1111 north 3rd street phone 602-264-1444 fax 602-264...

1111 North 3rd Street Phoenix, Arizona 85004

Phone 602-264-1444 Fax 602-264-1443

Copyright © 2014 Dependable Staffing Services, LLC. All rights reserved. of 7

LABOR AND DELIVERY SKILLS CHECKLIST

Instructions: Please complete this checklist to enable us to match your skills and interests with available assignments.

Place an "X" in the appropriate column that best describes your experience level with each skill.

LEVELS OF PROFICIENCY:1. Experienced - performs well and independently (at least 1 year experience)2. Limited experience - some assistance or practice needed (6 months to 1 year experience)3. Little experience - need more experience, assistance required (less than 6 months experience)4. No experience

SKILLS 1 2 3 4

A. ADMISSION Admission Data Collection Procedures 1. Review of maternal record for care plan ____ ____ ____ ____ 2. Maternal vital signs ____ ____ ____ ____ 3. Fetal heart rate Fetascope ____ ____ ____ ____ Doppler ____ ____ ____ ____ Electronic fetal monitor/ external and internal ____ ____ ____ ____ 4. Leopold's maneuvers Presentation ____ ____ ____ ____ Position ____ ____ ____ ____ Size ____ ____ ____ ____ 5. Assessment/palpitation of contractions Frequency ____ ____ ____ ____ Intensity ____ ____ ____ ____ Duration ____ ____ ____ ____ 6. Assessment of membrane status Nitrazine test (amnicator) ____ ____ ____ ____ Pooling of amniotic fluid ____ ____ ____ ____ Fern test ____ ____ ____ ____ 7. Assessment of show ____ ____ ____ ____ 8. Assessment of edema/ reflexes ____ ____ ____ ____ 9. Urine dipstick ____ ____ ____ ____ 10. Admission vaginal exam Station ____ ____ ____ ____ Effacement/dilation ____ ____ ____ ____ Presenting part ____ ____ ____ ____ 11. Assitance with sterile speculum exam ____ ____ ____ ____ 12. Initiation of IV access ____ ____ ____ ____ 13. Patient/family orientation to facility, procedures ____ ____ ____ ____ 14. Admission nursing documentation Nursing history ____ ____ ____ ____ Labor record ____ ____ ____ ____


Phone 602-264-1444 Fax 602-264-1443


B. FIRST STAGE OF LABOR Latent Phase 1. Assessment Maternal vital signs ____ ____ ____ ____ Fetal heart rate ____ ____ ____ ____ Contraction pattern ____ ____ ____ ____ Rate of effacement/dilation ____ ____ ____ ____ Rate of descent ____ ____ ____ ____ Behavior/sources of discomfort ____ ____ ____ ____ 2. Nursing interventions Diet/hydration ____ ____ ____ ____ Activity ____ ____ ____ ____ Elimination ____ ____ ____ ____ Hygiene ____ ____ ____ ____ Comfort/support ____ ____ ____ ____ Family involvement ____ ____ ____ ____ 3. Outpatient Nursing documentation ____ ____ ____ ____ Assessment of true vs false labor ____ ____ ____ ____ Physician notification ____ ____ ____ ____ Common tocolytic medications ____ ____ ____ ____ Discharge instructions/ nursing documentation for undelivered patient ____ ____ ____ ____ Critical thinking ____ ____ ____ ____

Active Phase 1. Assessment (following) SROM ____ ____ ____ ____ Hydration ____ ____ ____ ____ Activity ____ ____ ____ ____ Elimination ____ ____ ____ ____ Hygiene ____ ____ ____ ____ Comfort/support ____ ____ ____ ____ Family involvement ____ ____ ____ ____ 2. Patient Education ____ ____ ____ ____ 3. Nursing documentation Maternal vital signs ____ ____ ____ ____ Fetal Heart Rate Electronic fetal monitor/ external and internal ____ ____ ____ ____ IUPC, assist with ____ ____ ____ ____ Contraction pattern ____ ____ ____ ____ Rate of dilation/ descent ____ ____ ____ ____ Vaginal exam ____ ____ ____ ____ Fluid/ hydration status ____ ____ ____ ____ Behavior and sources of pain/ discomfort ____ ____ ____ ____ 4. Nursing interventions (following) SROM ____ ____ ____ ____ Hydration ____ ____ ____ ____ Activity ____ ____ ____ ____ Elimination ____ ____ ____ ____ Comfort/Support Whirlpool ____ ____ ____ ____ Psychoprophylactic ____ ____ ____ ____


Phone 602-264-1444 Fax 602-264-1443


Family support/ involvement ____ ____ ____ ____ 5. Analgesia/anesthesia IM/IV analgesics ____ ____ ____ ____ Epidural anasthesia, assistance with ____ ____ ____ ____

6. Patient Education ____ ____ ____ ____ 7. Nursing documentation ____ ____ ____ ____ 8. Critical thinking ____ ____ ____ ____

