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    Antenatal Assessment Format

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    Valarmathi
    This document contains an antenatal assessment form for collecting a pregnant patient's medical history and conducting a physical examination. The form includes sections for demographic data, reason for hospitalization, personal history, socioeconomic status, family history, medical history, obstetric history, physical examination findings, lab investigations, and psychological assessment. The physical exam involves inspection and palpation of the skin, eyes, nose, mouth, neck, breasts, chest, abdomen, genitalia, extremities, spine, anus and rectum, and vital signs.

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    Antenatal Assessment Format

    Uploaded by

    Valarmathi
    5K views10 pages
    This document contains an antenatal assessment form for collecting a pregnant patient's medical history and conducting a physical examination. The form includes sections for demographic data, reason for hospitalization, personal history, socioeconomic status, family history, medical history, obstetric history, physical examination findings, lab investigations, and psychological assessment. The physical exam involves inspection and palpation of the skin, eyes, nose, mouth, neck, breasts, chest, abdomen, genitalia, extremities, spine, anus and rectum, and vital signs.

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    This document contains an antenatal assessment form for collecting a pregnant patient's medical history and conducting a physical examination. The form includes sections for demographic data, reason for hospitalization, personal history, socioeconomic status, family history, medical history, obstetric history, physical examination findings, lab investigations, and psychological assessment. The physical exam involves inspection and palpation of the skin, eyes, nose, mouth, neck, breasts, chest, abdomen, genitalia, extremities, spine, anus and rectum, and vital signs.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    5K views10 pages

    Antenatal Assessment Format

    Uploaded by

    Valarmathi
    This document contains an antenatal assessment form for collecting a pregnant patient's medical history and conducting a physical examination. The form includes sections for demographic data, reason for hospitalization, personal history, socioeconomic status, family history, medical history, obstetric history, physical examination findings, lab investigations, and psychological assessment. The physical exam involves inspection and palpation of the skin, eyes, nose, mouth, neck, breasts, chest, abdomen, genitalia, extremities, spine, anus and rectum, and vital signs.

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    COLLEGE OF NURSING

    MADURAI MEDICAL COLLEGE

    MADURAI – 20

    OBSTETRICAL & GYNAECOLOGICAL NURSING

    ANTENATAL ASSESSMENT

    I.DEMOGRAPHIC DATA:

    Name of the mother : Name of Husband:

    Age : Age :

    Educational level : Educational level :

    Religion :

    Address :

    Occupation :

    Income :

    Admitted on :

    I.P.No. :

    Ward :

    Unit :

    Diagnosis :

    Obstetrical score :

    Date of assessment :
    II.REASON FOR HOSPITALIZATION/NEED FOR SEEKING HEALTH CARE:

    III.PERSONAL HISTORY:

    A. Nutrition : Non vegetarian/vegetarian


    Frequency of meals :
    Food fale :
    Food allergy :
    B. Habits : Alcohol/Smoking/Chewing pan/Using snuff/None

    C. Drugs : Over the counter/On prescription/Allergy

    D. Sleep :

    E. Rest :

    F. Hygiene :

    G. Exercises :

    H. Urinary pattern :

    I. Bowel pattern :

    J. Menstrual history :
    K. Marietal history :

    L. Nutritional assessment :

    IV.SOCIO ECONOMIC STATUS:

    V.FAMILY HISTORY:

    Multiple pregnancies :

    Communicable diseases :

    Chronic medical diseases : Hypertension/Diabetes mellitus/Bronchial asthma/others

    Mental illness :

    Genetic disorder :

    Any other :

    VI.MEDICAL HISTORY:

    Childhood illness :

    Previous illness :

    Surgeries :

    Any other :
    VII.OBSTETRICAL HISTORY:

    a. Past obstetrical history:

    Year of Antenatal Intranatal Postnatal Newborn Birth Breast Remarks


    delivery period period period sex weight feeding

    b. Present obstetrical history:

    Date of booking : LMP:

    Gestation at 1st visit : EDD:

    Height : Weight: BMI:

    First trimester :

    Second trimester :

    Third trimester :
    c. Attendances :
    Date Weight Urine B.P FHR Finding Treatment Remarks

    VIII.PHYSICAL EXAMINATION:

    1.Skin :

    2.Eyes :

    3.Nose :

    4.Mouth :

    5.Neck :

    6.Breast :

    7.Chest :
    8.Abdomen :

    Inspection :

    Size :

    Shape :

    Contour :

    Skin changes :

    Scar :

    Umbilicus :

    Flanks :

    Visible fetal movements:

    Abdominal girth:

    Fundal height :

    Palpation :

    Fundal :

    Lateral :

    Pelvic : Grip I –

    Grip II –

    Auscultation :
    OBSTETRICAL FINDINGS :

    Lie :

    Position :

    Presentation :

    Attitude :

    Height of the fundus :

    Engaged/Not engaged:

    Foetal heart rate :

    9. Genitalia :

    10. Extremities :

    Upper limbs -

    Lower limbs -

    11. Spine :

    12. Anus & Rectum :

    13. Reflexes :

    14. Vital signs :

    Temperature :

    Pulse :

    Respiration :

    Blood pressure:
    IX. LAB INVESTIGATION/DIAGNOSTIC PROCEDURE:

    Date Name Client Value Normal Value Remarks

    OTHER SPECIFIC ASSESSMENT:

    Knowledge Attitude behaviour


    Nutrition
    Hygiene
    Baby care
    Postnatal exercise
    Family planning
    Any other

    PSYCHOLOGICAL ASSESSMENT:

    1. Psychological status :

    2. Support system :
    College of Nursing,
    Madurai Medical College,
    Madurai-20

    OBSTETRICAL & GYNAECOLOGICAL NURSING

    ANTENATAL ASSESSMENT

    SUBMITTED TO:
    Mrs. S. Lilly Puspam, M.Sc (N).,
    Lecturer in nursing
    Miss P. Malliga, M.Sc (N)., M.A (Soc).,
    Mrs S. Auyisha Sithik, M.Sc (N)., MBA SUBMITTED BY
    Faculty in nursing Saranya. A
    College of nursing I Year M.Sc (N)
    Madurai medical college College of nursing
    Madurai -20 Madurai medical college
    Madurai-20

    SUBMITTED ON

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