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Assessment For Normal Pedia

This document contains an assessment form for pediatric patients, collecting information about a child's vital signs, personal history including prenatal and birth details, familial history, past medical history, nutritional history including feeding and eating patterns, rest and sleep patterns, elimination patterns, immunization status, physical exam findings, developmental assessment, and areas identified for health teaching. Sections include collecting details about the child's name, family, birth, neonatal period, siblings, housing, hospitalizations, feeding, eating, sleep, elimination, immunizations, physical exam, developmental milestones, and health education needs.

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151 views6 pages

Assessment For Normal Pedia

This document contains an assessment form for pediatric patients, collecting information about a child's vital signs, personal history including prenatal and birth details, familial history, past medical history, nutritional history including feeding and eating patterns, rest and sleep patterns, elimination patterns, immunization status, physical exam findings, developmental assessment, and areas identified for health teaching. Sections include collecting details about the child's name, family, birth, neonatal period, siblings, housing, hospitalizations, feeding, eating, sleep, elimination, immunizations, physical exam, developmental milestones, and health education needs.

Uploaded by

LizaEllaga
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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West Visayas State University COLLEGE OF NURSING La Paz, Iloilo City ASSESSMENT FOR NORMAL PEDIATRICS ( For Infants,

Toddlers, Pre-schoolers, Schoolers)

I. VITAL INFORMATION Name of Child: Sex: Date of Birth: Age: Address: Name of Mother: Educational Attainment: Occupation: Name of Father: Educational Attainment: Occupation: Approximate Income of the Family: Name of Informant: Relationship with child:

Age: Age: Monthly:

II. PERSONAL HISTORY A. Prenatal Mothers general health ( Did the mother had toxemias, analgesia or radiation therapy, viral or other infections?): Medications taken during pregnancy: Pain, bleeding, threatened abortion: None: Yes: Specify: B. Birth Duration and circumstances of labor: Analgesia Used: Delivery: Home: Complications: Birth Weight: AOG: C. Neonatal: Feeble: Resuscitated: Convulsions: Pallor:

Hospital:

Type:

Vigorous: Cyanosis: Hemorrhage: Dyspnea:

III. FAMILIAL HISTORY Birth Order of the Child: Number of living siblings: Serious diseases/ illness of siblings: Congenital diseases among siblings: Death of siblings: Heredo-familial diseases: Total Number of Siblings: Type of housing: Cause of death:

IV.PAST MEDICAL HISTORY Number of Past Hospitalizations: Date of last confinement: Reason for hospitalization: Number of days of hospitalization: V. NUTRITIONAL HISTORY Feeding (check and specify) Bottlefeed: Supplementary feeding: Vitamins: Food likes: Dislikes: Beliefs and fallacies: Breastfeed: Type: Amount: Mixed: ___________ Age started: When: Where:

VI.EATING PATTERNS (For older children) Usual Foods Taken Breakfast Time of Day

Lunch

Supper

Snacks

VII. REST AND SLEEP Usual bedtime: Naps: Bedtime rituals: Problems with sleep: Usual remedy: Total number of hours of sleep: VIII. ELIMINATION PATTERNS A. Bowel Elimination Frequency: Problems: Usual Remedy: B. Urinary Remedy Frequency: Problems: Usual Remedy: IX. IMMUNIZATION STATUS Rising time:

1ST dose age OPV DTP MMR BCG Hepa A Hepa B CT Others (specify):

2nd dose

3rd dose

booster 1

booster 2 Date received

Date age received

Date age received

Date age received

Date age received

X. CEPHALOCAUDAL ASSESSMENT Head:

Eyes:

Ears:

Nose:

Mouth:

Neck:

Chest:

Back:

Abdomen:

Extremities Upper:

Lower: Genito-anal:

Skin:

Temperature: Height: Weight:

Pulse:

Respiratory Rate:

BP:

XI. DEVELOPMENTAL ASSESSMENT Found in Textbook Actual Observation Significance

A.Gross Motor Development

B.Fine Motor Development

C.Sensory Development

D.Psychosocial Development and Socialization

E.Psychosexual Development

F.Spiritual Development

G.Cognitive/Intellectual Development

H.Language/Speech Development

XII. AREAS IDENTIFIED NEEDING HEALTH TEACHING A. Nutrition

B.

Activities

C.

Immunization

D.

Safety

E.

Others

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