Republic of the Philippines

Catanduanes State University

Virac, Catanduanes

COLLEGE OF HEALTH AND SCIENCES

PERFORMANCE EVALUATION CHECKLIST FOR IMMEDIATE NEWBORN CARE
NCM 107 RLE- Care of Mother, Child & Adolescent (Well Clients)
Name: ___________________________________ Score: _______________
Year/Block_________________________________ Group: ______________
GOAL: To give necessary care to the newborn after delivery.
CRITERIA FOR RATING:
5 – EXCELLENT Performs the expected behaviour in a consistent manner,
showing mastery of the procedure.
4 – VERY SATISFACTORY Performs the expected behaviour in a consistent manner, but
shows lesser mastery of the procedure
3 – SATISFACTORY Performs the expected behaviour most of the time but needs
moderate guidance to improve the performance of the procedure.
2 – FAIR Performs the expected behaviour from time to time and needs
much guidance to improve the performance of the procedure.
1 – POOR Fails to perform the expected behavior.
DIRECTIONS: Please rate the performance by checking the appropriate column; be guided by Criteria for
Rating.
PROCEDURE 5 4 3 2 1 Remarks
1. After the delivery of the head, clear the air
passages by wiping the secretions or mucus from
the baby’s mouth and nose using sterile gauze, or
aspirate secretions (PRN) with nasal aspirator or
bulb syringe if meconium is present.
2. After the delivery of the baby, place the baby at or
below the introitus for three (3) minutes (so the
fetoplacental circulation is not immediately occluded
by clamping the cord).

Get the APGAR score at one (1) minute to

determine the need for resuscitation. Then place
the baby on top of the mother’s abdomen. If the
score is six (6) or below, get the five (5) minute
APGAR score to have an accurate prediction or
prognosis regarding the survival of the baby.
3. CLAMPING and CUTTING of UMBILICAL CORD.
Grasp the cord and feel for the pulsation. If it stops,
clamp the cord with plastic umbilical clamp one (1)
inch (2-3cm) from the base, get a pair of forceps
and clamp five (5) cm from the base, and cut one
(1) cm from the cord clamp.
4. Put the identification tag on the baby’s leg or as
defined by the agency’s policy.
5. Let the baby lie on his/her abdomen and do the
 Republic of the Philippines
Catanduanes State University
Virac, Catanduanes

“skin-to-skin” contact for 30 minutes to one (1) hour

for latching, while on the mother’s abdomen.
6. During the skin-to-skin contact, be cautious not to
expose the baby unnecessarily; clean the baby,
remove the blood and spread the vernix caseosa.
7. After the skin-to-skin contact, place the baby naked
on the weighing scale and get his/her weight in
kilograms. (WT)
8. ANTHROPOMETRIC MEASUREMENTS:
Place the baby under droplight, on a clean and dry
blanket inside the crib.

Get the following circumferences in centimetre ( do

not insert your finger when taking the
measurements):
Head (HC) most prominent part of the head, at
the level of the eyebrow;

Chest (CC) at the level of the nipple;

Abdomen (AC) just above the umbilicus; and

Height (HT) from the heel of the foot to the head.

Record the data.

9. Take the temperature (T) per rectum, (to rule out
imperforate anus) following the thermometer
technique. Put on baby’s dress and diaper, keep
warm.
10. CREDE’S PROPHYLAXIS:
Open the eyelids, apply ophthalmic ointment to both
eyes, with pointed tip in slanting position starting
from the inner canthus outward.

If the mother is a suspect of STD, Crede’s

prophylaxis should be done after the delivery of the
head, right after the clearance of air passage.

Remove the excess ointment after one (1) minute

using sterile gauze.
11. Give vitamin K injection (0.1ml) to the baby’s LEFT
THIGH using the same procedure as in giving IM
injection. For pre-term baby, give 0.05ml. Give
Hepa B vaccine 0.5ml IM to the baby’s RIGHT
THIGH.
12. Wrap the baby comfortably and put him/her to
mother side.
13. Record all the data on the baby’s chart and delivery
record book.

_______________________________________
Rater’s Name & Signature/Date
Republic of the Philippines
Catanduanes State University
Virac, Catanduanes