Kingdom of Saudi Arabia King Saud bin Abdul Aziz University College Of Nursing Al-Ahsa

Name of Student Date Section:

Antenatal Assessment Tool 1 .History: Personal History: Name: Nationality: Consanguinity Occupation: Housing condition: Medical and surgical history: Diabetes Mellitus ( ) Hypertension Viral Infection ( ) ( ) Heart Disease Renal Disease ( ) ( ) Age: Marital Status: Address: Education: Family income:

Allergy and type ( )

Infections (vaginal, cervical and tubal) Others: History of previous operation: ( ) Present condition: Menstrual History: Age of menarche: Interval: Amount: Last menstrual period: Obstetric History: Gravida: Abortion: Number of living children: Type of last delivery: Family History: Diabetes Mellitus ( ) Heart Disease ( ) Parity: Still birth: Sex of children: Regularity: Duration: Menstrual pain: Expected date of delivery Type of operation ( ) Date of admission:

Hypertension Viral Infection

( ) ( )

Renal Disease Mental illness

( ) ( )

Congenital abnormalities ( ) Present complaints of the mother:

Allergic condition ( )

II .Examination: Physical Examination: General: Vital signs: Temperature: Blood pressure: Height: Weight: Pulse: Respiration:

General Well-being: 1. Skin, hair and nail:

2. Mouth gums: 3. Thyroid: 4. Chest and lung: 5. Heart: 6. Posture and range of motion: 7. Extremities:

Local Examination: Breast Examination: 1. Symmetry and pigmentation: 2. Type of nipples: 3. Colostrum: 4. Axillary nodes Abdominal Examination: Inspection: Size of abdomen: Scar of previous operation: Palpation: Shape of abdomen: Pigmentation:

Fundal Height: Position of the fetus: Lie: Engagement of fetal head: Auscultation: Fetal Heart Rate: Vaginal Examination: Vulval condition: Presence of vaginal discharge: Type: Presentation: Attitude:

III. Laboratory Investigation: Urine analysis: Albumin: Sugar: Acetone:

Blood Test: Blood group: Hematocrit: Toxoplasmosis: Rh: Fasting blood sugar: WBC: Others: Hemoglobin:

Result of ultrasound scanning:

Nursing Care Plan Assessment Nursing diagnosis Planning ( goal expected outcome intervention Goal Implementation Evaluation

-Objective data

Expected outcome

Intervention :1. 2. 3. 4. 5.

- Subjective data

Kingdom of Saudi Arabia King Saud bin Abdul Aziz University College Of Nursing Al-Ahsa

Name of Student Date Section:

Labor and delivery Assessment Tool 1 .History: Personal History: Name: Nationality: Consanguinity Occupation: Housing condition: Medical and surgical history: Diabetes Mellitus ( ) Hypertension Viral Infection ( ) ( ) Heart Disease Renal Disease ( ) ( ) Age: Marital Status: Address: Education: Family income:

Allergy and type ( )

Infections (vaginal, cervical and tubal) Others: History of previous operation: ( ) Present condition: Menstrual History: Age of menarche: Interval: Amount: Last menstrual period: Obstetric History: Gravida: Abortion: Number of living children: Type of last delivery: Family History: Diabetes Mellitus ( ) Heart Disease ( ) Parity: Still birth: Sex of children: Regularity: Duration: Menstrual pain: Expected date of delivery Type of operation ( ) Date of admission:

Hypertension Viral Infection

( ) ( )

Renal Disease Mental illness

( ) ( )

Congenital abnormalities ( ) Present complaints of the mother:

Allergic condition ( )

II .Examination: Physical Examination: General: Vital signs: Temperature: Blood pressure: Height: Weight: Pulse: Respiration:

General Well-being:

1. Skin, hair and nail: 2. Mouth gums: 3. Thyroid: 4. Chest and lung: 5. Heart: 6. Posture and range of motion: 7. Extremities: Local Examination: Breast Examination: 1. Symmetry and pigmentation: 2. Type of nipples: 3. Colostrum: 4. Axillary nodes Abdominal Examination: Inspection: Size of abdomen: Scar of previous operation: Palpation: Shape of abdomen: Pigmentation:

Fundal Height: Position of the fetus: Lie: Engagement of fetal head: Auscultation: Fetal Heart Rate: Vaginal Examination: Vulval edema: Presence of show: Condition of membrane: Intact ( ) Rupture ( ) Presentation: Attitude:

Color and odor of liquor amnii: Dilatation of cervical os: Effacement:

III. Laboratory Investigation: Urine analysis:

Albumin:

Sugar:

Acetone:

Blood Test: Blood group: Hematocrit: WBC: Rh: Fasting blood sugar: Others: Hemoglobin:

Result of ultrasound scanning:

Nursing Care Plan Assessment Nursing diagnosis Planning ( goal expected outcome intervention Goal Implementation Evaluation

-Objective data

Expected outcome

Intervention :1. 2. 3. 4. 5.

