👶 Assessment of a Newborn – Community Health Nursing Perspective
— Ensuring Survival, Growth & Development from Day One —
🧭 1. Introduction
Newborn assessment is a comprehensive and systematic evaluation of a baby immediately after birth and during the neonatal period (first 28 days of life). In community health, it is often done at home or sub-centre level by ANMs, ASHAs, or CHOs to identify any danger signs, promote early intervention, and provide postnatal care.
📋 2. Objectives of Newborn Assessment
Detect congenital abnormalities and birth injuries early
Assess vital signs and general well-being
Promote growth monitoring and breastfeeding support
Identify high-risk neonates for referral
Educate the mother/family on home-based newborn care (HBNC)
🩺 3. Timing of Newborn Assessment
Visit
When to Assess
Immediate
Within 1 hour of birth (by skilled birth attendant)
Early
Within 24 hours
Follow-up (HBNC)
Day 3, 7, 14, 21, 28 (as per guidelines)
🔎 4. Components of Newborn Assessment in Community Setting
A. General Observation
Parameter
What to Observe
Color
Pink (normal), Blue (cyanosis), Yellow (jaundice)
Activity
Active movement, lethargy, irritability
Cry
Strong, weak, absent
Tone
Flexed limbs = good tone; floppy = abnormal
Posture
Normal = flexed; abnormal = extended/floppy
B. Vital Signs
Vital Sign
Normal Range
Temperature
36.5–37.5°C (axillary)
Heart Rate
120–160 beats/min
Respiratory Rate
40–60 breaths/min
Capillary Refill Time (CRT)
< 3 seconds
📌 Cold stress, fast breathing, or low HR are danger signs.
C. Anthropometric Measurements
Measurement
Normal Value
Birth Weight
≥ 2.5 kg (Normal); <2.5 kg = Low Birth Weight (LBW)
Length
Around 50 cm
Head Circumference
33–35 cm
Chest Circumference
30–33 cm
📏 Use weighing scale, measuring tape, and growth charts.
D. Head-to-Toe Physical Examination
Body Area
What to Assess
Head
Fontanelles (open and flat), molding, caput, cephalohematoma
Eyes
Redness, discharge, congenital cataract
Ears
Position, shape, discharge
Nose
Patency (choanal atresia check)
Mouth
Cleft lip/palate, sucking reflex
Chest
Shape, chest in-drawing, respiratory distress
Abdomen
Umbilical stump, hernia, organ enlargement
Genitals
Ambiguous genitalia, testis position, discharge
Limbs
Movement, deformities (e.g., clubfoot), fractures
Skin
Birthmarks, peeling, jaundice, rash
E. Neonatal Reflexes (Primitive Reflexes)
Reflex
Description
Sucking
Touching lips causes sucking
Rooting
Stroking cheek causes baby to turn and open mouth
Moro (startle)
Sudden movement causes arms to flail out
Palmar Grasp
Baby grasps finger when palm is touched
Stepping
Stepping movement when feet touch surface
📌 Absence of reflexes indicates neurological problems.
F. Feeding and Elimination History
Parameter
Assessment
Breastfeeding
Initiated within 1 hour? Proper latch? Exclusive feeding?
Urine Output
At least 6 times/day by day 4
Stool Output
Meconium passed within 24–48 hours? Regular yellow stools?
G. Danger Signs to Watch For
⚠️ Immediate Referral Needed if:
Not feeding well or refusing feed
Convulsions
Severe chest in-drawing or fast breathing (>60/min)
High/low temperature (<36.5°C or >37.5°C)
Yellow palms/soles (severe jaundice)
Lethargy, unconsciousness, or weak cry
Umbilical redness extending to skin or pus
📝 5. Documentation and Follow-up
Use Home-Based Newborn Care (HBNC) register
Record date of visit, weight, feeding status, immunization status
Plan referral or next visit as per findings
📚 6. Role of Community Health Nurse
Conduct regular newborn assessments during HBNC visits
Educate mother/family on thermal protection, breastfeeding, immunization, and hygiene
Identify danger signs early and ensure timely referral
Promote exclusive breastfeeding for 6 months
Maintain records and reports
The assessment of a newborn in community health is a life-saving responsibility. It helps in early detection of complications, reduces neonatal mortality, and ensures that the baby transitions into a healthy infancy. The community health nurse, by visiting homes and empowering families, plays a vital role in achieving the goals of Safe Motherhood and Child Survival programs.
👶🧾 Assessment of a Toddler (1–3 Years)
— Community-Based Evaluation of Growth, Development, and Health
🧭 1. Introduction
A toddler is a child aged between 1 to 3 years. This is a critical stage for physical growth, brain development, motor skill acquisition, social learning, and speech development. Regular community-based assessment helps detect malnutrition, developmental delays, and ensures timely intervention.
