SAINT PAUL UNIVERSITY DUMAGUETE

COLLEGE OF NURSING
DUMAGUETE CITY
______ Semester, A.Y. ___________

Name of Student:_________________________________ Date: ____________________________

Year and Section: _________________________________ Clinical Area: ______________________

NEWBORN ASSESSMENT

A. Newborn Profile

Baby’s Name : _______________________________________________

Gender : _______________________________________________
Weight :_______________________________________________
Date of Delivery : _______________________________________________
Time of Delivery : _______________________________________________
Gestational Age : _______________________________________________
Mother’s Name :________________________________________________

B. APGAR SCORING (Score and Description)

Apgar Heart Rate Respiratory Muscle Irritability Color Total Interpretation

effort Tone
□ healthy newborn
□ moderately depressed
1 minute □ severely depressed

Description
and Results

□ healthy newborn
5 minutes □ moderately depressed
□ severely depressed

Description
and Results

C. BODY MEASUREMENTS

Circumference Findings Vital Signs____________________Findings

Head Circumference : __________________ Temperature : _________________

Chest Circumference : __________________ Heart Rate : _________________
Abdominal Circumference : __________________ Respiratory Rate : _________________
Height : __________________
Weight : __________________

Medications Needed Other

_______ Vitamin K (0.1ml IM) TERM _______ Vitamin K (0.05ml IM) PRETERM
_______ Hepatitis Vaccine (0.5 ml IM) _______ Cord Care
_______ Erythromycin Ointment

__________________ Other Medication

Proposed by Ms Dinopol, M., Ms Awayan, S., Ms Regis, S.(2018) 1

D. EXPANDED BALLARD SCORING

Proposed by Ms Dinopol, M., Ms Awayan, S., Ms Regis, S.(2018) 2

 HEAD TO TOE ASSESSMENT

A. SKIN
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B. Head and Scalp

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C. Eyes
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D. Ears
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F. Nose
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G. Mouth
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H. Neck
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I. Chest
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Proposed by Ms Dinopol, M., Ms Awayan, S., Ms Regis, S.(2018) 3

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J. Abdomen
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K. Genito-Urinary Elimination
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L. Anus and Genital

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M. Extremities and Spine

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N. Reflexes
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History taken by:

________________________________
SN-SPUD
Date:___________________________

Proposed by Ms Dinopol, M., Ms Awayan, S., Ms Regis, S.(2018) 4