Labor & Delivery RN Skills Assessment Today's Date: MM slash DD slash YYYY Name* First Last Email* Phone Number*Meds / IV TherapyAdminister PO Medications 0 1 2 3 Administer IM & SQ Meds 0 1 2 3 Peripheral IV Insertion 0 1 2 3 Administer IV Medications 0 1 2 3 Mix IV Infusion w/ Additives 0 1 2 3 Use of Heparin/Saline Locks 0 1 2 3 Use of Heparin/Saline Locks 0 1 2 3 Needle-less Systems 0 1 2 3 Administer/Monitor Oxytocin induction/augmentation 0 1 2 3 Administer/Monitor Magnesium Sulfate Therapy 0 1 2 3 Administer/Monitor Magnesium Sulfate Therapy Labor Suppressants -Ritordine 0 1 2 3 Administer/Monitor Magnesium Sulfate Therapy Antibiotics 0 1 2 3 Administer/Monitor Magnesium Sulfate Therapy Heparin 0 1 2 3 Discontinue Peripheral IVs 0 1 2 3 Administer Blood/Blood Products 0 1 2 3 Draw Blood for Lab Studies 0 1 2 3 Vital Sign Monitoring 0 1 2 3 Pulse Oximetry Setup 0 1 2 3 Pulse Oximetry Monitoring 0 1 2 3 Intrapartum PhaseContraction Characteristics 0 1 2 3 Determine Fetal Position 0 1 2 3 Status of Membranes 0 1 2 3 Fetoscope 0 1 2 3 Doppler Ultrasound 0 1 2 3 External Monitor: Tocotransducer 0 1 2 3 External Monitor: Ultrasound 0 1 2 3 External Monitor: Phono 0 1 2 3 External Monitor: Abdominal ECG Transducer 0 1 2 3 Internal Monitor 0 1 2 3 Variability/Reactivity 0 1 2 3 Decelerations-Early,Late,Variable 0 1 2 3 Pelvimetry 0 1 2 3 Assessment for Deep Reflexes 0 1 2 3 Assessment for Clonus 0 1 2 3 Intake and Output 0 1 2 3 Assessment for Edema 0 1 2 3 Insert Straight/Foley Catheter 0 1 2 3 Bedside Clinical Testing: Urine Dipstick 0 1 2 3 Blood Glucose Monitoring 0 1 2 3 Aseptic Technique Relative to L&DSet up a Delivery Table 0 1 2 3 Set up a Caesarean Section Table 0 1 2 3 Scrub for a Caesarean Section 0 1 2 3 Circulate/Scrub for a Postpartum Tubal Ligation 0 1 2 3 Assist with an AROM (Artificial Rupture of Membranes) Procedure 0 1 2 3 Assist with Placement of Fetal Scalp Electrodes for Internal Monitoring 0 1 2 3 Assist with Fetal Scalp Blood Sampling 0 1 2 3 Assist with Placement of Intrauterine Pressure Cath for Internal Monitoring 0 1 2 3 Perform a Vaginal Exam-Assess Dilation,Effacement,Station & Presentation 0 1 2 3 Ante/Intrapartum, Care of:Pregnancy-induced HTN 0 1 2 3 Preeclampsia & Eclampsia 0 1 2 3 Multiple Gestation 0 1 2 3 Placenta Previa 0 1 2 3 Abruptio Placenta 0 1 2 3 Malpresentations 0 1 2 3 Premature Labor 0 1 2 3 Diabetes Mellitus 0 1 2 3 Cardiac Disease 0 1 2 3 Asthma 0 1 2 3 Infectious Disease 0 1 2 3 Hemorrhage 0 1 2 3 Pyelonephritis 0 1 2 3 Cystitis 0 1 2 3 Sickle Cell Disease 0 1 2 3 Rh Incompatibilities 0 1 2 3 Oxytocin Challenge Test 0 1 2 3 Interventions During LaborProvide Physical Comfort Measures and Emotional Support 0 1 2 3 Coach Psycholprophylactic Breathing & Relaxation Tech. 0 1 2 3 Support, Guide, Labor Coach PRN 