Pediatric Physical Assessment

1. 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):_________________________
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2. 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:
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3. Discharge Planning/Patient (&/or) Parent Teaching:
Problem Nursing Diagnosis
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4. Rationale for Choosing Nursing Diagnoses (2)
Pathophysiology Of Diagnosis:
Medications (May Attach Med Cards or Separate Sheet)
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5. Developmental Impact (Real or Potential) of Hospitalization
Appropriate Play Therapy During Hospitalization
Safety Considerations Based on Developmental Age
By: Dave Jay S. Manriquez RN.
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