🎯 2. Objectives of Toddler Assessment
Monitor growth and development
Detect nutritional deficiencies or illnesses
Assess immunization status
Promote parental education on hygiene, feeding, safety
Provide referral for children with special needs or delays
📅 3. Timing of Assessment in Community
When
By Whom
During routine home visits
ANM, ASHA, CHO
At Anganwadi Centers (AWC)
ICDS workers, ANM
During Village Health and Nutrition Days (VHNDs)
Joint teams
🧩 4. Components of Toddler Assessment
A. 🧒 General Appearance and Behavior
Parameter
What to Observe
Posture and activity
Active or lethargic? Standing/walking confidently?
Behavior
Interaction with caregiver, stranger anxiety
Skin and hair
Dry, flaky skin? Hair color change (flag sign)?
Alertness
Response to sound, visual stimuli, playful behavior
B. 🩺 Anthropometric Measurements
Parameter
Normal Range (approx.)
Weight
10–12 kg by age 2
Height/Length
Around 85–90 cm by age 3
Mid Upper Arm Circumference (MUAC)
≥13.5 cm is normal
Head Circumference
45–50 cm
Chest Circumference
Slightly less than head size
📌 Use growth charts (WHO or ICDS) to assess nutritional status.
C. 🧠 Developmental Milestones
1. Gross Motor Skills
Age
Expected Skills
1–1.5 yrs
Walks without support, sits alone
2 yrs
Runs, kicks ball, climbs stairs with help
3 yrs
Jumps, rides tricycle, stands on one foot (briefly)
2. Fine Motor Skills
Age
Expected Skills
1.5–2 yrs
Turns pages, builds tower of 4–6 blocks
3 yrs
Can hold crayon, draw a circle or line
3. Language Skills
Age
Expected Skills
1 yr
Says 1–2 words, understands simple instructions
2 yrs
Vocabulary of 50+ words, 2-word sentences
3 yrs
Asks questions, uses short sentences, knows own name
4. Social and Emotional Development
Behavior
Signs
Plays with others
Parallel play, copying adults
Temperament
Tantrums, possessiveness
Communication
Points to body parts, responds to own name
📌 Any delay in milestones should be flagged and referred.
D. 🍚 Nutritional Assessment
What to Assess
How
Feeding practices
Type of food, frequency, weaning age
Appetite
Child’s interest in food
Deficiency signs
Pale conjunctiva (anemia), bitot spots (vit A), swelling (kwashiorkor)
24-hour diet recall
From mother to assess food intake quality
E. 💉 Immunization Status
Check if child has received vaccines as per Universal Immunization Program (UIP):
Additional Vitamin A doses every 6 months till 5 yrs
📌 Verify using Mother and Child Protection (MCP) card.
F. 🚽 Hygiene, Safety, and Environmental Factors
Factor
Observation
Handwashing habits
Mother and child
Toilet use or potty training
Is it started?
Water and food hygiene
Is food covered? Is water boiled?
Exposure to injuries or burns
Burns, falls, unsafe kitchen areas?
G. ❗ Common Signs for Referral
Delayed walking or talking
Not responding to name or sounds
Recurrent diarrhea or respiratory infections
Poor weight gain or visible wasting
Not making eye contact or unusual behaviors
📚 5. Tools Used for Toddler Assessment in Community
MUAC tape
Growth charts (WHO/ICDS)
Weighing scale and infantometer
MCP card or immunization record
Developmental screening tools (if available)
HBNC/HBYC checklists
📝 6. Role of Community Health Nurse/Worker
Monitor growth and development regularly
Educate mothers on nutrition, immunization, hygiene
Counsel on stimulation and positive parenting
Identify malnutrition or developmental delays early
Refer high-risk or sick toddlers to PHC/CHC
Document and follow up appropriately
Assessing toddlers in the community is key to reducing child morbidity, malnutrition, and mortality. By using simple tools and observation, community health nurses and workers can ensure that each child receives the care and support needed to grow, learn, and thrive.
🎒👧 Assessment of Preschool Child (3–6 Years)
— Community-Based Evaluation of Growth, Development, Nutrition, and Well-being
🧭 1. Introduction
The preschool age group (3–6 years) is a critical period for physical growth, personality development, school readiness, language acquisition, and socialization. Early detection of health problems, developmental delays, malnutrition, and behavioral issues is crucial.
In community health, this assessment is commonly done through home visits, Anganwadi centers, VHNDs, and school health programs.
