Professional Documents
Culture Documents
B Breast: Size, shape, & engorgement (usually occurs 2-3 days postpartum)
Angeles City -
COLLEGE OF NURSING
MOTHER
U Uterus: Is it contracted or not??
-
Name: Age: Sex: CS: Religion:
PR: PR:
Pain: Pain: E Emotional status & maternal-child bonding (Breast feeding, holding her child)
(1 – 10): (1 – 10): Taking-in phase: Dependence, discomfort, and prefers to talk about labor
experiences. Taking hold phase: Starts to initiate actions and focuses on newborn.
Letting go: Finally accepts her new role
R Response: LOCALIZED PAIN 5
FLEXES TO PAIN 3
EXTENDS TO PAIN 2
GPTPALM
G (# of pregnancy): Glasgow Coma Scale
P (24 weeks/500g): NO MOVEMENT 1
T (↑ 37 weeks):
P (25 – 36 weeks): EYE RESPONSE TOTAL
A (before viability – 24 weeks):
L (# living children):
M (multiple preg): SPONTANEOUSLY 4 Ask about: Hygiene:
Drinking Nails (Clean, Not Clean)
Smoking Teeth / mouth
OPEN TO VERBAL COMMAND 3 Hypertension / Hypotension Head
Anemic o Diabetic Nalinis na ba ang site:
Asthmatic o Heart Naligo na ba (Yes, No)
OPEN TO PAIN 2 Lungs o Liver
Breathing pattern
(fast, shallow)
NO EYE OPENING 1
VERBAL RESPONSE
ORIENTED 5
CONFUSED 4
INAPPROPRIATE WORDS 3
INTRAVENOUS FLUID + SIDE DRIP AND MEDICINES (given, instructed) DOSAGE
TPN FREQUENCY
INCOMPREHENSIBLE SOUNDS 2
IV Fluid
NO VERBAL REPONSE 1 Bottle No:
FOLLOWS COMMAND 6
Type of IVF Which hand/arm? Amount:
& Volume
Drug BABY
Additives
Temperature: Temperature:
Rate: