Zambowood Health Center

Barangay Zambowood, Zamboanga City

MATERNAL HEALTH RECORD Name of Mother: ________________________ Age: ____________ Name of Father: _________________________ Address: _________________________ DATE Nurse/ Midwife Remarks o o o o Family Number: __________________ G: ____________ P:____________ LMP: ___________________________ EDC: ___________________________

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Admitted at the health center/Answered a home delivery call at G ______ P______ Multipara/Primipara mother with chief complaint of lumbo-sacral pain noted, on and off prior to admission at _____ AM/PM Vital signs taken and recorded: B/P:___________ Temp: __________ Pulse:_________ Weight: __________ Abdominal palpitation done: Fundic Height (FH): ______________ Fetal Heart Tone (FHT):__________ Internal Examination (IE) done: Dilatation of the cervix: ________ cm + / - Bag of Water (BOW) Advised to walked Monitored interval and duration of contraction Prepared for delivery Bag of water ruptured at _______ AM/ PM Delivered spontaneously to an alive baby boy/girl with an APGAR score of ___ at _____ AM/PM Signs of placental separation observed Placenta expelled completely after ________ mins. by Shultz/duncans presentation. Uterus massaged until contracted Slight/moderate vaginal bleeding noted Cleaned perineum and checked for laceration Clean perineal pad applied Soiled linen change to clean one Hot nourishment given BP rechecked: ________ Initiated breastfeeding Health teachings given: Continue breastfeeding Wash perineum with decoction of boiled guava leaves especially before and after defecation Eat food rich in vitamins and minerals such as fruits and vegetables and protein rich food Increase fluid intake Perform light household chores Medicines on stock administered with proper instruction Oxytocin 1 ampule given Intramuscularly Vitamin A 1 caplet given now Ferrous sulfate #20 Sig. 1 Tablet once a day for 90 days (3 Months) Mefenamic Acid 500 mg #10 Sig 1 tab 3 x a day prn for pain Amoxicillin 50 mg 1 cap 3 x a day for 3 days

Zambowood Health Center

050713/NCabrera-ADZUBSN4

Barangay Zambowood, Zamboanga City

UNDER FIVE CHILD HEALTH RECORD Name of Child: __________________________ Sex: __________________________ Name of Mother: ________________________ Address: _______________________________ Date Remarks: o o o Born spontaneously to an alive baby boy/girl at _____ AM/PM with an APGAR Score of _________ Cord cut and tied and dressed aseptically Vital Signs Taken and Recorded: WEIGHT: ___________________ TEMPERATURE: _____________ HEART RATE: _______________ RESPIRATORY RATE: _________ HEAD CIRCUMFERENCE:________ CHEST CIRCUMFERENCE: _________ LENGTH: _________________ Dressed the baby warm and comfortable Placed baby on the mothers chest Good sucking reflex observed Administered 0.1 cc of Vitamin K via LEFT Vastus Lateralis Administered 0.5 cc of Hepatitis B Vaccine via RIGHT Vastus Lateralis Terramycin eye ointment applied to both eyes Family Number: __________________ Childs Number: __________________ Place of Delivery: _________________ Babys Weight: ___________________

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050713/NCabrera-ADZUBSN4