Cebu Normal University

College of Nursing

MONITORING PROGRESS OF LABOR

Labor Watch # 1 Date Fundal Height: cm

Name of Patient (Initial) LMP
Age OB Score
Hospital Registration No. EDC
Diagnosis Name of Physician

Time of Characteristic of Fetal

Date Contractions Duration Frequency Contractions Effacement Dilatation Heartbeat
Physiological Responses (Mother)
Vital Signs
BP mmHg T C
o

PR bpm RR cpm

Genito-Urinary: [ ] voided freely [ ] dysuria [ ] oliguria [ ] anuria

[ ] catheterized, describe the output: _________________________________________
__________________________________________________________________
Musculoskeletal: [ ] bipedal edema [ ] Homan’s sign [ ] deformities
Neurologic: [ ] seizures [ ] oriented to person, place, time
Fluids and Electrolytes: with IVF? [ ] Yes, please specify using matrix below [ ] No
IVF # IV Fluid Rate Level (in ml) Medication Added

Gastrointestinal: [ ] normal bowel movement [ ] constipated [ ] watery stool

[ ] hemorrhoids [ ] others, please specify: _______________________

Psychological Responses (Mother)

[ ] Fatigue [ ] Uncooperative
[ ] Cooperative [ ] Anxious
[ ] Fear of the Unknown [ ] Others, please specify: _______________________

Name and Signature Name and Signature

Student Clinical Instructor

________________________
Name and Signature
Nurse on Duty
Patient (Initial): _______________________

Chief complaint upon admission:

Time labor pain started:

___________________________________

___
 HANDLED CASE # 1

Name of Student: ____________________________________ Date: _______________________

Patient Name (Initial): Age:

Hospital Registration No.:
OB Scoring: G: P: T: P: A: L: M:
LMP: AOG: EDC:
Date & Time of Delivery of the Baby:
Sex of Baby: APGAR score: Ballard’s Score:
Mode of Delivery:
Date & Time of Delivery of Placenta:
Placenta: [ ] Duncan [ ] Schultz [ ] complete/intact
Postpartum Diagnosis:

Name of Hospital/Facility:

Assisted by:
Newborn Care by:

Evaluated by:

Name and Signature of Clinical Instructor

Concurred by:

Name and Signature Nurse on Duty

 Cebu Normal University
COLLEGE OF NURSING

ESSENTIAL INTRAPARTUM CARE CHECKLIST

Name of Student: Date:
Check each box if the task was done:
PRIOR TO WOMAN’S TRANSFER TO THE DR
Ensures that client is in her position of choice while in labor.
Asks client if she wishes to eat/drink or void.
Communicates with the client-informed her of progress of labor, gave reassurance and encouragement
WOMAN ALREADY IN THE DR
PREPARING FOR DELIVERY
Checks temperature in DR area to be 25-280C; eliminate air draft.
Asks woman if she is comfortable in the semi-upright position of delivery table.
Ensures the woman’s privacy.
Removes all jewelry then washed hands thoroughly observing the WHO 1-2-3-4-5 procedure.
Prepares a clear, clean newborn resuscitation area. Checked the equipment if clean, functional and within easy reach.
Arranges materials/supplies in a linear sequence:
Dry linen/s, bonnet, plastic clamp, instrument clamp, 2 scissors (Surgical & Bandage Scissors), kidney
basin/rectangular pan
Cleans the perineum with antiseptic solution.
Washed hands and put on sterile gloves aseptically.
AT THE TIME OF DELIVERY
Encourages the client to push as desired.
Drapes the woman’s abdomen with clean, dry linen in preparation for drying the baby.
Calls out time of birth and sex of the baby.
Informs woman of outcome.
Performs the remaining steps of the active management of the third stage of labor (AMTSL):
 Waits for strong uterine contractions then applied controlled cord traction (CCT) on the uterus, continuing until
placenta was delivered.
Massaged the uterus until it is firm.
Examines the placenta for completeness and abnormalities.
Disposes of the placenta according to institution’s protocol.
Advises client to maintain skin-to-skin contact with baby placed in prone position on mother’s chest/in between the
breasts with head turned to one side.
Advises woman to observe for feeding cues and cited examples of feeding cues.
Supports woman, instructed her on positioning and exclusive breastfeeding per demand.
Advises OPTIONAL/DELAYED bathing of baby (has explained the rationale).
In the first hour, checks woman’s vital signs and massaged uterus every 15 minutes, then every 30 minutes thereafter
Completes all RECORDS.
Clinical Instructor’s Remark/s:

