University of Southern Mindanao COLLEGE OF HEALTH SCIENCES Kabacan, Cotabato INDIVIDUAL SIMULATION PERFORMANCE EVALUATION ACHIEVING INTRA-PARTAL AND NEWBORN CARE Name: Date: Year and Sectio Clinical Instructor: SCALE INTERPRETATION ‘DESCRIPTION The student answers, performs and Highly Competent | execute these steps and is observable '90-100% accurately 5 The student answers, performs and Very Competent | execute these steps and is observable : 70-89% accurately The student answers, performs and Competent —_ execute these steps and is observable 3 50-69% accurately The student answers, performs and Fairly Competent | execute these steps and is observable 2 31-49% accurately The student answers, performs and "Not Competent/Needs | «ecute these steps and is observable Improvement om Procedures 3S 4 3 2 FY ‘SAFE AND QUALITY NURSING CARE (SQC) 1. {Obtains obstetrical history including parity, gravida score, LMP, EDC, AOG, BOW, onset of true labor. [Checks vital signs [Conducts physical examination Performs Leopold's Maneuver [Checks fetal heart rate and fundic height Monitor progress of labor/uterine contractions as to: 2. Frequency b. Duration lc intensity |. interval [Observes for timely rupture of membrane [Coaches mother on process of labor I [PRIOR TO WOMAN'S TRANSFER TO DR Ensures that the mother 1s in her position of chorea] while in labor. 10 [Asks mother if she wishes to eat or drink or void.uu Communicates with the mother — informs her of — progress of labor PERFORMS FUNCTIONS DURING ACTUAL LABOR. R ransports clients safely while providing privacy WOMAN ALREADY IN THE DR PREPARING FOR DELIVERY 3 [Check’s temperature in DR area to be 25-28 14 [Ask woman if she is comfortable in the semi-upright position (the default position of delivery table). 15 Places mother in lithotomy position 16 [Ensures woman privacy v7 [Removes all jewelry then wash hands thoroughly lobserving the WHO 1-2-3-4-5 procedure. 38 Prepares a clear, clean newborn resuscitation area jon a firm and fiat surface. Checked the equipment if, clean, functional and within easy reach 8 [Prepares room, instruments and equipment needed (sterile drape, sterile instruments and equipment, kelly pad, disinfectant) 20 Arranges materials/supplies ina linear sequence: sterile gloves ~ 72 sets iF solitary health care worker ib. 2.pcs. of dry towels/tinen Jc. 1 bonnet 6. Oxytocin 20IU and sterile syringe for IM injection je. 1 pe. (cc) syringe {Sterile plastic cord clamp or cord tie lg. Sterile instrument clamp or forceps lh. Sterile pair of scissors (separate from that used. for episiotomy, if done) i. Kidney basin |. Receptacle for placenta, container with 0.5% [chlorine for soiled gloves and instruments Newborn Care interventions/Supplies (after the first] breastfeed, approximate 1-2 hours after birth) ja. Eye prophylaxis ~ erythromycin or tetracycline lb. Stethoscope Jc Vitamin K ampule; cotton balls; sterile syringe (2c) for 1M injection Jd. Antichepatitis B vaccine; cotton bi syringe (1¢c) for IM injection Je. BCG vaccine; cotton balls; sterile syringe for 1D injection is; sterileCleanses perineum with antiseptic solution 21 |ipetadine) using sterile technique 2 |Washes hands and put 2 pairs of gloves aseptically. ( ifsame worker handles perineum and cord) 23 [Wears gown and gloves according to hospital policy 1 [AT THE TIME OF DELIVERY [Coaches mother on breathing and pushing 24 |rechniques 25 [Encourages woman to push as desired, 26 {Drapes the clean, dry linen over the mother’s} jabdomen or arms in preparation for drying the baby. [Applies perineal support and does controlled delivery 27 lof head. 28 [Perform Ritgen’s Maneuver safely 29 [Delivers the baby carefully 30 [Checks and manages cord recoil correctly 31 [Calls of time of birth and sex of baby 32 [Informs the mother of outcome [FIRST 30 SECONDS [Thoroughly dries the baby for at Teast 30 seconds starting from the face and head, going down to the| trunk and extremities while performing a quick check| for breathing, 33 34 [Establishes and maintains patent airway [DURING THE 1-3 MINUTES [Removes the wet cloth and places baby in skin-to- 35 skin contact on the mother’s abdomen and chest [Covers baby with dry cloth and the baby’s head with] 36 Ja bonnet. 37 [Performs and interprets APGAR scoring correctly. 38 [Place identification band on ankle 43g | Excludes a 2 baby by palpating the abdomen in preparation for giving oxytocin [Gives IM oxytocin within 1 minute of baby’s birth 40 after wiping the soiled gloves with the wet cloth. Dispose wet cloth properly |Removes 1” set of gloves after positioning the baby| for cord clamping. Decontaminates the gloves (in| 0.5% chlorine solution for at least 10 minutes). a 42 [Palpates umbilical cord to check for pulsations, [After pulsations stopped, clamps the umbilical cord 43 [using the plastic clamp or cord tie 2cm from the base correctly 144 [Places the instrument clamp Scm from the base and} |cut near plastic clamp correctly (nat midway),F MANAGEMENT OF THE THIRD STAGE OF LABOR| |(AMITSL) lWaits for strong uterine contractions then apply 45 |controlled cord-traction and counter-traction on the uterus, continuing until placenta was delivered. 