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Newborn Care Record Template

This document is a record of immediate newborn care for a baby delivered at an unnamed institution. It includes anthropometric measurements, APGAR scores, vital signs, details of skin-to-skin contact and breastfeeding positioning, medications given, and identifying information for the mother and physicians. Signatures are included from the student, staff nurse, clinical instructor, and supervisor to verify the care provided to the newborn.

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Marie Antionette Mondragon
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228 views1 page

Newborn Care Record Template

This document is a record of immediate newborn care for a baby delivered at an unnamed institution. It includes anthropometric measurements, APGAR scores, vital signs, details of skin-to-skin contact and breastfeeding positioning, medications given, and identifying information for the mother and physicians. Signatures are included from the student, staff nurse, clinical instructor, and supervisor to verify the care provided to the newborn.

Uploaded by

Marie Antionette Mondragon
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Cebu Institute Of Technology – University

c o l l e g e o f n u r s i n g and allied health sciences

RECORD OF IMMEDIATE NEWBORN CARE


Cord Care No. _______
Name of Institution : _____________________ Case/Hospital Number : ___________
Name of Baby : _______________________________ Gender : __________________
Date and Time Delivered: _____________ / ______AM/PM Mode of Delivery: ______________
Diagnosis : __________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Anthropometric Measurements : Length (cm) :________________________________
Weight (grams) :________________________________
Head Circumference (cm): _____________________________
Chest Circumference (cm): _____________________________
Mid-Arm Circumference (cm): __________________________
APGAR Score (1 & 5 mins) : _______ / _________ Ballard’s Score (weeks) :____________
Vital Signs : T = ___________ HR = ___________ RR = ___________
Please tick the details which were observed:
Skin to skin contact: ( ) Breastfeeding: ( )
Positioning: Neck not flexed/twisted ( ) Attachment: Mouth wide open ( )
Chin on Breast ( ) Lower lip turned outward ( )
Chest to chest ( ) Chin touching breast ( )
Support whole body ( ) Suckling slow and deep ( )
Medications Given :
Credes Prophylaxis : __ AM/PM Vitamin K: ___ AM/PM Hepatitis B Vaccine: ___AM/PM
Name of Mother : ______________________ Age: ________ Marital Status: __________
Address : __________________________________ Contact #: ______________
Gravida : __________ Parity: _________ G-T-P-A-L-M: ___________________
Diagnosis : __________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Physician (OB) : __________________________ Physician (Pedia) _______________
Handled By : __________________________________________________________
Assisted By : __________________________________________________________

_____________________________________ _______________________________________
Name & Signature of Student Name & Signature of D.R. Staff Nurse

_____________________________________ _______________________________________
Name & Signature of Supervising Name & Signature of D.R. Supervisor
Clinical Instructor

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