JFK/M Postpartum Assessment Tool
Nursing 122
Student:
Patient’s Initials:
Date:
Age:
PP Day:
Breast/Bottle:
Weight Gain:
Childbirth Education:
Present Obstetrical History
G/P:
Blood Type:
Type of Delivery:
Sex/Weight:
G.A./Apgars:
Type of Delivery:
Complications:
Past Obstetrical History
History of previous pregnancies/complications:
Cultural significant practices:
Relevant Medical/Surgical History:
Diagnostic/Lab Tests
H/H:
RBC:
Urinalysis pH:
Glucose:
WBC:
S.G.:
Platelets:
Blood:
Ketones:
Other relevant antepartum/postpartum diagnostic/lab tests:
Rubella status:
 Immune
 Non immune
Hepatitis status:
 Negative
 HBSAG +
Rhogam needed:
 Yes
Date:
 No
Protein:
Oxygenation:
Vitals signs/Pain:
Breath sounds:
Fundus (level, character):
Lochia (type, amount):
Nutrition
Diet:
IV Fluids:
Elimination
Bladder Output/Foley:
Bowel Function:
Bowel sounds:
Protection
Perineum/Episiotomy/Laceration (ecchymosis, edema, hematoma):
Abdominal Incision:
Abdominal Distention:
Ice Pack/Sitz Bath/ Peri Care:
Endocrine
Breasts (soft, engorged, etc.)/Nipples
Interdependence/Self concept
Emotional Status:
Bonding Behaviors:
Depression Scale Score:
Nursing Interventions
Educational Needs/Teaching:
A. Self Care:
B. Infant Care:
C. Involution/Hemorrhage/Lochia changes:
D. Breast Feeding/Bottle Feeding:
E.
Identified blocks to learning