_________________________________
Signature over Printed Name Date: ____________________
(Clinical Instructor)
 Republic of the Philippines
Cebu Normal University
COLLEGE OF NURSING – UNDERGRADUATE & GRADUATE STUDIES
CENTER OF EXCELLENCE IN NURSING
Level III Re-Accredited Status (AACCUP)
Osmeña Boulevard, Cebu City, Philippines Contact
No. (032) 254-4837 (telefax)
E-mail Address: cnucollegeofnursing@#live.com.ph

PERFORMANCE EVALUATION ACHIEVING INTRA-PARTAL CARE COMPETENCY

In accordance with PRC Board of Nursing Memorandum No. 01 Series 2009

Name of Student: ___________________ Date: _______________________

DESIRED ACTUAL
INTRA-PARTAL COMPETENCIES RATING RATING

I. SAFE AND QUALITY NURSING CARE (SOC)

1. Obtains obstetrical history including parity, gravid score, LMP, EDC, AOG, 4
BOW onset of true labor.
2. Checks vital signs 1
3. Conducts physical examination 2
4. Performs Leopold’s maneuver 2
5. Checks Fetal Heart Rate and Fundic height 2
6. Monitors progress of labor/ uterine contractions as to:
* Frequency 1
* Duration 1
* Intensity 1
* Interval 1
7. Observes for the timely rupture of membrane 1
8. Coaches mother on process of labor. 2
PERFORMS FUNCTIONS DURING ACTUAL LABOR
1. Transports client safely while providing privacy. 1
2. Places mother in lithotomy position. 1
3. Performs perineal care using sterile technique correctly. 1
4. Performs proper hand scrub. 1
5. Wears gown and gloves according to hospital policy. 1
6. Performs Ritgen’s maneuver safely. 2
7. Coaches mother on breathing and pushing techniques. 1
8. Delivers baby and placenta carefully.
 Checks and manages cord recoil correctly. 1
 Clamps and cuts the cord correctly. 1
 Identifies signs of placental separation. 1
 Checks the characteristic/completeness of the placenta. 1
 DESIRED ACTUAL
INTRA-PARTAL COMPETENCIES RATING RATING
9. Assesses amount of blood loss (Normal : <500 cc) 2
10. Employs interventions to achieve and maintain a well-contracted
uterus to prevent/control hemorrhage.
 Uterine massage 1
 Correct administration of oxytocin 1
 Cold compress 1
11. Assesses presence and degree of laceration 1
12. Assists in episiorrhaphy. 1
13. Checks size, consistency and location of uterus. 1
14. Performs perineal care and applies pad correctly. 1
15. Provides emotional support to the mother throughout labor and delivery. 1
16. Evaluates patient’s condition and records pertinent data accordingly. 2
17. Prepares patient for transfer to recovery room/ ward. 1
II. MANAGEMENT OF RESOURCES, ENVIRONMENT AND EQUIPMENT (MRE)
1. Prepares room, instruments and equipment needed
 Sterile drape 1
 Sterile instruments and equipment [ Forceps, scissors, bulb syringe, gauze, 1
suture, needle holder, catheter (optional) ]
1
 Kelly pad 1
 Disinfectant
2. Performs sterilization procedure. 1
3. Maintains adequacy of supplies as the delivery progresses. 1
4. Maintains orderliness of the sterile table. 1
5. Observes precautionary measures related to use of electrical equipment 1
6. Ensures a quiet environment 1
7. Uses supplies diligently. 1
8. Performs after care of the materials and equipment used. 1
9. Ensures proper disposal of hospital waste including blood and other fluids. 1
III. HEALTH EDUCATION (HE)
1. Teaches client on basic preparation during labor and deliver (can be done in the 1
labor room)
2. Coaches client on breathing/ bearing down technique. 2
3. Demonstrates proper “latch-on” breast feeding technique (done post-partum period) 1
4. Gives instructions to parents regarding infant care before discharge 1
(done post-partum period)
5. Provides discharge instructions as to feeding, bathing administration of ordered 1
medications, appointment dates for post natal and well baby check-up (done post-
partum period)
6. Responds to questions of clients and relatives regarding expectations. 1
IV. LEGAL RESPONSIBILITIES (LR)
1. Secures informed consent in all procedures related to labor and delivery. 1
2. Reports accurately and honestly the gender, time of delivery of the baby and placenta. 2
3. Ensures proper identification of the mother and newborn. 2
4. Documents all pertinent data correctly and completely. 1
 DESIRED ACTUAL
INTRA-PARTAL COMPETENCIES RATING RATING
V. ETHICO-MORAL RESPONSIBILITIES (EMR)
1. Respects the religious, cultural and ethnic practices of the family of the woman in 1
labor and delivery.
2. Promotes emotional security by supporting needs. 1
3. Ensures privacy and confidentiality. 1
VI. PERSONAL AND PROFESSIONAL DEVELOPMENT (PPD)
1. Updates oneself with the latest trends and development in labor and delivery. 1
2. Projects a professional image of a delivery room nurse. 1
3. Accepts criticisms and recommendations. 1
4. Performs functions according to standards. 1
VII. QUALITY IMPROVEMENT (QI) (Preferably done during post conferences)
1. Identifies deviation of practice from the standards. 1
2. Participates in audit practices in the delivery room/lying in. 1
3. Recommends corrective and preventive measures for the identified deviations. 1
VIII. RESEARCH (R ) (preferably done during post conferences)
1. Identifies researchable problems related to labor and delivery. 2
2. Utilizes findings of research studies in intra-partal care. 2
IX. RECORDS MANAGEMENT (RM)
1. Documents accurately relevant data about client. 1
2. Maintains an organized system of filing and keeping records of the client. 1
X. COMMUNICATION (Comm.)
1. Utilizes appropriately all forms of communication, verbal, non- verbal, electronics. 1
2.Informs client’s significant others of the progress of labor and delivery. 1
3. Listens attentively to clients and families queries and requests. 1
XI. COLLABORATION AND TEAMWORK (CTW)
1. Functions effectively as a team player in the delivery room/ lying in. 1
2. Communicates the progress of labor/delivery to significant others. 1
3. Establishes collaborative relationship with members of the health team and family 1
members.
TOTAL SCORE: 90

