CALAMBA DOCTORS’ COLLEGES

Parian, Calamba City, Laguna

Performance Evaluation Checklist

Name: ________________________ Date: _______________

Year and Section: _______________

Instruction: Rate the nursing skill performance of the student based as follows: 5 = Perfect (91-100), 4 = Very
Satisfactory (85-90), 3 = Satisfactory (80-84), 2 = Poor (79-75), 1 = Need Improvement (74 and below)

Essential Newborn Care

Preparation 5 4 3 2 1 Comments
1. Explain the procedure, the indications for, and the information that
will be obtained.
2. Wash hand
3. Assemble equipment
Equipment and Supplies
1. Sterile gloves, suction bulb (if needed) suction machine (if
applicable ), suction tip (preferably f.8 , if applicable) cord clamp
gauze, cotton balls, disinfectant, blanket , droplight, Vitamin K,
Hepatitis B , ophthalmic ointment
Procedure
1. Ensures all the available equipment needed for the newborn care

2. Wash hands and apply gloves (double gloving may apply)

3. Once the baby is out in the perineum, call out the time of birth
4. Use the first linen to dry the newborn. Dry the baby for at least 30
seconds. Suction if necessary.
5. Assess the baby while doing the drying. Remove the wet cloth.
6. Performs and interprets APGAR scoring.
Immediately after delivery
Assess after 5 minutes
7. Apply CREDE’s prophylaxis (eye ointment) both eyes, inner to
outer canthus.
8. Latches newborn immediately after birth, promote skin to skin
contact, put a dry cloth on the newborn to prevent hypothermia
9. Ensures proper identification of newborn ( name tag , name of
mother, date and time of birth, gender and attending physician’s
name)
10. Remove old gloves and replace with a new sterile glove. Performs
cord dressing using aseptic technique.
Disinfects area properly according to hospital policy
Check the 2 arteries and one vein.
Once pulsation stops, clamps and cut cord 2cm from the
umbilicus base
Dress the cord in aseptic technique and according to hospital
policy
11. Record anthropometric measures ( weight, head, chest abdomen
circumference and length)
12. Administer Vitamin K (1mg /IM ) Left anterior thigh and Hepa B
vaccine(0.5ml/IM) on Right anterior Thigh or vastus lateralis
13. Keeps baby warm by putting clothes with wrap under the droplight
or beside the mother , continuing proper breastfeeding ( or
according to hospital institution)
14. Record pertinent observations and nursing care done
15. Report any signs of abnormalities or any signs of deviation to the
resident on duty or pediatrician
Ave. Score =
Grade: __________
Evaluated by:

__________________________
Clinical Instructor