Socio Personal Data Sheet of Mothers - Nursing Assignment Help

Assignment Task:

Task:

Instructions
 Interview the mothers of preterm babies and put tick mark (√) on appropriate options and fill in the blanks wherever necessary.
 Don’t leave any questions unanswered.
1. Age (in years)
a. 18 - 22 ( )
b. 23 - 27 ( )
c. 28 - 32 ( )
d. 33 – 37 ( )
2. Educational qualification
a. No formal education ( )
b. Primary school education ( )
c. Secondary school education ( )
d. Degree ( )
e. Master’s degree ( )
3. Occupation
a. Home maker ( )
b. Self-employee ( )
c. Manual labourer ( )
d. Private employee ( )
e. Govt. Employee ( )

4. Area of residence
a. Panchayath ( )
b. Municipality ( )
c. Corporation ( )
5. Type of family
a. Nuclear family ( )
b. Joint family ( )
c. Extended family ( )
6. Socio class (Ration card)
a. APL ( )
b. BPL ( )
7. Frequency of ante natal check up
a. Minimum of 3 times ( )
b. Less than 3 times (Specify reason.....................................) ( )
c. More than 3 times (Specify reason……………………….) ( )
8. Mode of delivery
a. Normal ( )
b. Caesarean ( )
c. Instrumental [(a) vacuum (b) forceps] ( )
9. Place of delivery
a. Home ( )
b. Government Hospital ( )
c. Private hospital ( )

10. Number of children
a. One child ( )
b. Two children ( )
c. Three children ( )
11. Do you have previous history of preterm delivery?
a. Yes ( )
11a. Specify the gestational age of child at birth………………
11b. Specify health status of that child.......................................
b. No ( )
12. Do you had any medical illness during previous and this pregnancy?
a. Yes (Specify................................................) ( )
b. No ( )
13. Do you have adequate support from family during antenatal period?
a. Yes ( )
b. No (specify the reason..........................................................) ( )
14. Do you have any previous experience regarding the care of preterm babies?
a. Yes (specify the source........................................................) ( )
b. No ( )

SECTION B
Profile of the preterm baby
1. Post-natal age
a. 4 th day – 12 th day ( )
b. 13 th day – 21 st day ( )
c. 22 nd day – 30 th day ( )
2. Gender
a. Male ( )
b. Female ( )
3. Birth weight (grams)
a. 700gm – 900gm ( )
b. 1000gm – 1200gm ( )
c. 1300gm – 1500gm ( )
4. Weight of the baby during the data collection……………………….
5. Gestational age in weeks
a. 24 week – 26 week ( )
b. 27 week – 29 week ( )
c. 30 week – 32 week ( )
d. 33 week – 35 week ( )
6. Mode of pregnancy
a. Single ( )
b. Twin ( )
c. Triplet ( )

7. Birth order
a. First ( )
b. Second ( )
c. Third ( )
8. Reason for admission in SNICU
a. ARDS ( )
b. Low birth weight ( )
c. IUGR ( )
d. Sepsis ( )
e. Birth trauma ( )
9. Associated comorbidity of child
a. Congenital anomalies ( )
b. Physiological jaundice ( )
c. Haemolytic disease ( )
d. No comorbidities ( )
10. Type of feeding
a. Paladai ( )
b. Ryle’s tube feeding

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