Академический Документы
Профессиональный Документы
Культура Документы
1.________________
2.__________________
3.___________________
Immunization of Mother during pregnancy :yes ___________ No__________________ If yes Specify ___________
Dose
Vaccine
Gestational
Age
INTRANATAL: Normal___________
Delayed labour.: yes__________ no___________
If yes, specify____________
Type of delivery: normal_________
Instrumental delivery. Yes____ no______
If yes, specify__________
LSCS__________
POSTNATAL: Normal___________
Immediate cry: yes_________ no________
FAMILY ASSESSMENT:
Family pedigree:
key:
Male:
Female:
Disease:
Death:
Client:
Sociogram:
_____________________ ______________
___________________________________
Sensory Development:Vision
Binocular vision
______________________________________
Identifies shapes
______________________________________
_____________________________
Hearing:-
Tactile Stimulation
Taste
Smell
Increase perception ______________________________________
Responds when called by name __________________________________
Psychosocial Development:
Autonomy:-
______________________________________
Egocentric:-
______________________________________
______________________________________
Play :Balls
Musical toys:
Favorite toy:
Paroled
Group play or parallel play ______________________________________
Any delay in developmental mile stones:______________________________________
Reason for delay:-____________________________________________
Congenital defects:- ______________________________________
Neurological defects :- ______________________________________
Genetic disorders :- ______________________________________
_____________
Lab investigations:
NUTRITIONAL ASSESSMENT:
Expected calorie requirement: ____________
____________
Menu plan:
Impression_____________________________________________
Interventions:_______________________________________________
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