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