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    Pregnant Female Assesment

    Uploaded by

    Jen
    This document contains a form for assessing pregnant females which collects information on their medical history, current health status, family history, and social history. A physical assessment section is also included to record vital signs, exams of various body systems, and a pelvic exam.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd

    Pregnant Female Assesment

    Uploaded by

    Jen
    380 views4 pages
    This document contains a form for assessing pregnant females which collects information on their medical history, current health status, family history, and social history. A physical assessment section is also included to record vital signs, exams of various body systems, and a pelvic exam.

    Original Description:

    Pregnant Female Assesment

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    © Attribution Non-Commercial (BY-NC)

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    This document contains a form for assessing pregnant females which collects information on their medical history, current health status, family history, and social history. A physical assessment section is also included to record vital signs, exams of various body systems, and a pelvic exam.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    380 views4 pages

    Pregnant Female Assesment

    Uploaded by

    Jen
    This document contains a form for assessing pregnant females which collects information on their medical history, current health status, family history, and social history. A physical assessment section is also included to record vital signs, exams of various body systems, and a pelvic exam.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 4

    Assessment of the Pregnant Female

    Name: _____________________________________ Date: ________________


    Age: _________ Marital Status/Significant Other: __________________________
    Gravida: __________ Para: __________ AB: ____________LMP: ________ EDC: ________

    Review of history of the pregnant female:


    _____________________________________________________________________________
    YES/NO If YES, provide details:
    _____________________________________________________________________________

    Past Medical History


    Acute medical conditions ___________________________________________
    Chronic medical conditions ___________________________________________
    Gynecological conditions ___________________________________________
    Gynecological surgery ___________________________________________
    Infertility ___________________________________________
    Genetic conditions/concerns ___________________________________________
    Domestic abuse/violence ___________________________________________
    STD history ___________________________________________
    Nutrition history ____________________________________________
    Anemia ___________________________________________
    Cancer ___________________________________________
    Breast health (BSE) ___________________________________________
    Mental health ___________________________________________

    Past Obstetrical History


    Number of pregnancies ___________________________________________
    Number of term pregnancies ___________________________________________
    Number of live births ___________________________________________
    Abortions (type) ___________________________________________
    Deceased children (cause) ___________________________________________
    Obstetrical complications ____________________________________________
    Prenatal ____________________________________________________
    Intrapartal ___________________________________________________
    Postpartum __________________________________________________

    Assessment of the Pregnant Female Page 1 of 4


    © 2007, Pearson Education, Inc.
    Current Health Status
    Acute medical conditions _____________________________________________
    Chronic medical conditions _____________________________________________
    Mental health _____________________________________________
    Allergies _____________________________________________
    Medications ____________________________________________
    _____________________________________________
    Infertility treatment ____________________________________________
    Gynecological conditions ____________________________________________
    STD ____________________________________________
    Immunization status (hepB, hepA, influenza, tetanus) _______________________
    __________________________________________________________________
    Sexual activity (number of partners) _____________________________________
    Smoking ____________________________________________
    Substance use ____________________________________________
    Abuse/violence ____________________________________________
    Nutrition ____________________________________________
    Nausea/vomiting ____________________________________________
    Vaginal bleeding ____________________________________________
    Urinary symptoms _____________________________________________

    Family History
    Medical history: ________________________________________________________
    _______________________________________________________________________
    _______________________________________________________________________
    Genetic implications ____________________________________________________
    ___________________________________________________________________

    Social History
    Support: _____________________________________________________________
    Employment: _________________________________________________________
    Education: ___________________________________________________________
    Fitness activity: ______________________________________________________
    Living arrangements: __________________________________________________
    _____________________________________________________________________
    Violence: _____________________________________________________________

    Assessment of the Pregnant Female Page 2 of 4


    © 2007, Pearson Education, Inc.
    Review of history related to the current visit:
    Focused symptom analysis of current problem:

    Reason for visit: ________________________________________________________


    _______________________________________________________________________
    _______________________________________________________________________
    Character: _____________________________________________________________
    Onset: ________________________________________________________________
    Duration: ______________________________________________________________
    Location: ______________________________________________________________
    Severity: ______________________________________________________________
    Associated problems: ___________________________________________________
    Efforts to treat: _________________________________________________________

    Physical Assessment

    Vital Signs:
    BP: __________ Pulse: ________ Temperature: ________ Respirations: _________
    Height: __________ Weight: __________ BMI: ___________
    Pregnancy Test: _____________________________
    Urine (Note protein, RBCs): _____________________
    Hct/Hgb: ____________________________________
    Blood Type and Rh: __________________________
    FHT (location): ______________________________
    Skin: _________________________________________________________________
    HEENT: _______________________________________________________________
    Neck and thyroid: _______________________________________________________
    Lungs: ________________________________________________________________
    Breasts: _______________________________________________________________
    Heart/cardiovascular: ____________________________________________________
    _______________________________________________________________________
    Gastrointestinal: _______________________________________________________
    Neurological (Note reflexes): ______________________________________________
    _______________________________________________________________________
    Musculoskeletal: _______________________________________________________
    Extremities (Note edema): ________________________________________________
    Abdomen (size, shape, fundal height, fetal heart tones, fetal movement): ____________
    _______________________________________________________________________

    Assessment of the Pregnant Female Page 3 of 4


    © 2007, Pearson Education, Inc.
    Pelvic Exam
    External genitalia: ________________________________________________
    Pelvic measurements (if available): __________________________________
    Vagina: _________________________________________________________
    Cervix: __________________________________________________________
    Rectal exam: __________________________________________________________

    Analysis:
    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________

    Assessment of the Pregnant Female Page 4 of 4


    © 2007, Pearson Education, Inc.

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