CENTRO ESCOLAR UNIVERSITY

Manila * Makati * Malolos

SCHOOL OF NURSING

PROCEDURE CHECKLIST
Newborn Skills Procedure

Name of Student Score

Year/Section/Group/Number

Rate the student's performance by checking the appropriate box using the following criteria:
5 - Excellent (Carries out procedures efficiently, systematically and independently/Personality trait is
observed at all times)
4 - Very Satisfactory (Carries out procedures efficiently and systematically but requires minimal guidance
and supervision/Personality trait is observed at all times)
3 - Satisfactory (Carries out the procedures efficiently and systematically but requires moderate guidance
and supervision/Personality trait is observed at all times)
2 - Fair (Carries out the procedures efficiently and systematically but requires close guidance and
supervision/Personality trait is observed at all times)
1 - Poor (Carries out the procedures inefficiently, unsystematically even under close guidance and
supervision/Personality trait is observed at all times) 0 - Not done

Criteria 5 4 3 2 1 0
ASSESSMENT

1. Assess the newborn's APGAR Score.

PLANNING

2. Prepare the necessary equipment,tools and supplies

needed for the procedure.
Anthropometric Measurement:
a. Infant Weighing Scale
b. Tape Measure
c. Paper Towel
d. Clean Gloves
e. Paper or small notebook
Crede’s Prophylaxis
a. Tobramycin ointment
b. Sterile gauze
c. Dry cotton balls moistened w/Normal Saline
Solution
d. Sterile Gloves
Vitamin K Injection/ Hepatitis B vaccine
a. Vitamin K ampule
b. Hepatitis B vaccine in multiple dose vial
c. TBS-Tuberculine syringes (1 for Vitamin K./1
for Hepatitis B)
d. Aspirating Needles
e. Cotton Balls w/alcohol or alcohol swab
f. Dry Cotton Balls
g. Micropore Tape
h. Sterile Gloves
IMPLEMENTATION

3.Perform Hand Hygiene , put on PPE as indicated.

4.Introduce yourself to the mother and identify the

newborn using his/her identification tag.
5. Explain the procedure to the newborn’s mother

6. Provide privacy by closing the curtains around the bed

if possible. Make sure the baby is visible to the mother.

MEASURING THE WEIGHT

7.Place light drape or paper towel on the weighing scale

and calibrate the weighing scale into “0” position.
8.Completely undress the newborn
8.1 Place the newborn gently on the center of the
weighing scale
8.2 Keep one hand over or near the newborn on the
weighing scale at all times
8.3 Reads the weight of the newborn in kg or grams
and record newborn’s weight
8.4 Place the newborn in flat surface with drape and
cover the body area not measured to prevent
hypothermia.
MEASURING THE LENGTH

9.Holds the newborn’s head at midline point and extend

his/her legs fully
9.1 Stretches tape measure from crown of
newborn’s head to heel of newborn’s foot alongside
with the newborn’s body
9.2 Record newborn’s length in centimeters.
Normal Value = 47-50cm
MEASURING THE HEAD CIRCUMFERENCE

10.Place the tape measure around the fullest part of

newborn’s brow and around occipital prominence.
10.1 Record the newborn’s HC in centimeters.
Normal Value: 34-35cm
MEASURING THE CHEST CIRCUMFERENCE
11. Measures around the chest at the nipple line
keeping the measuring tape at the same level anterior
and posterior.
11.1 Record the newborn’s CC in centimeters.
Normal Value: 31-33cm

MEASURING THE ABDOMINAL CIRCUMFERENCE

12.Place the tape measure around the newborn’s
abdomen slightly just above the level of the umbilicus
12.1 Record the newborn’s AC in centimeters.
Normal Value :31-33cm
13.Dress the newborn comfortably and securely. Place
the newborn inside a basinet to promote safety and
security.

14. Remove Gloves and discard properly and apply

ABHR (alcohol based hands rub).
CREDE’S PROPHYLAXIS

15. Wear another pair of sterile gloves.

15.1 Clean the eyelids carefully with a sterile
cotton ball moistened with sterile NSS from
inner to outer canthus of the newborn’s eye.
cotton ball moistened with sterile NSS from inner
to outer canthus of the newborn’s eye.
15.2 Retract the lower lids using your thumb and
apply prescribed antibiotic ointment in the
lower conjunctival sac from inner to outer
canthus of the newborn’s eye
15.3 Wipe off excess ointment using sterile gauze
15.4 Do the same procedure with the other eye.
15.5 Document the condition of the newborn’s
eyes. Report if there is any swelling, redness
and irritations.
VITAMIN K INJECTION
16. Observe the 10 R’s in giving medications
17. Prepare the Vitamin K by opening the ampule
17.1 Aspirate Vitamin K 0.5mg to 1.0mg or 0.1mL
using TBS (Tuberculin Syringe)

17.2 Select the site for injection: Vastus Lateralis

(Left) and cleanse the site with cotton balls
moistened with alcohol using a circular motion
from inside to outside in a one stroke and
discard the cotton balls. Prepare a sterile dry
cotton ball in between your fingers.
17.3 Using your non dominant hand, compress or
grasp the muscle tissue in between your
fingers and pierce the skin at a 90 degrees
angle.
17.4 Aspirate to check if there is backflow of
blood, if none inject the medication slowly.
17.5 Prepare the dry cotton ball towards the
injection site and immediately remove the
syringe and apply direct pressure using the dry
cotton balls and secure with a micropore tape.
17.6 Observe and document any signs of bleeding
from the injection site.
HEPATITIS B VACCINE
18. Prepare the Hepatitis B vaccine in a multiple dose
vial
18.1 Using TBS (Tuberculin Syringe), change its
needle to an aspirating needle and aspirate:
> If Engerix-B is the stock on hand = 10mcg/0.
5mL or 0.5 mL
> If Recombivax HB is the stock on hand = 5
mcg/0.5mL or 0.5 mL
18.2 Change the aspirating needle with the needle
from TBS.

18.3 Select the site for injection: Vastus Lateralis

(Right) and cleanse the site with cotton balls
moistened w/alcohol using a circular motion
from inside to outside in a one stroke and
discard the cotton balls. Prepare a sterile dry
cotton ball in between your fingers.
18.4 Using your non dominant hand, compress or
grasp the muscle tissue in between your
fingers and pierce the skin at a 90 degrees
angle.
18.5 Aspirate to check if there is backflow of
blood, if none inject the medication slowly.
18.6 Prepare the dry cotton ball towards the
injection site and immediately remove the
syringe and apply direct pressure using the dry
cotton balls and secure with a micropore tape.
 and apply direct pressure using the dry cotton balls
and secure with a micropore tape.
18.7 Remove and discard gloves properly and wash
hands.
18.8 Observe and document any signs of bleeding
from the injection site.
EVALUATION:
19. Obtain newborn’s latest vital signs.
20. Secure the newborn’s clothing completely.
21. Observe for any signs of complications.
22. Hand the newborn to his/her mother supporting
head, neck and back.
23. Encourage the mother to breastfeed her newborn.
24. Document all findings in the newborn's chart.
TOTAL SCORE:

Computation: Total Score ÷ 53 items x 20 (factor) =

*Total Points shall be transmuted using the table for 100 pts. Passing cut-off point is 6 5.

Equivalent Numeric Grade:

Interpretation:

Comments/Suggestions:

Evaluator: Conforme: Conforme:

Clinical Instruction's Student's Signature Date

Printed Name & Signature