- Subjective data

Kingdom of Saudi Arabia King Saud bin Abdulaziz University y for Health Sciences Collage of Nursing Al Ahsa

Name of Student: Date: Section: Post Partum Assessment Tool

I. History Personal History: Name: Nationality: Consanguinity Occupation: Housing condition: Medical and Surgical History for: Diabetes Mellitus ( ) Hypertension Viral Infection ( ) ( ) Heart Disease ( ) Age: Marital Status: Address: Education: Family income:

Renal Disease ( ) Allergy and type ( )

Infections (vaginal, cervical and tubal)

Others: History of previous operation: ( ) Present condition: Menstrual History: Age of menarche: Interval: Amount: Last menstrual period: Obstetrical History: Gravida: Abortion: Number of living children: Type of last delivery: Family History: Diabetes Mellitus Hypertension Viral Infection ( ) ( ) ( ) Heart Disease Renal Disease Mental illness ( ) ( ) ( ) Parity: Still birth: Sex of children: Regularity: Duration: Menstrual pain: Expected date of delivery Type of operation ( ) Date of admission:

Congenital abnormalities ( ) History of present condition Type of delivery: Outcome of delivery: Condition of perineum: Type of episiotomy of present: Complaints of the mother: II. General and local examination Date T.P.R. Time Bl.P Condition of Breast Type of nipple Lactation

Allergic condition ( )

Condition of Characteristics of Uterus Lochia Height: Type: Shape: Colour: Amount Odour Consistency

Presence of colostrums Size: Consistency

III. Laboratory investigation Urine analysis: Albumin: Blood Test: Blood group: Hematocrit: Rh: WBC: Hemoglobin: Others: Sugar: Acetone:

Nursing Care Plan Assessment Nursing diagnosis Planning ( goal expected outcome intervention Goal Implementation Evaluation

-Objective data

Expected outcome

Intervention :1. 2. 3. 4. 5.

- Subjective data Kingdom of Saudi Arabia Name of Student:

King Saud bin Abdulaziz University y for Health Sciences Date: Collage of Nursing Al Ahsa IV. History Personal History: Name: Nationality: Consanguinity Occupation: Housing condition: Medical and Surgical History for: Diabetes Mellitus ( ) Hypertension Viral Infection ( ) ( ) Heart Disease ( ) Age: Marital Status: Address: Education: Family income: Section: Family Planning and Gynecological Assessment Tool

Renal Disease ( ) Allergy and type ( )

Infections (vaginal, cervical and tubal) Others: History of previous operation: ( ) Present condition: Type of operation ( ) Date of admission:

Menstrual History: Age of menarche: Interval: Amount: Last menstrual period: Obstetrical History: Gravida: Abortion: Number of living children: Type of last delivery: Family History: Diabetes Mellitus Hypertension Viral Infection ( ( ( ) ) ) ) Heart Disease Renal Disease Mental illness ( ( ) ) ( ) Parity: Still birth: Sex of children: Regularity: Duration: Menstrual pain: Expected date of delivery

Congenital abnormalities ( History of contraception: Intrauterine device (IUD): (

Allergic condition ( )

Pills: Spermicidal agent: Condom: Natural method:

( ( ( (

) ) ) )

Complaints from contraception: Gynecological history for: Prolapse: ( ) ) ) ) ) )

Retroversion flexion of the uterus: ( Ovarian cyst: Pelvic inflammatory disease Neoplasia: Other: ( ( ( (

History of gynecological operation: Hysterectomy: Repair of fistula: ( ( ) ) )

Dilatation and curettage (D&C) (

Cauterization: Others

( (

) )

History of gynecological investigation: Laparoscopy: Papanicolaou smear: Ultrasound: Others ( ( ( ( ) ) ) )

Present gynecological complaints of the patient: . II .Examination: Physical Examination: General: Vital signs: Temperature: Blood pressure: Height: Weight: Pulse: Respiration:

General Well-being: 1. Skin, hair and nail: 2. Mouth gums: 3. Thyroid: 4. Chest and lung: 5. Heart: 6. Posture and range of motion: 7. Extremities: Local Examination: Breast Examination: 5. Symmetry and pigmentation: 6. Type of nipples: 7. Colostrum: 8. Axillary nodes Vaginal examination Abnormal vaginal discharge: Type:

Presence of:

Cystocele: Uterine prolapse: Tumor:

( ( (

) ) )

Rectocele:

) ) )

Cervical erosion: ( Other: (

III. Laboratory Investigation: Urine analysis: Albumin: Blood Test: Blood group ( ( ) ) Hemoglobin: ( ) Hematocrit: ( ) WBC: ( ) Others: Sugar: Acetone:

Result of ultrasound scanning:

Nursing Care Plan

Assessment

Nursing diagnosis

Planning ( goal expected outcome intervention Goal

Implementation

Evaluation

-Objective data

Expected outcome

Intervention :1. 2. 3. 4.

- Subjective data

Kingdom of Saudi Arabia King Saud bin Abdulaziz University y for Health Sciences Collage of Nursing Al Ahsa Drug Form Name of drug Date of ordered classification Dose Route

Name of Student: Date: Section:

Action

Indications

Nursing responsibilities

Guideline for case presentation 1. Patient data Name: Age: Gravida Para Educational qualification Occupation Income Religion Years of marriage Marital status: married ( 2. Obstetric history Gravida Nature of & para delivery G Full Pre P term term

) widow ( ) single ( ) divorcee ( ) Bad Outcome of pregnancy child obstetric history Sex alive Normal Any if any CS other Puerperium & family planning history

3. Past medical history

4. Past surgical history

5. Present complaints

6. Assessment a. General examination b. Per abdominal examination

c. Pelvic examination 7. Investigation 8. Diagnosis

9. Treatment

10.Clinical presentation Signs & symptoms as per the book

Signs & symptoms present in the patient

Related path physiology

11.Management a. Aim b. Medical, obstetrical & nursing management c. complications 12.Health teaching 13.Bibliography -

Evaluation criteria for case presentation

SN Criteria 1 Content/ subjective & objective data 2 Problems &needs identified & Nsg. Care plan for mother & child 3 Effectiveness of presentation 4 Correlation with patient & book 5 Group participation 6 bibliography Total

Mark 3 5 3 3 3 3 20

Mark obtained

Signature of Students

Signature of Supervisor