0 1 2 3 Change Woman's Position PRN 0 1 2 3 Perineal Prep 0 1 2 3 Provide Care & Monitor After Rupture of Membranes 0 1 2 3 Fetal Heart Rate - Doppler 0 1 2 3 Fetal Heart Rate - Auscultate 0 1 2 3 Variability 0 1 2 3 Variable Decelerations 0 1 2 3 Spiral Electrode 0 1 2 3 Interventions During DeliverySpontaneous Vaginal Delivery 0 1 2 3 Emergency Delivery 0 1 2 3 Forceps Vaginal Delivery 0 1 2 3 Labor Room Delivery 0 1 2 3 General Anesthesia Monitoring 0 1 2 3 Epidural Anesthesia Monitoring 0 1 2 3 Spinal Anesthesia Monitoring 0 1 2 3 Local Infiltration (Preparation) 0 1 2 3 Immediate Care of Infant Post-birth (Suction & Weigh Infant) 0 1 2 3 Physically Examine Newborn (Anomalies, Respiratory Status) 0 1 2 3 Perform Cardiopulmonary Resuscitation: Adult 0 1 2 3 Perform Cardiopulmonary Resuscitation: Infant 0 1 2 3 Identify Infant Using Bracelet, Footprints, and Mother's Bands 0 1 2 3 Eye Prophylaxis 0 1 2 3 Collect Cord Blood Samples 0 1 2 3 Transfer to Newborn Nursery 0 1 2 3 Vacuum Extraction 0 1 2 3 Assist with High Risk Delivery 0 1 2 3 Shoulder Dystocia 0 1 2 3 Hemorrhage/Shock 0 1 2 3 Perineal Prep 0 1 2 3 Circulate for C-Section 0 1 2 3 Scrub for C-Section 0 1 2 3 Patient with General Anesthesia 0 1 2 3 Circulate for Tubal Ligation 0 1 2 3 Scrub for Tubal Ligation 0 1 2 3 Assist with Placenta Delivery 0 1 2 3 Assist with Cervical Laceration Repair 0 1 2 3 Assist with Uterine Laceration Repair 0 1 2 3 Assist with Episiotomy Repair 0 1 2 3 Postpartum PhasePostpartum Assessment 0 1 2 3 Fundus Consistency/Location 0 1 2 3 Initiate Fundal Massage PRN 0 1 2 3 Lochia 0 1 2 3 Bladder Distention 0 1 2 3 Insert Straight/Foley Catheter 0 1 2 3 Provide/Instruct Perineal Care 0 1 2 3 Episiotomy Care 0 1 2 3 Apply Ice to Perineum 0 1 2 3 C-section Incision Care 0 1 2 3 Assess Homan's Sign 0 1 2 3 Manage Postpartum Pain 0 1 2 3 Initiate Post-anesthesia Care: Spinal 0 1 2 3 Initiate Post-anesthesia Care: Epidural 0 1 2 3 Initiate Post-anesthesia Care: General 0 1 2 3 RhoGam Administration 0 1 2 3 Rubella Vaccine 0 1 2 3 Fundal Height 0 1 2 3 Fundal Massage 0 1 2 3 Lochia 0 1 2 3 Maternal Vital Signs 0 1 2 3 Recovering Post-Op C-Section Patient 0 1 2 3 Recovering Post-Op Tubal Ligation Patient 0 1 2 3 Fluid Balance 0 1 2 3 Assessment for DVT 0 1 2 3 Parent/Infant BondFoster Parent/Infant Bonding 0 1 2 3 Assist/Instruct Breastfeeding 0 1 2 3 Assist/Instruct Bottlefeeding 0 1 2 3 Discharge Teaching 0 1 2 3 Age of Patients Cared ForNewborn (birth-30 days) 0 1 2 3 Infant (30 days - 1 year) 0 1 2 3 Toddler (1 - 3 years) 0 1 2 3 Preschooler (3 - 5 years) 0 1 2 3 School Age (5 - 12 years) 0 1 2 3 Adolescents (12 - 18 years) 0 1 2 3 Young Adults (18 - 39 years) 0 1 2 3 Middle Adults (39 - 64 years) 0 1 2 3 Older Adults (64+ years) 0 1 2 3 Candidate SignatureSignature of*