Certified True and Correct: ______________________________ Year Graduated: _______________

(Student’s Signature over Printed Name)

MCN Coordinator
Clinical Instructor License Number:
License Number: PRC Card – Validity Date:
PRC Card – Validity Date:

RLE Coordinator DEAN

License Number: License Number: ____________________
PRC Card – Validity Date: ________________
PRC Card – Validity Date:
 ASSISTED CASE # 1

Name of Student: ___________________________________________ Date: ______________________

Patient Name (Initial): Age:

Hospital Registration No.:
OB Scoring: G: P: T: P: A: L: M:
LMP: AOG: EDC:
Date & Time of Delivery of the Baby:
Mode of Delivery:
Sex of Baby: APGAR score: Ballard’s Score:
Date & Time of Delivery of Placenta:
Placenta: [ ] Duncan [ ] Schultz [ ] complete/intact
Perineum:
[ ] intact [ ] laceration, specify: _____________________________________
[ ] episiotomy, if yes please specify: _____________________________________________
[ ] edematous [ ] ecchymotic
Postpartum Diagnosis:

Name of Hospital/Facility:

Handled by:
Newborn Care by:

Evaluated by:

Name and Signature of Clinical Instructor

Concurred by:

Name and Signature Nurse on Duty

125
 PERFORMANCE RATING SCALE FOR ASSISTING DELIVERIES

Name: Date:
Area: Level:

Please check the appropriate value column:

Exemplary.............................. 4
Accomplished ........................... 3
Developing .............................. 2
Beginning ............................... 1

Levels of Achievement
No. Procedure 4 3 2 1
1 Ascertains obstetric history of mother and nature of progress of labor
2 Does medical hand washing.
3 Positions patient on the delivery table, elevate patient’s legs simultaneously
and position in padded stirrups, adjusting to leg length.
4 Prepares sterile set, supplies, drapes and equipment needed in the delivery.
5 Assists in the cleaning of the perineal area and draping the patient.
6 Washes hands, dry with sterile towel then wear sterile gloves aseptically.
7 Supports the perineum by applying pressure using palm of the hands every time
the mother bears down until the baby’s head is out.
8 Releases perineal support when the baby is out then get OS and wipe mucus
from baby’s nose and mouth.
9 Notes the time of delivery and the status of the baby.
10 Assists in the delivery of the placenta.
11 Notes the time of the delivery of the placenta as well as its presentation and
completeness.
12 Assesses the status of the perineum.
13 Assists in the repair of the episiotomy or laceration if necessary.
14 Performs perineal care and provides clean diaper and changes soiled gown.
15 Cleans used instruments and packs thereafter
16 Cleans up used DR table, basins, and etc.
17 Assists in the completion of DR records.

