ASSIST BABY CARE HANDLE

DATE (M/D/Y): __________ TIME: _________ DATE (M/D/Y): __/__/__ TIME: ___________ DATE (M/D/Y): __/__/__ TIME: ___________
H: ______ A: _________ BC: __________ MOTHERS NAME (L,F,M) _________________ MOTHERS NAME (L,F,M) _________________
Mothers Name (L,F,M): ___________________ BABY: (_) F (_) M BABY: (_) F (_) M
AGE: _____
LMP/AOG: ________ HT: ____ WT: _____ (_) sterile gloves (_) Wash hands
BP: ____ TEMP: ____ RR: _____ HR: _____ (_) drape (_) Gown
FH: _____ GTPAL: ___________________ (_) Cut cord (_) Sterile gloves
BUBBLE-HE: ________________________
NOTES: APGAR SCORE: 1min 5min Baby Out: ________
_________________________________________ Placenta Out: _______
_________________________________________ (_) Assist episiotomy
(_) Assist episorrhapy
(_) Clean gloves
(_) Open sterile equipments

(_) Perineal Prep

OXYTOCIN: _________ (_) IM (_) IV

________ (_) IM (_) IV

ANTHROPOMETRICS:
Ht: ___ Wt: ___ MUAC: __

ASSIST BABY CARE HANDLE

DATE (M/D/Y): __________ TIME: _________ DATE (M/D/Y): __/__/__ TIME: ___________ DATE (M/D/Y): __/__/__ TIME: ___________
H: ______ A: _________ BC: __________ MOTHERS NAME (L,F,M) _________________ MOTHERS NAME (L,F,M) _________________
Mothers Name (L,F,M): ___________________ BABY: (_) F (_) M BABY: (_) F (_) M
AGE: _____
LMP/AOG: LABOR________ ANDHT:DELIVERY
____ WT: _____ LABOR AND DELIVERY
(_) sterile gloves (_) Wash handsLABOR AND DELIVERY
BP: ____ TEMP: ____ RR: _____Pregnancy
Care of Women in High-Risk HR: _____ (_) drape Care of the Normal Newborn (_) Gown Care for Normal Pregnancy
Gives care toGTPAL:
FH: _____ a patient___________________ Assess
(_) Cutnewborn:
cord Perform
(_) SterileLeupolds
gloves
with: Weight Maneuver
BUBBLE-HE: ________________________
Pre-existing medical Length Listen to/monitor
NOTES: APGAR SCORE: 1min 5min Baby Out: ________
condition e.g. cardiac, Reflexes fetal heartOut:
tone/rate
_________________________________________ Placenta _______
cardiovascular, renal, Physical Exam Measure fundic
_________________________________________ Performs credes (_) Assist episiotomy
diabetes height
prophylaxis (_) Assist episorrhapy
Pre- Compute the
(_) Clean gloves Bathes the baby:
eclampsia/eclampsia following:
(_) Open sterile equipments Initial Bath
Bleeding problems Fetal weight
Multiple pregnancy Bathes the baby: Fetal maturity/AOG
(_) Perinealrupture
Premature Prep of Daily Bath Expected Date of
membranes Administer Vit. K Delivery (EDD)
OXYTOCIN:
Other chronic _________ (_) IM (_) IV OB Score (GPTPAL)
________ (_) IM (_) IV
condition, specify
Gives care to an Delivery (Handle)
adolescent/elderly Perform perineal care
patient* (pre-and post-partum)
Gives care to a gram Give enema in
multipara client* preparation for
ANTHROPOMETRICS: delivery*
Care of the Normal Newborn (Baby Care) Ht: ___ Wt: ___ MUAC: __ Monitor uterine
Performs measures to contraction
initiate respiration Monitor cervical
e.g. suctioning, dilation
positioning, tactile Monitor cervical
stimulation effacement
Assess newborn: Positions and drapes
APGAR score client for delivery
Anthropometric Delivers a newborn
measurements Delivers a placenta
Maturity scoring Performs uterine
Temperature massage to prevent
Respiration postpartum bleeding
 ASSIST BABY CARE HANDLE
DATE (M/D/Y): __________ TIME: _________ DATE (M/D/Y): __/__/__ TIME: ___________ DATE (M/D/Y): __/__/__ TIME: ___________
H: ______ A: _________ BC: __________ MOTHERS NAME (L,F,M) _________________ MOTHERS NAME (L,F,M) _________________
Mothers Name (L,F,M): ___________________ BABY: (_) F (_) M BABY: (_) F (_) M
AGE: _____
LMP/AOG: ________ HT: ____ WT: _____ (_) sterile gloves (_) Wash hands
BP: ____ TEMP: ____ RR: _____ HR: _____ (_) drape (_) Gown
FH: _____ GTPAL: ___________________ (_) Cut cord (_) Sterile gloves
BUBBLE-HE: ________________________
NOTES: APGAR SCORE: 1min 5min Baby Out: ________
_________________________________________ Placenta Out: _______
_________________________________________ (_) Assist episiotomy
(_) Assist episorrhapy
(_) Clean gloves
(_) Open sterile equipments

(_) Perineal Prep

OXYTOCIN: _________ (_) IM (_) IV

________ (_) IM (_) IV

ANTHROPOMETRICS:
Ht: ___ Wt: ___ MUAC: __