🎯 2. Objectives of Preschool Child Assessment
Monitor growth and developmental milestones
Detect nutritional deficiencies and health problems
Ensure immunization completion
Promote early childhood education and hygiene habits
Provide parental counseling and health education
Identify special needs and refer appropriately
📅 3. Timing of Assessment in Community
Assessment Location
Frequency
Home Visit
As per HBNC/HBYC schedule
Anganwadi Centre (AWC)
Monthly growth monitoring
School Health Program
Once/twice a year
VHNDs
Every month for screening and health education
🧩 4. Components of Preschool Child Assessment
A. 🩺 General Physical Examination
Parameter
Observation
Appearance
Neat, well-nourished, clean clothing
Activity level
Alert, interactive, curious
Skin
Dryness, rashes, pallor, infections
Hair
Texture, color changes, brittleness (sign of protein deficiency)
Eyes
Conjunctiva (anemia), Bitot spots (vitamin A deficiency)
Teeth
Dental caries, hygiene status
Nails
Hygiene, signs of iron deficiency (spoon nails)
B. 📏 Anthropometric Measurements
Parameter
Normal Value (Approx.)
Weight
14–18 kg (varies with age and sex)
Height
95–110 cm
MUAC
>13.5 cm = normal; <12.5 cm = undernourished
BMI
Optional, if tools available
Head Circumference
48–52 cm
📌 Use ICDS growth charts or WHO charts for plotting.
C. 🧠 Developmental Milestones
1. Gross Motor Skills
Age
Milestone
3–4 yrs
Runs, jumps, climbs stairs alternating feet
4–5 yrs
Balances on one foot, hops
5–6 yrs
Skips, rides a bicycle, throws a ball overhead
2. Fine Motor Skills
Age
Milestone
3–4 yrs
Draws circle, holds pencil
4–5 yrs
Can draw a square, dress/undress self
5–6 yrs
Ties shoelaces, copies triangle, uses scissors
3. Language Development
Age
Milestone
3–4 yrs
Talks in 3-4 word sentences, asks questions
4–5 yrs
Knows name, age, talks clearly
5–6 yrs
Tells short stories, asks many questions, understands instructions
4. Social and Emotional Skills
Milestone
Observation
Plays in group, follows rules
Shows independence (wants to do things alone)
Expresses emotions, understands turn-taking
Begins to differentiate right and wrong
📌 Use Denver Developmental Screening Tool (DDST) if available.
📌 Also counsel on balanced diet and feeding habits.
E. 💉 Immunization Status (as per UIP)
Age
Vaccine
16–24 months
DPT Booster-1, OPV Booster
5 years
DPT Booster-2
4–6 years
Measles-Rubella (if missed earlier), JE (in endemic areas)
📌 Cross-check with MCP card or immunization record.
F. 🧽 Hygiene and Personal Habits
Factor
Observation
Handwashing
Before food and after toilet?
Nail hygiene
Clean and trimmed
Dental hygiene
Brushing twice a day?
Toilet training
Fully or partially trained
Clothing
Clean and seasonal
G. 🧠 Behavioral and School Readiness Assessment
Area
Examples
Attention span
Can sit still for 5–10 minutes?
Social skills
Shares toys, plays with peers
Cognitive
Recognizes colors, shapes, counts objects
School attendance
Regularity and adjustment
H. ❗ Identification of Health Problems (Refer if needed)
Stunting or wasting (growth failure)
Speech or language delay
Behavioral problems (aggression, withdrawal)
Vision or hearing impairment
Poor hygiene, neglect, abuse
📝 5. Documentation and Tools Used
Tool
Purpose
Growth monitoring chart (ICDS)
Weight and height tracking
MUAC tape
Malnutrition screening
MCP card
Immunization verification
HBNC/HBYC forms
Health record keeping
Referral slips
For children needing specialist care
👩⚕️ 6. Role of Community Health Nurse/Worker
Conduct regular health assessments during home visits or AWC days
Educate caregivers on nutrition, hygiene, stimulation, discipline
Provide deworming and Vitamin A supplementation
Ensure immunization completion
Refer high-risk children to PHC/CHC
Collaborate with Anganwadi Workers and school teachers
The assessment of preschool children in the community is crucial for promoting optimal growth, early learning, and disease prevention. By integrating health, nutrition, education, and parental support, community health nurses play a key role in laying the foundation for a healthy and productive future generation.
🎒📋 Assessment of School-Going Children (6–14 Years)
— Promoting Child Health through School and Community Collaboration
🧭 1. Introduction
The school-going age (6–14 years) is crucial for physical growth, mental development, learning, emotional well-being, and behavior formation. Assessing school children helps in early detection of health problems, ensuring their well-being, academic success, and overall development.
This is often conducted under the School Health Program (SHP) or RBSK (Rashtriya Bal Swasthya Karyakram).
🎯 2. Objectives of School Child Assessment
Early identification of nutritional, physical, mental, and developmental problems
Promote health education and hygiene awareness
Detect and manage communicable diseases
Monitor growth and development
Ensure complete immunization and deworming
Provide referral and follow-up services
Promote health-promoting schools
🧩 3. Components of School-Going Child Assessment
A. 📏 Anthropometric Measurements
Parameter
Normal Values (varies by age/sex)
Height
Increases 5–6 cm/year
Weight
Increases 2–3 kg/year
BMI
Should be within normal range (as per WHO chart)
MUAC
Used for nutritional assessment if needed
📌 Use growth charts (WHO/IAP) for plotting data.
