MISSION
“MABINI COLLEGES provides quality
instruction, research and extension service
programs at all educational levels as its monumental
contribution to national and global growth and
VISION development.
“MABINI COLLEGES shall Specifically, it transforms students
cultivate a CULTURE of MABINI COLLEGES into:
God – fearing
EXCELLENCE in Education.”
College of Nursing Nation – loving
Law abiding
Daet Camarines Norte Earth caring
Productive, and
Locally and Globally competitive
persons
PERFORMANCE CHECKLIST
VITAMIN K INJECTION – NEWBORN
Name: __________________________ Year/Section:___________ Rating: _______
Instruction: Rate the following criteria after having satisfactorily practiced the skills. Check
appropriate scale.
Legend; 2 – Able to Perform 1 – Able to Perform with Assistance 0 – Unable to Perform
PERFORMANCE CRITERIA 2 1 0 REMARKS
I – KNOWLEDGE (40%)
1. Defines Vitamin K intramuscular injection.
.2. State the purposes of injection.
3. Enumerate special considerations.
4. Identify the materials/equipment needed.
5. State the preparation of the patient.
6. State the principles/rationale behind specific action.
II – SKILLS/ABILITY (40%)
1. Perform hand hygiene.
2. Prepare needed equipment and supplies.
Sterile syringe with needle -1 ml
Gloves
Vitamin K ampule
Cotton balls
Adhesive tape – micropore
3. Check medication order. Confirm the order for Vitamin
K administration.
4. Prepare correct medication dose from ampule or vial.
Verify the dose (typically 1 mg for full-term infants and
0.5 mg for preterm infants).
5. Inspect the Vitamin K Vial/Ampule:
Check the expiration date and ensure the solution is clear,
without particles.
6.. Draw the Dose:
Clean the top of the vial or ampule with an alcohol swab.
Use a sterile needle and syringe to draw the prescribed
dose of Vitamin K from the vial/ampule.
7. Remove any air bubbles from the syringe.
8. Select the Injection Site. The preferred site for Vitamin
K administration is the vastus lateralis muscle in the
anterolateral aspect of the thigh.
9. Position the Infant: Hold the infant securely with the leg
slightly flexed to relax the muscle.
10. Inject the Vitamin K: Insert the needle at a 90-degree
angle into the vastus lateralis muscle. Depress the plunger
steadily to inject the Vitamin K.
11.. Withdraw the needle swiftly and apply gentle pressure
to the site with a sterile gauze if needed.
12. Dispose of the needle and syringe in a sharp container.
13. Monitor the Infant: Observe the injection site for any
signs of bleeding, swelling, or adverse reactions.
14. Monitor the infant for any signs of an allergic reaction,
though these are rare.
Parent Education:
Inform the parents/mother
Explain the importance of Vitamin K to the parents.
Provide information on what to expect and what
signs and what signs to watch for that might require
medical attention.
22. Perform hand hygiene.
23. Document medication name, dose, route, time and date
in medication sheet.
III – ATTITUDE (20%)
1. Demonstrate preparedness, readiness and confidence in
the performance of the procedure.
2. Accepts corrections/suggestions and shows willingness
to improve performance.
3. Answers questions politely and tactfully.
4. Shows respect and considerations of the recipient of
care.
5. Observe proper decorum and behave as a mature student
nurse.
_______________________________ ____________________________________
Student’s Signature Clinical Instructor’s Signature
Date: ___________________ Date: _____________________