6 [identifies signs of placental separation [Checks the characteristic/ completeness of the 47 [placenta 48 [Assesses amount of blood loss (Normal: <500cc) lEmploys interventions to achieve and maintain a well contracted uterus to prevent/control hemorrhage. 49 a. uterine massage [b. correct administration of oxytocin lc. cold compress aspects The Tower VERING STG BETTEUM TOT 50 |lacerations/tear and repairs lacerations/tears, as necessary 51 [Assists in episiorrhaphy (if needed) 52 |Checks size, consistency, and location of uterus qa [Meanses the mother: does perineal flushing and applies perineal pad/napkin/cloth 54 I checks baby’s color and breathing (APGAR scoring); [Check that mother is comfortable and that uterus is contracted. 55 Provides emotional support to the mother oe throughout labor and delivery. [Disposes of the placenta in a leak-proof container o7| 57 Iplastic bag. [Decontaminates (soaked in 0.5% chiorine solution) 58 [instruments before cleaning; decontaminates 2nd pair of gloves before disposal, stating that Idecontamination lasts for at least 10 minutes. [Advises mother to maintain skin-to-skin contact. 59 [Baby should be prone on mother's chest/in between the breast with head turned to one side. [Evaluates patient's and bab'ys condition and records pertinent data accordingly. [BY 15-90 MINUTES [Advises mother to observe for feeding cues and cites © lexamples of feeding cues [Supports mother, instructs her on positioning and © Jattachment. (63 |Waits for full breastfeed to be completed. er a complete breastfeed, administers eye] ointment (first), 65 [Proceeds to the physical examination,Fe [performs vital signs Ipedorms anthropometric measurement {head} 67 lenest, abdominal circumference, length), & [Weighs the baby. IGives the vitamin K Injection Teimultaneoushy} 69 | explains the purpose) Gives the hepatitis B injection TamnaTaneoTsTy 70 Jexplains the purpose) ives the BCG injection [simUTaneOUsT SPITE Te 7} |purpose) fadvises OPNONAT 7 DECAYED bathing of baby Tard n was able to explain the rationale) 73 [Advised breastfeeding per demand [Records pertinent observations and nursing care] 74 \done. Gy [Revers any signs of de S pediatrician. [| MANAGEMENT OF RESOURCES, ENVIRONMENT, ion/abnormality to the| |AND EQUIPMENT [Maintains adequacy of supplies as the delivery] 78 lorogresses 77 [Maintains orderliness of the sterile table 78 [Ensures a quiet environment 78 [Uses supplies diligently Performs aftercare of the materals and equipments} 80 lused, fEnsures proper disposal of Rospltal waste including] 82 |lood and other fiuids IN THE FIRST HOUR eck’s baby's DreaiNing and Cola and CheCTS 2 |mother’s vital signs and massage uterus every 15 minutes. [INTHE SECOND HOUR [Checks the mother and the baby every 30 minutes to 83 | hour. 84 [Completes al records, Vi [HEALTH EDUCATION ‘ag | Teaches client on basic preparation during labor and] |delivery (can be done in the labar room) [Demonstrates proper "latch-on” breast feeding| technique (done past partum period) 127 [ONES instructions to parents regarding infant care| before discharge (done post partum period) Provides discharge instructions az to feeding bathing * administration of ordered medications, 88 Jappointment dates for post natal and well baby| check up (done post partum period) gq | Provides instructions to the mother on dally cord |care and prevention of cord infection,[—Jrranies decharge Tstructions t6 the mother on when to expect cord t0 fall off oF to report signs of cord infection Provides information regarding newborn] 91 |screening,immunization, feeding, etc. Responds to questions of clients and relatives| 22 Jregarding expectations Vil [LEGAL RESPONSIBILITIES | —fSecares informed consent iy all procedures related 93 | labor and delivery. Reports honestly and accurately the gender, time o 94 delivery of the baby and placenta Documents all_pertinent data correctly and] 95 |completely identifies newborn by comparing 10 band with data 96 Tin the chart. Documents al perinent data —correetly and] a jcompletely. Reports accurately any deviations/abnormal maine 98 | and nursing interventions rendered Vili ETHICO-MORAL RESPONSIBILITIES 49 [Respects the religious, cultural, and ethnic practices| lof the family of the woman in labor and delivery 100 promotes emotional security by supporting needs 101 [Ensures privacy and confidentiality, 1X [PERSONAL AND PROFESSIONAL DEVELOPMENT Projects a professional image ofa delivery room 102 I nurse 103 |projects a professional image ofa pediatric nurse 104| Accepts criticisms and recommendations 105 [Performs functions according to standards X_[COMMUNICATION [Utilizes appropriately all forms of communication; 106} verbal, non-verbal,electronic Informs client's significant others of the POL and 107 laetivery. Listens attentively to clients and family's queries and requests. 108 X1_ [COLLABORATION AND TEAMWORK Functions effectively as a team player in the delivery 109] 110] Communicates the progress of labor 13 [Es*2blshes collaborative relationship with members lof the health team and family members Percentage Score: =