B. 🩺 General Physical Examination
System/Area
What to Assess
Skin
Scabies, fungal infections, wounds, pallor
Hair
Lice infestation, dryness, brittleness
Eyes
Redness, squint, visual acuity, discharge
Ears
Hearing, wax, discharge
Nose
Nasal obstruction, sinusitis
Teeth
Caries, hygiene, malocclusion
Gums
Bleeding, inflammation (vitamin C deficiency)
Throat
Tonsillitis, voice changes
Spine
Scoliosis or posture issues
Limbs
Deformities, gait, injuries
Abdomen
Palpable masses or organomegaly (if symptomatic)
C. 🧠 Mental and Behavioral Assessment
Area
Indicators
Cognitive ability
Poor memory, inattentiveness, learning difficulty
Behavior
Aggression, withdrawal, anxiety, lack of peer interaction
Sleep and eating habits
Irregularities may indicate emotional or nutritional issues
School performance
Frequent absenteeism, low grades
📌 Refer to psychologist or special educator if behavioral concerns arise.
D. 🍚 Nutritional Assessment
What to Look For
Signs
Protein-Energy Malnutrition (PEM)
Thin limbs, swelling, lethargy
Anemia
Pale conjunctiva, fatigue
Vitamin A deficiency
Night blindness, Bitot spots
Vitamin D deficiency
Rickets (bow legs, knock knees)
Vitamin B deficiency
Cracks at corners of mouth, glossitis
📌 Counsel for balanced diet and midday meal intake.
E. 💉 Immunization and Deworming Status
Age
Vaccine
5–6 years
DPT Booster-2
10 years
Td (Tetanus-Diphtheria)
16 years
Td Booster
Every 6 months (5–14 years)
Deworming with Albendazole (under NDD)
📌 Verify immunization with MCP card or school health record.
F. 🧽 Personal Hygiene Practices
Area
Observation
Hand hygiene
Clean hands, nails trimmed
Oral hygiene
Brushing teeth regularly
Hair
Clean and lice-free
Uniform/clothing
Neat, clean, season-appropriate
Use of toilet
Toilet-trained, knowledge of handwashing
📌 Provide hygiene education through health talks or posters.
G. 🧠 Vision and Hearing Screening
Test
Purpose
Snellen’s Chart
Visual acuity screening
Whisper Test
Hearing ability
Tuning Fork (if available)
Basic hearing assessment
📌 Refer to ENT/ophthalmologist if abnormal findings.
H. ❗ Identification of Common Health Problems
Malnutrition (underweight/obesity)
Refractive errors (poor vision)
Dental caries and gum disease
Worm infestations
Skin diseases (scabies, ringworm)
Speech or behavioral problems
Learning disabilities
🧰 4. Tools Used for School Health Assessment
Tool
Use
Weighing scale & stadiometer
Weight and height measurement
MUAC tape
Nutritional screening
Snellen’s chart
Vision test
Torch & tongue depressor
Oral and throat examination
Growth charts
Record plotting
Health checkup card
Record findings and follow-up
👩⚕️ 5. Role of Community Health Nurse in School Health
Conduct regular school health check-ups
Coordinate with school staff and parents
Educate children on hygiene, nutrition, and safety
Provide first aid and manage minor ailments
Identify and refer children needing special care
Ensure immunization, supplementation, and deworming
Maintain records and submit reports
Assessment of school-going children ensures that health problems are identified early, nutritional and developmental issues are addressed, and every child gets an equal chance to grow, learn, and thrive. Community health nurses are key players in bridging health and education, contributing to a healthier, smarter generation.
🧑⚕️📋 Assessment of Adolescents (10–19 Years)
— Promoting Holistic Health and Early Intervention in Community Settings
🧭 1. Introduction
Adolescence (10–19 years) is a transitional period from childhood to adulthood characterized by rapid physical, psychological, emotional, and social changes. It is a vulnerable phase with unique health needs.
In community health, adolescent assessment is done through home visits, schools, Anganwadi centers, Adolescent Friendly Health Clinics (AFHCs), and special outreach programs like RKSK (Rashtriya Kishor Swasthya Karyakram).
🎯 2. Objectives of Adolescent Assessment
Detect growth abnormalities, nutritional issues, or anemia
Assess mental health, risk behavior, and substance use
Promote personal hygiene, menstrual health, and sexual & reproductive health (SRH)
Identify emotional/behavioral problems early
Support development of self-esteem, coping skills, and healthy choices
🧩 3. Components of Adolescent Assessment
A. 📏 Anthropometric Measurements
Parameter
Normal Considerations
Height & Weight
Plot on WHO/IAP growth charts
BMI
Calculate to identify underweight, normal, or overweight
MUAC (if needed)
For malnutrition screening
Growth Spurts
Assess rapid changes especially around puberty (8–13 yrs in girls, 10–15 yrs in boys)
B. 🩺 Physical Health Assessment
Area
What to Examine
Skin
Acne, fungal infections, scabies
Eyes
Refractive errors, conjunctivitis
Hair
Dandruff, lice, patchy loss
Mouth & Teeth
Dental hygiene, caries, ulcers
Posture & Spine
Look for scoliosis or hunchback
Thyroid
Enlargement/goiter
Menstrual history (girls)
Age of menarche, cycle regularity, dysmenorrhea, hygiene practices
Secondary sexual characteristics
Normal pubertal development (breast, voice, body hair)
📌 Use Tanner’s stages for assessing puberty (if trained).