C. SECOND STAGE OF LABOR 1. Assessment of second stage Maternal vital signs ____ ____ ____ ____ Fetal heart rate ____ ____ ____ ____ Contraction pattern ____ ____ ____ ____ Rate of descent ____ ____ ____ ____ Behavior/sources of pain ____ ____ ____ ____ 2. Nursing interventions Breathing/pushing techniques ____ ____ ____ ____ Suprapubic/fundal pressure (shoulder dystocia) ____ ____ ____ ____ Pain relief/support ____ ____ ____ ____ Maternal positioning Birthing bed ____ ____ ____ ____ Family support/ involvement ____ ____ ____ ____ 3. Preparation for/Assistance with delivery Routine setup of equipment/ supplies/ delivery cart ____ ____ ____ ____ Spontaneous delivery ____ ____ ____ ____ Forceps-assisted delivery ____ ____ ____ ____ Vacuum-assisted delivery ____ ____ ____ ____ 4. Patient Education ____ ____ ____ ____ 5. Nursing documentation ____ ____ ____ ____

D. THIRD STAGE OF L AND D OF PLACENTA 1. Post-delivery assessment of newborn

APGAR score ____ ____ ____ ____ Initial newborn vital signs ____ ____ ____ ____ Initial newborn screening assessment ____ ____ ____ ____ 2. Nursing interventions for newborn stabilization Comfort/Support Drying/wrapping techniques ____ ____ ____ ____ Skin to skin contact ____ ____ ____ ____ Radiant warmer ____ ____ ____ ____ Maintenance of airway/ suctioning Bulb ____ ____ ____ ____ De Lee ____ ____ ____ ____ Wall ____ ____ ____ ____ Identification Bands ____ ____ ____ ____ Footprint sheets ____ ____ ____ ____ 3. One touch ____ ____ ____ ____ 4. Vitamin K ____ ____ ____ ____ 5. Erythromyacin ointment ____ ____ ____ ____


Phone 602-264-1444 Fax 602-264-1443


6. Cord blood ____ ____ ____ ____ 7. Parental/newborn bonding ____ ____ ____ ____ 8. Maternal assessment Placental separation ____ ____ ____ ____ 9. Maternal nursing interventions Fundal pressure ____ ____ ____ ____ Pitocin ____ ____ ____ ____ Examination of placenta/ membrane/ cord ____ ____ ____ ____ Disposal of placenta ____ ____ ____ ____ 10. Assistance with perineal repair ____ ____ ____ ____ 11. Patient education ____ ____ ____ ____ 12. Nursing documentation ____ ____ ____ ____

E. THIRD STAGE OF LABOR RECOVERY OF MOTHER 1. Maternal assessment

Maternal vital signs ____ ____ ____ ____ Fundus ____ ____ ____ ____ Fundal massage ____ ____ ____ ____ Lochia ____ ____ ____ ____ Perineum ____ ____ ____ ____ Fluid/hydration status ____ ____ ____ ____ Bladder/voiding status ____ ____ ____ ____ Anal/hemmorhoid assessment ____ ____ ____ ____ 2. Maternal nursing interventions Diet/hydration ____ ____ ____ ____ Ambulation ____ ____ ____ ____ Elimination ____ ____ ____ ____ Diet/hydration Perineal cleansing ____ ____ ____ ____ Application of pad ____ ____ ____ ____ Comfort/ Pain relief Perineal ice pack ____ ____ ____ ____ Maternal/ newborn bonding Breastfeeding ____ ____ ____ ____ Bottle feeding ____ ____ ____ ____ Cord care ____ ____ ____ ____ Bathing the newborn ____ ____ ____ ____ Bulb syringe ____ ____ ____ ____

F. SPECIAL SITUATION/COMPLICATIONS 1. Emergency transfer to L&D ____ ____ ____ ____ 2. Emergency transfer to Surgery ____ ____ ____ ____ 3. Transfer to another facility ____ ____ ____ ____ 4. Vaginal birth after Cesarean (VBAC) ____ ____ ____ ____ 5. Assessment of VBAC patient ____ ____ ____ ____ 6. Management/nursing interventions ____ ____ ____ ____ 7. Patient education ____ ____ ____ ____ 8. Nursing documentation ____ ____ ____ ____

Induction/Augmentation of labor/ artificial rupture of membranes 1. Assessment of need for Picotin induction/ augmentation ____ ____ ____ ____


Phone 602-264-1444 Fax 602-264-1443


2. Management/ nursing interventions ____ ____ ____ ____ 3. Patient education ____ ____ ____ ____ 4. Nursing documentation ____ ____ ____ ____ 5. Assistance with AROM Assessment of fluid color, odor ____ ____ ____ ____ 6. Softening agents ____ ____ ____ ____

Meconium-stained amniotic fluid 1. Assessment of meconium in labor ____ ____ ____ ____ 2. Management/ nursing interventions ____ ____ ____ ____ 3. Amnioinfusion ____ ____ ____ ____ 4. DeLee suctioning on the perenium ____ ____ ____ ____ 5. Nursing documentation ____ ____ ____ ____ 6. Patient education ____ ____ ____ ____

