PPR Healthcare Staffing
333 1st. St. North -- Suite 200
Jacksonville Beach, FL 32250
Fax:(888) 794-5038

  

ANTEPARTUM/POST-PARTUM SKILLS CHECKLIST
First Name:
Last Name:
Phone:
Email:
SSN (last 4 only):
Date:
 
Key - for each box mark:   1 - Limited or no experience 2 - Somewhat experienced but may need review
    3 - Can function independently 4 - Competent to supervise
  1     2     3     4     1     2     3     4
STAGES OF PREGNANCY   |   Care of Patient with continued  
Pregnancy/Antepartum   |     Cardiac Disease
  Assessment   |     Chorioamnionitis
    Comfort of Normal Changes   |     Collagen Vascular Disease
    of Pregnancy |     Diabetes
    Breathing/Relaxation Techniques |     Eclampsia
    Vital Signs   |     Hepatitis B
      BP |     HELLP Syndrome
      Heart Rhythms |     Hemolytic anemias
    Fetal Heart Tones |     Hemorrhage
    Fetal Development Measures |     HIV Positive
    General Systems Assessment |     Hypertension
    Knowledge Deficits re:   |     Malpresentations
    Pregnancy Issues |     Multiple gestation
    Lab Values   |     Infections
      Blood Glucose |     Placenta Previa
      Ketones |     Preeclampsia
    Edema |     Premature Labor
    Deep Tendon Relexes |     Pyelonephritis
  Procedures   |     Rh Disease
    Sonogram   |     Sickle Cell Disease
      Amniotic Fluid Index |   Medications  
      Assist with Sonogram |     Indomethacin (Indocin)
      Biophysical Profile |     Insulin
    Stress Testing |     Magnesium Sulfate
    Non-stress Testing |     Nifedipine (Procardia)
    Vaginal Examination |     Ritodrine (Yutopar)
    Pelvimetry |     Terbutaline (Brethine)
  Equipment   |     Betamethasone
    Sonogram Machine |     Dexamethasone (Decadron)
    Glucose Reflectometer |     Antihypertensives
  Care of Patient with   |
    Abruptio Placenta |
    Asthma |  

 
  1     2     3     4     1     2     3     4
Infant Care Post-Delivery   | Assessment continued  
  Assessment   |     Fundal Height
    Apgar Scoring |     Lochia
    Newborn Physical Assessment   |     Vital Signs
      Dubowitz/Ballard Exam |   Procedures  
      Finnegan Scoring |     Fundal Massage
  Procedures   |     Baby Care Teaching
    Cord Care |     Breast Feeding Instruction
    Heelstick Glucose Determination |     Catheterization
    Infant Identification |   Equipment  
    Neonatal Resuscitation |     Breast Pump
    Phototherapy |     Catheter Tray and Bag
    Suctioning   |   Care of Mother with  
      Bulb |     Vaginal Delivery  
      Wall |       with Epidural Anesthesia
  Equipment   |       with Spinal Anesthesia
    Infant Warmer |     Cesarean Delivery  
    Isolette |       with General Anesthesia
  Care of Infant with   |       with Spinal Anesthesia
    Circumcision |     Precipitous Delivery
    Phototherapy |     Perineal Lacerations
    Diabetic Mother (IDM) |   Medications  
    Large for Gestational Age (LGA) |     Antibiotics
    Small for Gestational Age (SGA) |     RhoGAM
    Intrauterine Growth Restriction (IUGR) |     Oxytocin
  Medications   |     Analgesics
    Eye Prophylaxis |
    Vitamin K |
Mother Care Post-Delivery   |
  Assessment   |
    Bladder Distention |
    Breast Feeding   |
      Knowledge Level |
      Positioning |
      Latch-on |
    Deep Vein Thrombosis (DVT) |
    Episiotomy |
    Fluid Balance |
|
The information I have provided in this skills checklist is true and accurate to the best of my knowledge. I hereby authorize PPR to release this information to client facilities of PPR in relation to consideration of my employment to those facilities.
 



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