Conduct regular screening during Adolescent Health Days or VHNDs
Ensure WIFS, deworming, immunization
Provide counseling on SRH, hygiene, nutrition, stress management
Involve parents in health education
Refer high-risk adolescents to Adolescent Friendly Health Clinics (AFHCs)
Maintain proper documentation and follow-up
Assessment of adolescents in the community helps ensure a healthy transition into adulthood. Early detection and counseling related to nutrition, reproductive health, emotional well-being, and behavior can significantly reduce health risks. Community health nurses play a vital role in empowering adolescents through education, support, and access to care.
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🤰📋 Assessment of Antenatal Women (ANC) – Community Health Nursing
— Ensuring Safe Motherhood from the First Trimester Onwards
🧭 1. Introduction
Antenatal assessment is the systematic and periodic examination of a pregnant woman to ensure the health of both mother and fetus. It is the first step in safe motherhood, allowing early detection of risk factors, complications, and timely interventions.
In community settings, antenatal care (ANC) is provided through sub-centers, Anganwadi centers, VHNDs, and home visits by ANMs, ASHAs, and CHOs.
🎯 2. Objectives of Antenatal Assessment
Confirm and date the pregnancy
Monitor maternal and fetal health
Detect high-risk pregnancies and complications early
Provide health education, nutritional counseling, immunization
Promote institutional delivery and birth preparedness
📅 3. Timing of ANC Visits (as per Government Guidelines)
Visit No.
Timing
1st Visit
Within 12 weeks (1st trimester)
2nd Visit
Between 14–26 weeks (2nd trimester)
3rd Visit
Between 28–34 weeks
4th Visit
Between 36 weeks and term
Additional Visits
As needed, especially in high-risk pregnancies
📌 At least 4 ANC visits are essential; monthly home follow-ups are encouraged.
🧩 4. Components of Antenatal Assessment
A. 📋 History Collection
Category
Key Points
Personal history
Name, age, address, education, occupation, socioeconomic status
Obstetric history
Gravida, para, abortions, living children (G-P-A-L), last menstrual period (LMP), EDD
>145 cm (short stature = risk for obstructed labor)
Weight
Baseline and regular monitoring (gain of ~10–12 kg during pregnancy)
Pallor
Check for anemia (conjunctiva, tongue)
BP
<140/90 mmHg
Pulse & temperature
Within normal range
Oedema
Mild pedal edema may be normal; facial/generalized edema = preeclampsia risk
Oral health
Gums, teeth condition
Breasts
Nipples, lumps, tenderness
Skin
Rashes, pigmentation, stretch marks
C. 📏 Abdominal Examination
Aspect
Assessment
Fundal height
In cm = roughly corresponds with weeks of gestation (after 20 weeks)
Abdominal girth
For fetal growth tracking
Fetal lie and presentation
After 32 weeks
Fetal heart sound (FHS)
Using fetoscope/doppler (~120–160 bpm normal)
Uterine activity
Contractions or tenderness
D. 🔬 Laboratory Investigations (Basic Tests)
Test
Purpose
Hemoglobin (Hb)
Detect anemia (Normal ≥11 g/dL)
Blood grouping & Rh typing
Identify incompatibility
VDRL
Syphilis screening
HIV & HBsAg
Mandatory under PPTCT
Urine (albumin & sugar)
Detect preeclampsia, gestational diabetes
Blood sugar (fasting/random)
Screen for GDM
Optional (based on facility):
Thyroid, CBC, ultrasound, malaria, stool test
E. 💉 Immunization and Supplementation
Service
Schedule
Tetanus & Diphtheria (Td)
2 doses at 1-month interval; or 1 booster if immunized previously
Iron Folic Acid (IFA)
1 tablet daily for 180 days (60 mg iron + 500 mcg folic acid)
Calcium supplements
500 mg twice daily
Deworming
After 2nd trimester (Albendazole 400 mg, once)
F. 🤰 Fetal Well-being Monitoring
Parameter
Significance
Fetal movements
Should begin ~18–20 weeks; reduced movements = alarm sign
FHS
Regularity and rate (120–160 bpm normal)
Symphysis-fundal height
Growth indicator; deviation may mean IUGR or polyhydramnios
Ultrasound findings
For dating, growth, congenital anomalies, placental position
G. 📚 Health Education and Counseling
Topics
What to Teach
Nutrition
Balanced diet, iron-rich foods, hydration
Rest and work
Avoid heavy lifting, adequate rest
Warning signs
Bleeding, swelling, severe headache, reduced fetal movements
Birth preparedness
Place of delivery, transport, financial planning
Hygiene
Personal and perineal care
Family planning
Postpartum options
Breastfeeding
Early initiation, exclusive for 6 months
TT immunization and danger signs
H. ❗ Identification of High-Risk Pregnancy
Conditions to Watch
Examples
Age <18 or >35 years
Anemia (Hb < 9 g/dL)
Hypertension, diabetes
Multiple pregnancies
History of abortion, stillbirth, cesarean
Bleeding, abnormal lie, oligohydramnios
Malaria, TB, HIV
📌 Such cases should be referred to PHC/CHC immediately.