Prolapsed cord 1. Assessment/identification of prolapsed cord ____ ____ ____ ____ 2. Management/ nursing interventions ____ ____ ____ ____ 3. Patient education ____ ____ ____ ____ 4. Nursing documentation ____ ____ ____ ____

Group B Strep 1. Assessment/identification of prolapsed cord ____ ____ ____ ____ 2. Risk factors ____ ____ ____ ____ 3. Management/ nursing interventions ____ ____ ____ ____ 4. Cultures ____ ____ ____ ____

Postpartum hemorrhage 1. Assessment/identification ____ ____ ____ ____ 2. Management/nursing interventions Fundal massage ____ ____ ____ ____ Picotin ____ ____ ____ ____ Methergine ____ ____ ____ ____ Hemabate ____ ____ ____ ____ 3. Patient education ____ ____ ____ ____ 4. Nursing documentation ____ ____ ____ ____

Cesarean sections 1. Consents ____ ____ ____ ____ 2. Teaching ____ ____ ____ ____ 3. Preparation of patient Bicitra ____ ____ ____ ____ Foley ____ ____ ____ ____ Shave prep ____ ____ ____ ____ 4. Labs ____ ____ ____ ____ 5. Notify surgery, nursery, pediatrician ____ ____ ____ ____ 6. Crash cart ____ ____ ____ ____ 7. Warmer ____ ____ ____ ____ 8. Suction and oxygen setup in OR ____ ____ ____ ____

Medications 1. Administration responsibilities/ five rights ____ ____ ____ ____ 2. Patient education ____ ____ ____ ____


Phone 602-264-1444 Fax 602-264-1443


3. Nursing documentation ____ ____ ____ ____

Common Medications for Labor and Delivery 1. Demerol ____ ____ ____ ____ 2. Morphine ____ ____ ____ ____ 3. Nubain ____ ____ ____ ____ 4. Phenergan ____ ____ ____ ____ 5. Pitocin ____ ____ ____ ____ 6. Methergine ____ ____ ____ ____ 7. Hemabate ____ ____ ____ ____ 8. Prostin E ____ ____ ____ ____ 9. Terbutaline ____ ____ ____ ____ 10. MgS04 ____ ____ ____ ____ 11. Stadol ____ ____ ____ ____ 12. Cytotec ____ ____ ____ ____ 13. Vistaril ____ ____ ____ ____

Antepartum 1. Antepartum testing NST ____ ____ ____ ____ CST ____ ____ ____ ____ OCT ____ ____ ____ ____ 2. Amniocentesis ____ ____ ____ ____ 3. Hemorrhage ____ ____ ____ ____ 4. External version ____ ____ ____ ____ 5. Preterm labor management ____ ____ ____ ____ 6. Trauma ____ ____ ____ ____

Special Circumstances 1. Still born-nonviable fetus Definitions Miscarriage ____ ____ ____ ____ Stillborn ____ ____ ____ ____ Live Birth ____ ____ ____ ____ 2. Social services ____ ____ ____ ____ 3. Disposal of ____ ____ ____ ____ 4. Patient teaching ____ ____ ____ ____ 5. Nursing documentation ____ ____ ____ ____

High Risk 1. PIH Assessment Risk factors ____ ____ ____ ____ Definition ____ ____ ____ ____ Classifications ____ ____ ____ ____ Treatment management ____ ____ ____ ____ Nursing documentation ____ ____ ____ ____ 2. Diabetes Definition ____ ____ ____ ____ Assessment ____ ____ ____ ____ Risk factors ____ ____ ____ ____ Classifications ____ ____ ____ ____ Treatment/management ____ ____ ____ ____ Nursing documentation ____ ____ ____ ____


Phone 602-264-1444 Fax 602-264-1443


3. HIV/Hepatitis B Assessment ____ ____ ____ ____ Risk factors ____ ____ ____ ____ Classifications ____ ____ ____ ____ Treatment/management ____ ____ ____ ____ Nursing precautions ____ ____ ____ ____ Confidentiality ____ ____ ____ ____ Documentation ____ ____ ____ ____ 4. Drug Abuse Assessment ____ ____ ____ ____ Risk factors ____ ____ ____ ____ Classifications ____ ____ ____ ____ Treatment/management ____ ____ ____ ____ Nursing precautions ____ ____ ____ ____ Confidentiality ____ ____ ____ ____ Documentation ____ ____ ____ ____ 5. Placenta Previa/Abruption Assessment ____ ____ ____ ____ Risk factors ____ ____ ____ ____ Definition ____ ____ ____ ____ Treatment/management ____ ____ ____ ____ Nursing precautions ____ ____ ____ ____ Documentation ____ ____ ____ ____

Age Specific Experience Circle each of the following age groups you have experience providing age specific care to:

Neonatal Infant-Children(0-11) Adolescent (12-18) Adult Geriatric

_______________________________________________ ________________ Employee Signature Date

1111 north 3rd street phone 602-264-1444 fax 602-264...

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