Early Explorers Early Head Start Newborn Assessment/Postpartum Home Visit Checklist and Assessment form (I) (6) Parent s Name Date

Transcription

1 Early Explorers Early Head Start Newborn Assessment/Postpartum Home Visit Checklist and Assessment form (I) (6) Parent s Name Date Baby s Name Baby s DOB Health Coordinator Family Visitor Place of Birth Birth length Birth Weight Most Recent Length Wt Date taken Next MD appointment: with whom WIC appointment Labor and Delivery: Was labor induced? If yes, how? Length of Labor: Vaginal or C-section? was there any Complications? If yes what kind? Delivered before/after due date. Delivered by: Who was you support person during the delivery? Was Anesthetic used? If yes what kind? Length of hospital stay: was there any complications with mom or baby during the Hospital stay? if yes, explain: Did baby spend most of the hospital stay in room or the nursery: Has Social services been notified of birth? (If on MA) Was Infant boy Circumcised? Appearance: Umbilical cord apperance: Coloring today: Apgar score 1min 5min Baby responds to voice: Reflexes noted? Moro? Finger Grasp? Walking reflex? Fontanel Appearance: Overall appearance of Infant: Baby appears: (Circle one) content/fussy Mom s comments: Sleep pattern: Breastfed or formula fed? If formula feeding skips next three questions If breastfeeding does family have lactation support? If breastfeeding, breast/nipple condition: Breastfeeding every hrs. Minutes each side. Is the nursing infant having at least 8 wet diapers in a 24-hour period If not explain?

2 Is the nursing infant nursing at least 8 times in a 24-hour period If not explain? Formula type: OZ/feeding every Hours Comments: Sucking reflex Strong/Weak Cry: weak/strong is child exposed to second hand smoke yes/no Was Hep B startedyes/no any other Immunizations: Is child sleeping over 6-8 hours without nursing or bottle-feeding? Postpartum: Lochia present? Color: Amount: Postpartum check-up date: with whom: Birth control Plan: Are your currently taking any other medications? If yes what kind: Support person: Are you having difficulty with Bowel or bladder? Hemmorroids? Do you feel like you are suffering from any baby blues or sign of postpartum depression? If yes Explain concerns: Are you or have you experienced any of the following Mood changes in the last two weeks: Point scale 1-5 1: Strongly disagree5: Strongly agree and Comments: 1. Panic Attacks (SOB, Dizzy, Sweating, Heart pounding, Need to urinate Frequently, lightheadedness) 2. Trouble sleeping even when baby is asleep. 3. Feeling your emotions were on a rollercoster Or excessive mood swings 4. Difficulty returning to sleep after waking 5. Becoming quickly frustrated 6. Do you have a significant change or lost your appetite? 7. I sometimes think of hurting others or myself? Staff will discuss the following during the Newborn Assessment should discuss the following topics.

3 Rest and Activity Rest with feet up whenever possible for 2 weeks Mild exercise only for at least 6 weeks(walking is best) Nap when your baby naps Gradually resume previous activities Limits stair climbing as much as possible No heavy Lifting Shower/bath daily in clean tub No tampons or douching for 6 weeks Sexual Activity can be resumed after 6 weeks or after you Physician has given you the ok Perineal or Incision cares Use a peri bottle for 1 to 2 weeks to clean incision after using bathroom(if you tore or had a episiotomy Use a sitz bath two times daily or sit in 2 to 3 inches of warm water in a clean bath tub while stitches are still sore Keep incision clean and dry-bath daily Use medicated sprays or ointments only if prescribed by your doctor Diet Eat a well balanced diet for energy and healing Do not diet or attempt to loss weight at this time Drink at least 8 glasses of fluids a day and more if your nursing Eat foods rich in fiber to avoid constipation (fruits, vegetables, whole grains) Breast Care Wear a bra for support for the first 2 weeks postpartum If nursing wear a bra the first 6 weeks postpartum If bottle-feeding avoid any breast stimulation. Don t Squeeze out any milk or touch your breasts a lot, since this will result in more milk production. Wash nipples gently and if showering don t let hot water run over your breasts since this will stimulate milk production. Ice packs on your breasts, especially under the arms will help. An over the counter pain reliever may help the discomfort. To Prevent and treat sore nipples, air dry after feeding for 15 to 20 minutes Alternate breast or offer baby your least sore nipple at start of feeding Medication Instructions Finish prenatal vitamins Has the Dr. prescribed any medication if so what? Birth control Discuss methods of birth control Plans to start yes/no Postpartum follow-up care Postpartum exam scheduled if so when? Emergency care-when to notify the doctor Bathing/Skin care Sponge bath until cord falls off-then bath in a sink or infant tub

4 Use mild sop without p[perfumes (ivory or baby baths) Umbilical cord Apply alcohol at each diaper change until cord falls off in about 1 to 2 weeks of age Keep cord out of diaper-fold diaper over to prevent diaper form rubbing on area There may be a small amount of bleeding when cord falls off Circumcision Keep area clean-wash with soap and water Yellow spots forming on glands is normal-do not try to remove4 Vaginal care Wipe girls from front to back White or pinkish discharge is normal during the first couple weeks Bowel movement May have several stools daily-one stool a day-or skip a day Consistency may be soft, seedy or liquid Observe for changes from your baby s normal pattern-call the doctor if no stools for more than 48 hours Urination 6 to 8 white diapers in 24 hours indicates an adequate fluid intake Feedings Feed baby on demand-schedule may vary day to day Do not force baby to finish a bottle every feeding Never put your baby to bed with a bottle since he/she may choke and the milk/formula should harm the teeth. Never microwave bottle to heat-it may form hot spots in the bottle and cause a burn and it also changes the nutritional value of the breast milk or formula Boil water for formula preparation or use bottled water the first 6 weeks after that tap water may be used unless you have your own well Never feed a bottle that has been left out a room temperature for over an hour or that was used for an earlier feeding Discard unused Formula, do not reuse or put back in refrigerator Rashes May have bumps on face- little red spots or blotchy pink/ red rash with a white raised center Keep area clean and dry Change the diaper more frequently Call Dr. if rash is draining or causes baby discomfort Holding your baby Support your babies weak neck and heavy head by laying the palm of you hand on the back of the babies neck and back that head with your fingers Crying Baby s way of communicating, hunger, tired, wet or dirty, lonely or gassy etc. Responding to you baby s cries will help baby establish trust that his/her needs will be met by you

5 Some babies do cry a lot in the first 6-8 weeks of life Bonding Go skin to skin, when possible to enhance the bonding Discuss contact with the baby, cuddling, holding, message Car seats Children must be in a car seat it is the law Rear facing until infant is 20 pound and/or one year Safety Back to sleep and other SIDS concerns Limit contact with people that are ill First aid kit Emergency numbers Safety checklist Enrollment: New release Copy of birth certificate Do you want me to return in 4-6 weeks or call to see if you may have concerns at that time yes/no If yes: Follow up care or concerns Parent signature Date Nurse s signature Date