📋 5. Documentation Tools
Tool
Use
MCP Card
Mother and Child Protection Card – to track ANC, immunization, weight, etc.
ANC Register
For record keeping at Sub-centers
Home Visit Form
For ANMs and ASHAs
Referral slip
For high-risk or emergency cases
👩⚕️ 6. Role of Community Health Nurse/ANM
Conduct regular and timely ANC check-ups
Identify high-risk pregnancies and refer early
Educate the mother and family on birth preparedness
Distribute IFA, calcium, and immunizations
Promote institutional deliveries
Conduct home visits and follow-up care
A thorough antenatal assessment at the community level forms the foundation of safe motherhood. Early detection of complications, effective counseling, and timely referrals by community health personnel greatly reduce maternal and neonatal mortality and contribute to better health outcomes.
🤱📋 Assessment of Postnatal Women (PNC) – Community Health Nursing
— Ensuring Safe Recovery for the Mother and Newborn After Delivery
🧭 1. Introduction
Postnatal care (PNC) refers to the care given to the mother and her newborn from immediately after delivery up to 6 weeks (42 days). This is a critical period where both the mother and baby are vulnerable to life-threatening complications.
In community health, postnatal assessment is conducted through home visits, Sub-Centre check-ups, and Village Health & Nutrition Days (VHNDs) by ANMs, ASHAs, CHOs, and PHNs.
🎯 2. Objectives of Postnatal Assessment
Monitor the physical and emotional recovery of the mother
Detect complications like infection, bleeding, or anemia
Promote exclusive breastfeeding and newborn care
Educate the mother on self-care, nutrition, and family planning
Ensure timely immunization and follow-up for mother and baby
📅 3. Recommended Schedule of Postnatal Visits (Home-Based)
Visit No.
Timing
1st visit
Within 48 hours of delivery
2nd visit
On 3rd–5th day
3rd visit
On 7th–14th day
4th visit
On 21st day
5th visit
On 42nd day
📌 As per HBNC/HBYC guidelines, more visits may be done in home deliveries or high-risk cases.
🧩 4. Components of Postnatal Assessment
A. 🩺 General Physical Examination of the Mother
Parameter
What to Assess
Temperature
Fever may indicate infection
Pulse
Tachycardia could signal hemorrhage or sepsis
Blood Pressure
Monitor for postnatal hypertension
Respiration
Check for breathlessness (may indicate anemia or embolism)
Pallor
Anemia (conjunctiva, tongue)
Oedema
Could indicate preeclampsia or anemia
Weight
Gradual return to pre-pregnancy weight
B. 👩⚕️ Local Examination (Per Abdomen & Perineum)
Area
What to Assess
Uterine involution
Fundus should reduce by 1 finger/day
Lochia (vaginal discharge)
Rubra (red) – 1st week
Serosa (brownish) – 2nd week
Alba (whitish) – after 2 weeks 📌 Foul smell, excessive bleeding = infection | Perineal area | Cleanliness, stitches (if any), pain, redness, pus | Cesarean wound (if applicable) | Redness, discharge, separation
C. 🤱 Breast Examination
Aspect
What to Check
Shape and size
Engorgement or asymmetry
Nipples
Inverted, cracked, bleeding
Signs of mastitis
Redness, pain, fever
Milk flow
Adequate, easy let-down
📌 Educate on breastfeeding techniques and hygiene
D. 🧘 Emotional and Psychological Assessment
Indicator
Observation
Mood swings
Common, but should not interfere with bonding
Sleep disturbance
Severe disturbance may indicate postpartum depression
E. 🧫 Investigations (If Not Done or Follow-Up Needed)
Test
When to Do
Hemoglobin
If anemia is suspected
Blood pressure
If hypertensive during pregnancy
Blood sugar
Follow-up for GDM cases
Urine test
For UTI suspicion
F. 🍚 Nutritional Assessment and Counseling
Parameter
Assessment
Appetite
Adequate intake?
