Client Data 3.

risk for impaired parenting r/t

Client’s name: confidential unplanned pregnancy
Nickname: bebe Emergency contact person/s
Client’s DOB: 12/30/86 age:23 Name: Vicente Naduma
Client’s ins. & no._NONE_ Relationship: Father
Client’s SS no. NONE Phone: none
Clients race: __white __black Address: tupsan, mahinog camiguin
__hispanic _√_other province
EDC: Sept.18,2010 Doctor(must use PCP if applicable)
weeks gestation: 34 weeks Name: Dr. Quiblat
Primary language: Filipino, cebuano Hospital: Camiguin General Hospital
_√_home __shelter Phone: NONE
__homeless __staying with Address: Mambajao, camiguin
relatives Consulting Doctors on care: Dr. Solapy
Current residence address: Phone:
tupsan,mahinog,camiguin province 1._________________________
Phone: 09161420509 2._________________________
Best time to contact: daytime 3._________________________
Diagnoses Other consultants:
1. excess body fluid r/t ankle edema 1. SW______________________
2. disturbed body image r/t 1st time 2. other_____________________
pregnancy
Exacerbating potentials:
1. Planned hospital for delivery: camiguin general hospital
2. History of prenatal care this pregnancy: 5 times
3. Planned delivery
_√_vaginal __C-section
I. Prior OB history: G_1_ P_0_
PIH_NO_ GDM_NO_ IDDM_NO_ Eclampsia_NO_
No. of children living with her and their ages:____none____
Any children in foster care, or living elsewhere: ____none__
II. Current state of Health:
1. Physical : weight= 51.2 kg height= 5’4 ft
2. Mental: coherent and spontaneous
3. Emotional: at first, she tried to it from her family, she stayed at home for early
months
4. Social: at first, she tried to it from her family, she stayed at home for early
months
5. Hospitalizations/surgeries: no prior hospitalization or surgeries
6. Diet/ Nutrition/ weight prior to pregnancy; weight gain so far: she needs to
always be looked after since she likes to eat junkfoods. Her weight prior to
pregnancy is 42kg and her wight gain so far is 8.2kg.
7. Activity: more on walking, sweeping the ground and more on sleeping.
8. Physical Limitations: no carrying of heavy objects
9. Support Systems: at first, her mother can not accept her pregnancy but she was
never inflicted pain physically. Her mother is taking care of her since she is
moody.
10. Limitations: no carrying of heavy objects
11. Medications – time, frequency, amount, purpose, side effects
Clusivol OB and ferrous, P.O, OD
12. Teaching needed
__transportation __self-treatment
_√_changes during pregnancy
_√_nutrition _√_home safety __community resources
__utilities
__phone
__housing
__cooking
__water
__respite
__ref
__others
__growth/dev.
_√_parenting education
_√_budgeting of financial resources
_√_parenting skills _√_parenting education
__gestational diabetes __premature labor
__rupture of membrane __signs/symptoms of labor
13. Referrals already made: no referrals need since she could still be cater in
Camiguin General Hospital
14. Referrals needed: NONE
__WIC __Wheels
IV. Family data/support network:
1. Other household members(name, age, medical issues)
2. Other significant others/extended family members
Are they available to assist with care of child- when delivered? YES
3. Summary of household function- do people work together?
Do they get along? YES Who is in charge? PARENTS
4. Evidence of drug/ETOH use: NONE
5. Smoker: her father smokes occasionally

Housing Information
1. Current residence _√_permanent __temporary
2. Type of residence _√_house __apt. __shelter __other explain
3. Length of time in current residence: 22 years
4. Are there plans to move? __yes _√_no when?________________
New address:_____________________________________________________
5. Layout of house
No. of bedrooms _4_ no. of bathrooms_2_
_√_kitchen _√_dining area _√_living area _√_furniture
Condition of house: newly renovated
Safety issues at House:
Outlets: __2 prongs __3 prongs __adeq. no. __inadeq. no.
Smoke alarms: __yes _√_no no.of alarms____
Stable railings: _√_yes __no
Adequate lighting: _√_yes __no(specify)
Emergency nos. posted: __yes _√_no
Sanitation: no. of bathrooms: 2
A. Is kitchen sanitary?_√_yes __no(specify)
B. Pest control: are the following present:
_√_roaches _√_rats/mice _√_flies
C. Plumbing problem: none
Medication storage: specify plan for storage, if refrigeration needed
Infection control needs surrounding care:
Summary of client home needs assessment
Problem List – Priliminary
Plan
 Cagayan de Oro College
Phinma Education Network
College of Nursing

PERINATAL HOME NEEDS ASSESSMENT TOOL

SUBMITTED BY:
ABUGA-A, SHEENA QUEEN
ESPAÑO, SIERA LEE ELAINE
NADUMA, ANALYN

SUBMITTED TO:
MR. JOEY PEQUIT,RN,MN
INSTRUCTOR