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Discipline

: Paediatrics

Sub Discipline

: Neonatology

Document Title

: Neonatal Jaundice - Nursing Assessment on Admission

Header / Title

Referring Unit/Hospital

Baby's Sex

Place Of Birth

Date And Time Of Birth

Home Address

Date And Time Of Admission

FAMILY INFORMATION

Mother's Name

Father's Name

Father's Work Place

Address

Others

VITAL SIGNS

Vital Signs & Other Observations

General Condition

Pink

Cyanosis

Pallor

Plethoric

High pitch

Weak Cry

Activity

ActiveLethargic Irritable Seizures

Level Of Jaundice

Above umbilicus Below umbilicus Palms and Soles

MANAGEMENT AND NURSING CARE

Start Phototherapy

ConventionalIntensive

Eye Pad

YesNo

Comments

Plan

SIGNATURES

Notes Component

FAMILY INFORMATION
VITAL SIGNS
MANAGEMENT AND NURSING CARE
SIGNATURES

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