Food groups
Balanced diet – cereals, pulses, milk, fruits, green veggies
Iron-rich foods
Dates, jaggery, green leafy vegetables
Water intake
At least 2–3 liters/day
📌 Counsel for IFA and calcium continuation
G. 💊 Supplementation and Immunization
Service
Schedule
IFA tablets
1 tablet daily for 180 days post-delivery
Calcium tablets
2 tablets/day for 6 months
Vitamin A (with measles vaccine for baby)
Postnatal dose to mother if deficient
TT Booster (if not received)
As per antenatal record
H. 👶 Baby’s Condition (Brief Assessment)
What to Check
Why
Baby’s feeding
Exclusive breastfeeding status
Immunization
BCG, OPV, Hep-B (at birth)
Weight gain
Normal = 20–30 grams/day
Hygiene
Skin, cord stump, eyes
Danger signs
Not sucking, fever, fast breathing, umbilical infection
I. 💬 Health Education and Counseling Topics
Topic
Key Messages
Breastfeeding
Exclusive for 6 months, proper latch
Postnatal exercises
Gentle movement after 2–3 weeks
Family planning
Options: condoms, PPIUCD, pills, injectables
Personal hygiene
Handwashing, perineal care, changing pads
Nutrition
High-protein, iron-rich food
Danger signs
Bleeding, fever, pain, baby not feeding
Birth spacing
At least 2 years between pregnancies
📝 5. Documentation Tools
Tool
Use
Mother and Child Protection (MCP) Card
To record PNC visits, baby’s growth, immunization
HBNC register
For field-level tracking
Referral slip
If complications detected
Postnatal visit checklist
For structured assessments
👩⚕️ 6. Role of Community Health Nurse/ANM/CHO
Conduct home visits as per PNC schedule
Educate the mother and family on self-care, baby care, hygiene
Identify danger signs and refer appropriately
Ensure compliance with supplements and immunization
Support early initiation and exclusive breastfeeding
Promote institutional delivery for future pregnancies
Maintain accurate records and follow-up
Postnatal assessment is a vital part of continuity of care for the mother and newborn. In community health, early detection of problems, proper counseling, and timely referral during the postnatal period can greatly reduce maternal and neonatal mortality and morbidity. Community health nurses are central to ensuring safe motherhood and healthy infancy.
🧑⚕️📋 Assessment of Adults in Community Health
— Promoting Preventive, Promotive & Curative Services at the Grassroots Level
🧭 1. Introduction
Assessment of adults (18–60 years) in community health involves evaluating the physical, mental, social, and functional health status of individuals. The aim is to detect diseases early, promote healthy behavior, manage chronic conditions, and reduce morbidity and mortality at the community level.
This assessment is commonly done through home visits, health camps, VHNDs, and screening programs under national health missions like NPCDCS, NHM, etc.
🎯 2. Objectives of Adult Health Assessment
Identify communicable and non-communicable diseases
Promote healthy lifestyle and preventive practices
Screen for chronic diseases such as hypertension, diabetes, and cancers
Assess nutritional status, hygiene, and mental well-being
Provide health education, referral, and follow-up services
📋 3. Components of Adult Assessment in Community Health
A. 🧾 Personal and Medical History
History Type
Key Questions
Demographic
Name, age, sex, occupation, marital status
Medical history
Past illnesses (TB, malaria, typhoid, diabetes, hypertension)
Ask about meal frequency, fruit/vegetable intake, salt/oil/sugar intake
📌 Counsel for balanced diet and portion control.
E. 🧠 Mental Health Assessment
Aspect
Screening Questions
Mood
Feeling low, hopeless, or irritable?
Sleep
Disturbance, insomnia
Memory
Forgetfulness, concentration issues
Anxiety
Constant worry or panic
Substance abuse
Alcohol, tobacco, or drug dependence
Depression
PHQ-9 or simple yes/no questions
📌 Refer to mental health counselor or CHC psychiatrist if needed.
F. 💡 Lifestyle and Behavior Assessment
Risk Factor
Questions to Ask
Smoking/Tobacco
How many per day/week? Since when?
Alcohol
How often and how much?
Physical Activity
Do you walk or exercise daily?
Sleep
How many hours/day? Any disturbances?
Stress
Work or family-related issues?
📌 Encourage behavior change through motivational counseling.
