NNJ CHECKLIST AIRWAY

NAME: PATENT

DOB: NOT PATENT – STRIDOR, GURGGLING

CURRENT AGE (HOL): BREATHING

BIRTH WEIGHT: CURRENT WEIGHT: TACHYPNIC

WEIGHT LOSS:
RECESSION
GESTATION:
CIRCULATION
<35 WEEKS
WARM, GOOD PV, GOOD SKIN TURGOR,
35W – 37 WEEKS + 6DAYS
COOLISH, POOR PV, MOTTLE SKIN
> 38 WEEKS
DISABILITY
G6PD STATUS:
CEPHALOHAEMTAOMA
MBOG:
HAEMATOMA
ANC:

HISTORY OF LEAKING
KRAMERS RULES:
BABY BLOOD GROUP:

STRATIFICATION OF NNJ:

HIGH RISK

MEDIUM RISK

LOW RISK

HOPI:

ACTIVE

FEEDING

BO

PU TSB LEVEL TODAY

RESULT PHOTOLEVEL ET
(PL)
PHYSICAL EXAMINATION:

GENERAL CONDITION

ACTIVE
PLAN:
LETHARGIC
REFERRAL AND ADMIT

DISCHARGE