc syringe (for Lidocaine) (1)
4 ✓ At perineal bulging,
wear sterile gloves.

5 ✓ Observe for cardinal

movements of labor.
Encourage the mother to
bear down.
6 ✓ Deliver the baby
following the modified
Ritgen’s Maneuver.
7 ✓ Call out the time of
birth, seconds included.

8 ✓ Place the newborn on

the mother’s abdomen
for skin to skin contact.

9 ✓ Palpate for cord

pulsations. Allow the
cord pulsations to stop.

10 ✓ Clamp the cord at 2

centimeters from the
umbilical base.

11 ✓ Apply the 2nd clamp at 5

centimeters from the
base of the umbilicus.

12 ✓ Cut the umbilical cord.

13 ✓ Observe for signs of
placental separation.

❖ Student must recite the

signs of placenta
separation.
14 ✓ Deliver the placenta and
check for its
completeness. Call out
the time placenta is out.
15 ✓ Check on the mother’s
condition. Observe for
vaginal bleeding.
16 ✓ Assist the physician for
episiotomy/laceration
repair as needed.

17 ✓ Perform perineal care to

the mother.

18 ✓ Clean the instruments

used.

19 ✓ Perform hand hygiene.

20 ✓ Document the
procedure.
C. ATTITUDE
✓ 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/ 40 x 50 + 50 = grade

Evaluated by: Conforme:

___________________________ _______________________________
Clinical Instructor Name and Signature of Student