NOME: IDADE: CIDADE: LEITO:

ADM: COMORBIDADES:
DATA DO PARTO: HORA : IG: G( )P( ) A ( ):
TIPO DE PARTO : MOTIVO: EPÍSIO ( )N ( ) S
GSM: GSRN: VDRL: DMG ( )S ( ) N _____________ DHEG ( )S ( )N _______________
LAQUEADURA ( )S ( )N ________________
_________________________________________________________________________________________________________________
#PACIENTE COM ________ H DE PARTO ___________
#EM USO DE ATB: ___________________________________________________ #EM USO: __________________________________________________________
1. DIETA: 2. FLATOS:
3. DIURESE: 4. SVD ( )S ( )N
5. EVACUAÇÃO: 6. FLATOS:
6. QUEIXAS:

#AO EXAME: ESTADO GERAL:

1. SSVV: PA: ___________ FC: ____________ FR: ___________ SPO2:________ T: ______

2. MAMAS: EXPRESSÃO MAMILAR: LACTAÇÃO ( )S ( )N COM COLOSTRO ________________/ MAMILOS: PROTUSO ( ) SEMIPROTUSO ( )
INVERTIDO ( ) __________________________________________________________________________________________________
3. ABDOME: ______________________________________________________________________________________________________
4. AFU:___________________________________________________________________________________________________________
5. LÓQUIOS: ____________________________ / SECREÇÕES: ______________________________________________________________
6. EXT: EDEMAS ( ) S ( ) N _______ / TVP:_______________________________________________________________________________

OBS: ____________________________________________________________________________________________________________
EXAMES REALIZADOS: _______________________________________________________________________________________________
#CD: ____________________________________________________________________________________________________________

NOME: IDADE: CIDADE: LEITO:

ADM: COMORBIDADES:
DATA DO PARTO: HORA : IG: G( )P( ) A ( ):
TIPO DE PARTO : MOTIVO: EPÍSIO ( )N ( ) S
GSM: GSRN: VDRL: DMG ( )S ( ) N _____________ DHEG ( )S ( )N _______________
LAQUEADURA ( )S ( )N ________________
_________________________________________________________________________________________________________________
#PACIENTE COM ________ H DE PARTO ___________
#EM USO DE ATB: ___________________________________________________ #EM USO: __________________________________________________________
2. DIETA: 2. FLATOS:
4. DIURESE: 4. SVD ( )S ( )N
7. EVACUAÇÃO: 6. FLATOS:
8. QUEIXAS:

#AO EXAME: ESTADO GERAL:

7. SSVV: PA: ___________ FC: ____________ FR: ___________ SPO2:________ T: ______

8. MAMAS: EXPRESSÃO MAMILAR: LACTAÇÃO ( )S ( )N COM COLOSTRO ________________/ MAMILOS: PROTUSO ( ) SEMIPROTUSO ( )
INVERTIDO ( ) __________________________________________________________________________________________________
9. ABDOME: ______________________________________________________________________________________________________
10. AFU:___________________________________________________________________________________________________________
11. LÓQUIOS: ____________________________ / SECREÇÕES: ______________________________________________________________
12. EXT: EDEMAS ( ) S ( ) N _______ / TVP:_______________________________________________________________________________

OBS: ____________________________________________________________________________________________________________
EXAMES REALIZADOS: _______________________________________________________________________________________________
#CD: ____________________________________________________________________________________________________________