G. 🧼 Personal Hygiene and Environment
Observation
Notes
Bathing & clothing
Cleanliness, appropriate dressing
Oral hygiene
Brushing habit, dental problems
Toilet use
Sanitation availability and usage
Safe drinking water
Source and storage method
Household ventilation
Overcrowding, smoke exposure
H. ❗ Red Flags or Referral Indicators
BP >140/90 mmHg
RBS >200 mg/dL
Unexplained weight loss
Breast lump or unusual vaginal discharge
Depression, suicidal thoughts
Persistent cough >2 weeks (suspect TB)
Vision or hearing loss
Oral lesions (non-healing ulcers, leukoplakia)
🧰 4. Tools and Forms Used in Adult Assessment
Tool
Purpose
BP apparatus
Hypertension screening
Glucometer
Blood sugar screening
Stethoscope
Chest/heart auscultation
Adult NCD card/register
Record findings
BMI chart
Nutrition evaluation
VIA/Pap smear kits (for women)
Cervical cancer screening
Mental health screening checklist
Depression/anxiety evaluation
👩⚕️ 5. Role of Community Health Nurse / CHO / ANM
Conduct screening and health assessments during VHNDs, home visits, camps
Provide health education on diet, exercise, addiction, family planning
Distribute IFA, calcium, deworming tablets as per requirement
Maintain records and follow-up for hypertensive/diabetic cases
Identify and refer suspected cases to PHC/CHC
Encourage early detection and health-seeking behavior
Adult assessment in the community helps detect early signs of chronic illnesses, encourages healthy habits, and ensures timely referral and treatment. Through regular screenings and counseling, community health nurses contribute significantly to reducing the burden of preventable diseases and promoting healthier communities.
👵👴📋 Assessment of Elderly in Community Health Nursing
— Promoting Healthy Aging and Independent Living
🧭 1. Introduction
The elderly population (age 60 years and above) is growing rapidly and is more vulnerable to chronic illnesses, disabilities, neglect, and emotional issues. Comprehensive geriatric assessment in community health is essential to ensure healthy aging, functional independence, and improved quality of life.
Assessment is carried out during home visits, geriatric camps, sub-centres, and through programs like the National Programme for Health Care of the Elderly (NPHCE).
🎯 2. Objectives of Elderly Assessment
Detect and manage chronic diseases early
Evaluate functional, nutritional, emotional, and cognitive status
Identify disability, neglect, abuse, or social isolation
Promote preventive care, safety, and health education
Encourage family involvement and referral to geriatric services
🧩 3. Components of Elderly Assessment in the Community
Pale conjunctiva, glossitis, mouth sores, bone pain
📌 Counsel for protein-rich, soft, and easy-to-digest meals
D. 💪 Functional Assessment (ADL & IADL)
1. Activities of Daily Living (ADL)
Activity
Can the Elderly Person…?
Bathe independently
Yes/No
Dress self
Yes/No
Use toilet
Yes/No
Eat without help
Yes/No
Walk or transfer
Yes/No
Maintain hygiene
Yes/No
📌 Use Katz Index or Barthel scale for evaluation.
2. Instrumental Activities of Daily Living (IADL)
Activity
Check Ability to:
Use telephone
Manage finances
Take medications correctly
Cook meals
Go shopping
Use transport
📌 Loss of IADL = early sign of declining independence.
E. 🧠 Cognitive and Mental Health Assessment
Area
Key Questions/Signs
Orientation
Name, place, time
Memory
Short-term memory loss
Mood
Sadness, hopelessness, apathy
Dementia signs
Forgetfulness, confusion, wandering
Depression
Loss of interest, sleep/appetite changes
Anxiety or fear
Paranoia, agitation
📌 Tools: Mini Mental Status Exam (MMSE) or Geriatric Depression Scale (GDS)
F. 🧬 Screening for Common Conditions
Condition
Method
Hypertension
BP check
Diabetes
RBS using glucometer
Cataract/vision loss
Visual exam/Snellen chart
Hearing loss
Whisper test
TB or chronic cough
Ask for >2 weeks cough, sputum test
Urinary incontinence
Bladder control questions
Osteoporosis/arthritis
Joint pain, mobility status
Cancer screening
Breast, oral, cervical (if indicated)
G. 🛌 Environmental and Social Assessment
Area
Observe/Ask
Living conditions
Ventilation, lighting, clean bedding
Safety
Fall risks, bathroom grab bars, slippery floors
Social engagement
Isolation, support system
Abuse or neglect
Bruises, emotional signs, poor hygiene
Finances
Income, dependency, pension access
Accessibility
Nearby health center, transport availability
🧰 4. Tools and Forms Used
Tool
Purpose
BP apparatus, glucometer
NCD screening
Katz ADL scale / Barthel index
Functional status
Geriatric Depression Scale
Mental health
Visual/hearing charts
Sensory screening
IFA/calcium register
Supplementation
Elderly health card
Documentation (under NPHCE)
👩⚕️ 5. Role of Community Health Nurse/CHO/ANM
Conduct regular elderly health checkups at home or sub-centre
Provide health education on nutrition, fall prevention, exercise
Distribute iron, calcium, deworming, and other supplements
Screen for NCDs, depression, dementia, and sensory loss
Ensure referral and follow-up for serious health conditions
Promote vaccinations (flu, pneumonia, COVID-19)
Collaborate with ASHA, families, and panchayats for social support
Community-based elderly assessment ensures healthy aging, helps manage chronic diseases, and supports functional independence. Community health nurses play a key role in ensuring quality of life for the elderly through preventive, promotive, and supportive care.