LABOR

AND

DELIVERY

KNOWLEDGE

&

SKILLS CHECKLIST NAME:       ID #:       DATE:       This Skills Checklist is for use by nurses with more than one year experience in their discipline and specialty. Please be accurate with your assessment. DESCRIPTION 1 2 3 4 MEDICATION ISTRATION 1. Interactions, incompatibilities, and side effects

2. ister IM, SC medications 3. Monitor IV Drips a. Oxytocin induction, augmentation b. Magnesium sulfate therapy (& other anti-convulsants for preeclampsia) c. Labor suppressants (e.g. Ritrodrine)

d. Antibiotics e. Heparin 1. 2. 3. 4. 5. 6.

IV THERAPY Start IV lines Regulate IVs Mix IV infusion using additives Discontinue peripheral IVs Use IV infusion pumps Use heparin locks 7. Institute and monitor blood/blood

products

8. Draw blood for lab studies ASEPTIC TECHNIQUE RELATIVE TO L & D 1. Set up a delivery table 2. Set up a cesarean section table 3. Circulate for cesarean section 4. Scrub for a cesarean section 5. Circulate, scrub for a post partum tubal ligation

6. Assist with an Artificial Rupture of Membranes

7. Assist with placement of fetal 1 | Page

scalp electrodes for monitoring 8. Assist w/ fetal scalp blood sampling

9. Insert a straight or Foley catheter 10. Perform a vaginal exam & assess effacement, dilatation, station, presentation

DIRECTIONS: Please indicate your level of experience by placing a check (√) in the box. Experience level: 1 NO EXPERIENCE 2 MINIMAL EXPERIENCE-requires supervision/assistance

3 4

MODERATELY EXPERIENCED-requires initial review, then performs independently VERY EXPERIENCED- proficient

DESCRIPTION 1 2 3 4 PROVIDE INTRAPARTUM CARE TO PATIENT WITH 1. Pregnancy – induced hypertension 2. Preeclampsia 3. Eclampsia (seizures) 4. Placenta previa 5. Abruptio placenta 6. Multiple gestation 7. Malpresentations 8. Premature labor 9. Diabetes mellitus 10. Cardiac disease 11. Asthma 12. Infectious diseases 13. Hemorrhage 14. Pyelonephritis 15. Cystitis 16. Sickle Cell Disease 17. Rh incompatibilities OBSTETRIC TECHNIQUES AND PROCEDURES 1. Stress test (oxytocin challenge test) 2. Conduct Fetal Activity

LABOR SKILLS CHECKLIST Determinants 3. Perform cardiopulmonary resuscitation a. Infant (assist intubation) b. Infant (umbilical artery catheter) c. Infant (mix resuscitation drugs) d. Infant (ister IM narcan) 4. Assess & document progression of labor a. Contraction characteristics b. Changes in behavior, appearance c. Status of membranes d. Assess and document fetal status e. Determine fetal position

2 | Page

AND

DELIVERY

KNOWLEDGE

&

LABOR

AND

DELIVERY

KNOWLEDGE

&

SKILLS CHECKLIST breathing and relaxation technique

Name:       DESCRIPTION 1 2 3 4 OBSTETRIC TECHNIQUES AND PROCEDURES (CONT) f. Auscultate FHR (fetal heart rate) using: (1) Fetoscope (2) Doptone (Doppler Ultrasound) 5. Monitor uterine activity & FHR patterns using fetal monitors: a. External monitor (tocotransducer, ultrasound, phono or abdominal ECG transducer) b. Internal monitor (including connecting the leads and calibrating machine)

c. Identify FHR patterns (1) Variability reactivity (2) Decelerations- early, late, variable (3) Tachycardia – Brachycardia 6. Assess & document maternal status: a. Vital signs (BP, P) according to stage of labor and patient stability b. Deviations from the norm (edema, deep reflexes, clonus) 7. Assess and document maternal status: a. Intake and output including testing urine for glucose, protein, specific gravity, ketones 8. Escort patient to assist with: a. Pelvimetry b. Ultrasound scan INTERVENTIONS DURING LABOR 1. Provide physical comfort measures 2. Provide emotional 3. , guide labor coach 4. Change woman’s position 5. Do a perineal prep 6. Coach in psychoprophylactic 3 | Page

INTERVENTIONS DURING DELIVERY 1. Spontaneous vaginal delivery 2. Provide care and monitor after rupture of membranes (spontaneous or artificial)

3. Cesarean section 4. Labor room delivery

ID #:       DESCRIPTION 1 2 3 4 5. Obstetric anesthesia – monitor those requiring: a. Special surveillance b. General anesthesia c. Regional anesthesia d. Epidural e. Spinal f. Local infiltration IMMEDIATE CARE OF INFANT POST-BIRTH 1. Assign Apgar scores 2. Physically examine newborn (anomalies, respiratory status)

3. Suction infant 4. Weigh infant 5. Identify infant using bracelet, footprints, and mother’s bands

6. Eye prophylaxis 7. Collect cord blood samples 8. Transfer to newborn nursery POSTPARTUM ASSESSMENT 1. Fundus consistency 2. Lochia 3. Bladder distension 4. Episiotomy 5. Incision (for Cesarean delivery) 6. Vital signs POSTPARTUM INTERVENTION 1. Initiate fundal massage 2. Provide perineal care 3. Apply ice to perineum 4. Foster parent-infant bonding

LABOR

AND

DELIVERY

KNOWLEDGE

&

SKILLS CHECKLIST 3. Able to communicate and instruct patient according to their age, maturity and comprehension ability.

5. Initiate post-anesthesia recovery precautions a. Epidural b. General c. Spinal COMPUTERIZED CHARTING 1. Cerner 2. Eclipsys 3. Epic 4. McKesson 5. Meditech 6. Other:

A

B

C

D

E

F

G

H

I

4. Able to provide a safe environment according to the specific needs of various age groups. A

B

C

D

E

F

G

H

I

Name:       Please check the boxes below for each age group for which you have expertise in providing age-appropriate nursing care. A. Newborn/Neonatal (birth – 30 days) B. Infant (30 days – 1 year) C. Toddler (1 – 3 years) D. Preschool (3 – 5 years) E. School Age Children (5 – 12 years) F. Adolescent (12 – 18 years) G. Young Adults (18 – 39 years) H. Middle Adults (40 – 64 years) I. Older Adults (64 + years) EXPERIENCE WITH AGE GROUPS: 1. Able to assess age appropriate behavior, motor skills and physiological norms. A

B

C

D

E

F

G

H

I

2. Able to adapt care according to normal growth and development. A

B

C

D

E

F

G

H

I

ID #:       I HAVE CURRENT CERTIFICATIONS FOR: TYPE DATE (MM/DD/YY) ARRHYTHMIA CRITICAL CARE ACLS BLS TNCC NRP PALS NALS CCRN Other       Other      

                                                                 

The information I have provided in this knowledge and skills checklist it true and accurate to the best of my knowledge.       Signature (Written/Electronic)

ID #:       4 | Page

EXPIRATION

      Date

LABOR SKILLS CHECKLIST This skills checklist has been reviewed and approved by Nicole Bloxham, RN.       Signature

      Date

(Written/Electronic)

ID #:       Please return to: Northwest Company, PA ATTN: Records Dept. Fax: (866) 352-4338

Nurse

Email: [email protected]

5 | Page

Staffing

AND

DELIVERY

KNOWLEDGE

&