____________________________
Student’s Name & Signature
Rating: _______________________
____________________________ Date: ________________________
Clinical Instructor’s Name & Signature
 IMMEDIATE CARE OF THE NEWBORN CASE # 1

Student’s Name: _________________________________ Date: _______________________

Name of Newborn (Initial): Sex: Birth order:

Hospital Registration No.:
Date & Time of Delivery:
Mode of Delivery:
APGAR score: Ballard’s Score:
Medications Given:
Date Name of Time
Given Medication Route Site Amount Given

Anthropometric Measurements:
Length: _____________ cm Weight: ___________ grams

Head Circumference: __________ cm Chest circumference: ____________ cm

Mid-Upper arm circumference: _________ cm Abdominal girth: ________ cm

Newborn Diagnosis:

Attending Physician:
Name of Hospital/Facility:

Handled by:

Assisted by:

Evaluated by:

Name and Signature of Clinical Instructor

Concurred by:

Name and Signature Nurse on Duty

 Cebu Normal University
COLLEGE OF NURSING-UNDERGRADUATE STUDIES
Osmeña Boulevard, Cebu City

ESSENTIAL NEWBORN CARE CHECKLIST

Name of Student: Date:
Check each box if the task was done:
FIRST 30 SECONDS AFTER BIRTH
Thoroughly dries baby for at least 30 seconds, starting from the face and head, going down to the trunk and extremities
while performing a quick check for breathing.
1-3 MINUTES
Removes the wet cloth.
Places baby in skin-to-skin contact on the mother’s abdomen or chest.
Covers baby with dry cloth and the baby’s head with a bonnet.
Uses wet cloth to wipe the soiled gloves.
Disposes of wet cloth properly.
Palpates umbilical cord to check for pulsations.
After pulsation stopped, clamps cord using the plastic clamp or cord tie 2 cm (1 inch) from the base.
Places the instrument clamp 5cm from the base or 3 cm from the plastic clamp.
Cuts near plastic clamp (not midway).
Checks the baby’s color and breathing, checked that woman was comfortable, uterus contracted.
Advises client to maintain skin-to-skin contact with baby placed in prone position on mother’s chest/in between the
breasts with head turned to one side.
15-90 MINUTES
Advises woman to observe for feeding cues and cited examples of feeding cues.
Supports woman, instructed her on positioning and attachment.
Waits for FULL BREASTFEED to be completed.
After a complete breastfeed, administers eye ointment (first), did thorough physical examination,
then administers Vit. K 1mg at the R anterior thigh (has explained the rationale in giving each medication).
*Ensures that Hepatitis B and BCG immunizations are administered per institutions protocol
Advises OPTIONAL/DELAYED bathing of baby (has explained the rationale).
Advises breastfeeding per demand.
In the first hour, checks baby’s breathing and color every 15 minutes then every 30 minutes to 1 hour.
Completes all RECORDS.
Clinical Instructor’s Remark/s:

Date: ___________________________
Signature over Printed Name
(Clinical Instructor)
 Republic of the Philippines
Cebu Normal University
COLLEGE OF NURSING – UNDERGRADUATE & GRADUATE STUDIES
CENTER OF EXCELLENCE IN NURSING
Level III Re-Accredited Status (AACCUP)
Osmeña Boulevard, Cebu City, Philippines Contact
No. (032) 254-4837 (telefax)
E-mail Address: cnucollegeofnursing@#live.com.ph

