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www.drjayeshpatidar.blogspot.com
COMMUNITY HEALTH NURSING
(NO. _____)
NAME OF STUDENTS :- ______________________________...
www.drjayeshpatidar.blogspot.com
FAMILY PROFILE DATA
Primary Health Centre: ________________________________
Sub Centre : ...
www.drjayeshpatidar.blogspot.com
3. FAMILY COMPOSITION
S
N
Name Relationship
With Head
of the Family
Age Sex Education Occ...
www.drjayeshpatidar.blogspot.com
B) NUTRITIONAL STATUS OF FAMILY MEMBERS
Name of the Member Nourished/Under Nourished Maln...
www.drjayeshpatidar.blogspot.com
NURSING CARE PLAN
Assessment Nursing Diagnosis Objective/ Goals Nursing Interventions Eva...
www.drjayeshpatidar.blogspot.com
Assessment Nursing Diagnosis Objective/ Goals Nursing Interventions Evaluation Outcome
www.drjayeshpatidar.blogspot.com
Vital Sign GRAPHIC SHEET
* Mouth
* Rectal
Month……………………….
Name, Age, Sex, Status Religion...
www.drjayeshpatidar.blogspot.com
NURSE’S NOTES
Date Time Nursing Intervention Signature
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Transcript of "Family folder format"

  1. 1. 1 www.drjayeshpatidar.blogspot.com COMMUNITY HEALTH NURSING (NO. _____) NAME OF STUDENTS :- _________________________________ CLASS :-__________________________________ DATE FROM :-________________ TO ______________
  2. 2. www.drjayeshpatidar.blogspot.com FAMILY PROFILE DATA Primary Health Centre: ________________________________ Sub Centre : _______________________________ Name of the Village: _________________________________ 1. IDENTIFICATION INFORMATION Head of family – Name:__________________________________________ Occupation : ___________________________________________________ Address_________________________________________________________________ ________________________________________________________________________ Type of family: Nuclear Joint Religion: Hindu Muslim Christian Any other 2. HOUSING CONDITION 1.Type of House: Completed Independent Tileld Sheeted Hut Owned Rented 2. Rooms : Number - Adequate Inadequate 3. Kitchen : Separate Attached to room. 4. Fuel Used : Gas Kerosene Fire Wood Electricity 5. Ventilation : Adequate Inadequate 6. Bath Room : Separate Common 7. Lighting : Electricity Oil Lamp 8. Drainage : Open Close 9. Water Supply : Tap/Hand Pump Well Chlorined. - Yes/No Open Tank Chlorinated 10 Toilet : Own Public Open field 11 Disposal of Waste:Composing Burning Buying 12 Cattle Shed : Separate Within the House
  3. 3. www.drjayeshpatidar.blogspot.com 3. FAMILY COMPOSITION S N Name Relationship With Head of the Family Age Sex Education Occupation Health Status Immun ization Status 1 2 3 4 5 6 4. TRASPORT AND COMMUNICATION FACILITIES B. Communication Media A. Transport Yes No Own Yes/No Telephone Tractor Tempo Wheeler Television Bus City Bus RSRTC Private Radio Autos Taxies Train Newspaper/Magazines Post & Telegraph 5. LANGUAGES KNOWN Marwadi Mewadi Gujrati English Hindi Any Other 6. A)NUTRITIONAL PATTERN Vegetarian Non Vegetarian Staple Food : Rice Wheat Ragi Mixed Vegetables : Grown Purchased Quantity used per day: ……kg Milk : Quantity used per day ………litres Non Vegetarian Dish: Specify…………………. How often ……………
  4. 4. www.drjayeshpatidar.blogspot.com B) NUTRITIONAL STATUS OF FAMILY MEMBERS Name of the Member Nourished/Under Nourished Malnutrition 7. RECORD OF ILLNESS Name of the Member Age Illness Duration Main Investigation Treatment Characteristics done 7. PREGNANT WOMAN Name Age Gravida No. of Children Whether Registered in Receiving Iron & Para Living Hospital/Nursing Home and Folio Acid 9. ELIGIBLE COUPLES Name Age Family Planning Method Not interested willing to use Adopted in Family Planning Family Planning method 10. IN CASE OF SICKNESS, WHERE DO YOU GO FOR TREATMENT? Name/Primary Health Centre Private Nursing Home Sub Centre Indigenous Doctor/Dai
  5. 5. www.drjayeshpatidar.blogspot.com NURSING CARE PLAN Assessment Nursing Diagnosis Objective/ Goals Nursing Interventions Evaluation Outcome
  6. 6. www.drjayeshpatidar.blogspot.com Assessment Nursing Diagnosis Objective/ Goals Nursing Interventions Evaluation Outcome
  7. 7. www.drjayeshpatidar.blogspot.com Vital Sign GRAPHIC SHEET * Mouth * Rectal Month………………………. Name, Age, Sex, Status Religion Hospital No. Occupation, Income Ward, unit, Bed No. B.P. 7a.m. to 7p.m. (Total in m.l.) Intake 7p.m. to 7a.m. (Total in m.l.) 7a.m. to 7p.m. (Total in m.l.) Urine 7p.m. to 7a.m. (Total in m.l.) Stools No. of Times Aspiration/Drainage (24 Hrs. Total in m.l.) Sputum Weight Bath Date: No. of Days Days Post-op Time Pulse Temp C F 210 41.1 106 200 40.6 105 190 40.8 104 180 39.4 103 170 38.9 102 160 38.3 101 150 37.8 100 140 37.2 99 130 36.7 98 120 36.1 97 110 35.6 96 100 35 95 90 Resp-060 80 50 70 40 60 30 50 20 40 10
  8. 8. www.drjayeshpatidar.blogspot.com NURSE’S NOTES Date Time Nursing Intervention Signature

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