SAN PEDRO COLLEGE

Davao City

PERFORMANCE CHECKLIST
NEWBORN CARE

Name: ______________________________________________________ Grade: ___________________

Year & Section: _______________________________________________ Date: ____________________

LEGEND: 5- EXCELLENT 4- VERY GOOD 3-GOOD 2-FAIR 1-POOR

I. PROCEDURE 5 4 3 2 1
1. Disinfects and prepares the crib before the delivery of the newborn.
2. Prepares the two (2) droplights.
3. Assemble all equipment.
4. Performs medical handwashing then, disinfects hand using sanitizer.
5. Prepares Kidney basin as waste receptacle.
6. Prepares the hypotray:
a. 4 Cotton Balls ( 2 dry; 2 soaked with alcohol)
b. Tape measure
c. Eye Ointment
d. Vitamin K Ampule
e. Tuberculin Syringe
f. Thermometer
g. Comb
7. Prepare medications. (Terramycin ointment; Vitamin K)
8. Washes hands and don a pair of working gloves.
9. Upon receiving the newborn , checks the ID band; weighs the baby, provides warmth,
checks for bruises and deformities.
10. Takes Vital Signs for 1 full minute( RR, CR, rectal Temp)
11. Takes the Anthropometric Measurements accurately and record it.
12. Restrain the upper and lower extremities.
13. Applies Crede’s Prophylaxis properly from inner to outer canthus
14. Gets 1 sterile cotton ball with alcohol and disinfects the site for intramuscular
injection.
15. Injects the vitamin K correctly into the vastus lateralis, and applies light pressure using
dry CB.
16. Releases the restraints from the upper and lower extremities.
17. Takes the vital signs (RR,CR,Temp:axillary).
18. Cleanses the newborn using a towel and comb.
19. Dress the Newborn:
a. Provide a clean bonnet
b. Change the newborn’s layette
c. Put on the newborn’s sterile gown
c. Put on the diaper, mittens and booties
20. Swaddle the baby.
21. Does the after care. Soaks instruments for 30 minutes in a disinfectant solution then
rinses and dries the instruments.
22. Document accurately.
23. Monitors the vital signs every 15 minutes until stable. Then, every 30 minutes X 4
takes.
II. PERSONAL ATTRIBUTES
1. Performed procedure with ease and confidence.
2. Showed interest in his/her work.
3. Attentive while doing the procedure.
4. Analyzed the importance of personal hygiene and good grooming.
5. Accepted constructive criticism and suggestions with a positive attitude.
6. Performed procedure with honesty.
7. Handled the newborn with tender loving care.
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COMMENTS:

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CLINICAL INSTRUCTOR’S SIGNATURE DATE