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Pediatric Physical Assessment

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					                                  Department of Nursing Education

                                  Pediatric Physical Assessment
Name:__________________________                             Date:____________________________

Pt. Initials:_____Pt. Age:_______Family Member/CG Present:____________________

Admission
Diagnosis:_____________________________________________________________

Presenting Signs and
Symptoms for Admission:_________________________________________________

Erikson’s Stage of Development:____________________________________________


Ht._____ Wt._____ HR______ RR______ BP______ Temp______ Allergies_________

Pain Scale: (0-10) ______Verbal Report/Faces Scale/FLACC (circle how assessed)

Nutrition
Diet:______________________ IV Fluids (type and rate):_______________________
Recent wt. loss/gain:________ Birthweight _______ Lips/Gums/Teeth______________

Integumentary
Skin Color:______________                    Texture:___________       Rashes:___________
Incisions:________________                   IV site:____________      Ostomy:__________

Neurological/Head
LOC/State:_______________          Facial Symmetry___________________________
Sensory Deficit Aids:_____________________ Reflexes:______________________
Fontanels (anterior, posterior size and appearance if present)____________________
Eyes - Pupils:_______________ Discharge:__________           Clarity:___________
Strabismus_________________ Swelling:___________             Ptosis:____________
Ears – Shape:_______________ Symmetry:__________             Discharge:_________

Oxygenation
Respirations (rate, rhythm, depth)___________________________________________
Retractions:___________ Nasal Flaring:_____________      Grunting:_________
Breath Sounds:_________________________________________________________
O2 Therapy:______________________________          O2 Saturation:___________
Cough:______________________Sputum(describe):__________________________
Skin/Nail Bed Color:__________________MucousMembranes:__________________
Respiratory Therapy Treatments(type and frequency):_________________________


Nursing\Forms\Nursing Forms\Pediatric Physical Assessment
DLadd 1/24/05                                                                                   1
Cardiovascular
Apical Heart Rate_________       Rhythm__________          Murmur_________
Capillary refill__________ Peripheral Pulses/location__________________________
Skin Turgor_______________       Edema___________________________

Musculoskeletal
ROM:_____________________________                           Symmetry:_______________________
Activity Tolerance:___________________                      Strength:_________________________

GI/GU/Abdomen
Abdomen Appearance:_________________ Bowel Sounds:____________________
Last BM/Usual Pattern:___________________________________________________
Urinary Output:_____________________     Urine Characteristics:_______________

Labs:




Diagnostic Tests/Procedures:




Nursing\Forms\Nursing Forms\Pediatric Physical Assessment
DLadd 1/24/05                                                                                    2
Discharge Planning/Patient (&/or) Parent Teaching:




Problem                                                     Nursing Diagnosis




Nursing\Forms\Nursing Forms\Pediatric Physical Assessment
DLadd 1/24/05                                                                   3
Rationale for Choosing Nursing Diagnoses (2)




Pathophysiology Of Diagnosis:




Medications (May Attach Med Cards or Separate Sheet)


Nursing\Forms\Nursing Forms\Pediatric Physical Assessment
DLadd 1/24/05                                               4
Developmental Impact (Real or Potential) of Hospitalization




Appropriate Play Therapy During Hospitalization




Safety Considerations Based on Developmental Age




Nursing\Forms\Nursing Forms\Pediatric Physical Assessment
DLadd 1/24/05                                                 5

				
Jun Wang Jun Wang Dr
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