PERFORMANCE EVALUATION ACHIEVING IMMEDIATE CARE OF THE

NEWBORN COMPETENCY
In accordance with PRC Board of Nursing Memorandum No. 01 Series 2009
Signature over Printed Name of Student: Date :
DESIRED ACTUAL
NEWBORN COMPETENCIES RATING RATING
I. SAFE AND QUALITY NURSING CARE (SOC)
1. Establishes and maintains patent airway. 3
2. Puts the newborn in Trendelenburg position. 1
3. Suctions mouth and nose of the newborn gently. 2
4. Dries newborn and wraps warmly.
 Places under droplight as needed. 1
5. Performs and interprets APGAR scoring correctly.
 Immediately after delivery 2
 After 5 minutes 2
6. Ensures proper identification of newborn (name tag, name of mother, date and time of 2
delivery, gender and name of attending physician)
7. Performs physical assessment. 2
8. Takes anthropometric measurements including weight, height, head, chest, abdominal 2
circumference.
9. Takes vital signs (temperature per rectum to check patency) 1
10. Gives oil/water and soap bath according to institutional policy. 1 N/A
11. Latches newborn to the mother’s breast immediately after birth. 1
12. Applies CREDE’s prophylaxis on the eyes. 1
13. Performs cord dressing aseptically.
 Disinfects area properly according to hospital policy 1 N/A
 Clamps and cuts cord 1 inch from the abdomen 1
 Checks for the presence of 2 arteries and 1 vein 1
 Dresses cord aseptically according to hospital policy 1
14. Administers Vitamin K (1 mg/M) into the lateral anterior thigh or vastus lateralis. 1
15. Keeps baby wrapped warmly under floor lamp or beside mother according to institutional 1
policy until discharge.
16. Records pertinent observations and nursing care done. 1
17. Reports any signs of deviation/abnormality to the pediatrician. 1
 DESIRED ACTUAL
NEWBORN COMPETENCIES RATING RATING
II. MANAGEMENT OF RESOURCES, ENVIRONMENT AND EQUIPMENT (MRE)
1. Prepares instrument and equipment needed 4
 Suction bulb, cord clamp, gauze, cotton balls, disinfectant, blanket,
droplight, Vitamin K, antimicrobial ophthalmic ointment
2. Ensures use of sterile equipment during immediate care of the newborn. 1
3. Maintains adequacy of supplies as newborn care is rendered. 1
4. Maintains orderliness of the working area. 1
5. Observes precautionary measures related to use of electrical equipment. 1
6. Ensures a warm and quiet environment. 1
7. Uses supplies diligently. 1
8. Ensures proper disposal of hospital waste. 1
III. HEALTH EDUCATION (HE)
1. Provides instructions to the mother on daily cord care and prevention of cord 2
infection.
2. Provides discharge instructions to the mother on when to expect cord to fail off or to 1
report signs of cord infection.
3. Provides information regarding newborn screening, immunization, feeding, etc. 2
4. Responds to questions of mother and relatives regarding expectations. 1
1V. LEGAL RESPONSIBILITIES (LR)
1. Identifies newborn by comparing ID band with data in the chart. 2
2. Documents all pertinent data correctly and completely. 1
3. Reports accurately any deviations/abnormal findings and nursing interventions 1
rendered.
4. Ensures that birth certificate and other civil registration forms are accomplished/ filled 2
out according to institutional policy.
5. Performs foot printing according to hospital policy. 1
V. ETHICO-MORAL RESPONSIBILITIES (EMR)
1. Respects the religious, cultural and ethnic practices of the family of the newborn. 1
2. Maintains privacy and confidentiality of findings of assessments. 1
VI. PERSONAL AND PROFESSIONAL DEVELOPMENT (PPD)
1. Updates oneself with the latest trends and developments in newborn care. 1
2. Projects a professional image of the pediatric nurse. 1
3. Accepts criticisms and recommendations. 1
4. Performs functions according to standards. 1
VII. QUALITY IMPROVEMENT (QI)
1. Identifies deviation of practice from the standards. 1
2. Participates (whenever possible) in audit practices in the nursery. 1
3. Recommends corrective and preventive measures for the identified deviations. 1
VIII. RESEARCH (R )
1. Identifies researchable problems related to immediate care of newborn. 2
2. Utilizes findings of research studies in the immediate care of the newborn. 2
IX. RECORDS MANAGEMENT (RM)
1. Documents accurately relevant data about the newborn. 1
2. Maintains an organized system of filing and record keeping . 1
 DESIRED ACTUAL
NEWBORN COMPETENCIES RATING RATING
X. COMMUNICATION (Comm.)
1. Utilizes appropriately all forms of communication, verbal, non-verbal, electronic. 1
2. Maintains an open line of communication with the mother and other 1
family members.
3. Informs mother of relevant information about the newborn. 1
4. Listens attentively to queries and requests of mothers and family members. 1
XI. COLLABORATION AND TEAMWORK (CTW)
1. Functions effectively as a team player in the nursery. 1
2. Communicates findings of assessment to all concerned. 1
3. Establishes a collaborative relationship with members of the health team and family of 1
the newborn.
TOTAL SCORE: 75

Certified True and Correct: ______________________________ Year Graduated: ______________

__________________________________
(Student’s Signature over Printed Name)

MCN Coordinator
Clinical Instructor License Number:
License Number: PRC Card – Validity Date:
PRC Card – Validity Date:

RLE Coordinator DEAN

License Number: License Number: ____________________
PRC Card – Validity Date: ________________
PRC Card – Validity Date: