Student Name: __________________________________________

Date: _____________________________

Pre-Assessment: Please answer all:

1. True/False? When assessing a 2 year old you should focus on the parent and allow the child to observe
you and the interaction before begin the exam?____________________________
2. True/False? When assessing a preschooler it is encouraged that the patient handle the equipment?
_______________
3. Generally in pediatrics in what order do you perform Vital signs?________________________________
4. True/False: When measuring a pediatric patients Respiratory rate and a Pulse rate you should count the
rate for 30 seconds and multiply by 2?_________________
5. What would you use to measure pain in a pediatric patient? __________________________________

Performance Criteria

Meets
Expectations

I.

Does Not Meet

Expectations

Demonstration of Professionalism

Punctual
Uniform as per policy
Prepared
Demonstrates Hand Hygiene
Introduces self and role to patient
and family
Verifies patient identity band
Communicates appropriately with
caregiver/ parent
Teamwork
Additional comments:

II. Pediatric Head to Toe Physical Assessment

Comments

Performance Criteria
Obtains & records vital signs
Weight
Height
Temperature
Head Circumference
Heart Rate
Respiratory Rate
Blood Pressure
Pulse Oximetry

Assess Neurological Status:

Alertness
Activity/Strength
Pupils
Fontanels
Assess Respiratory Status:
Breath Sounds
Respiratory Effort
Assess Cardiovascular Status:
Pulses
Heart Sounds/Rhythm
Assess GI/GU Status:
Output
Input

Meets
Expectations

Does Not Meet

Expectations

Comments

IV. Miscellaneous Skills

Changes Diaper
Swaddles Infant
Gives report to receiving nurse
Measures input/output correctly

Date:__________________
Student Signature:_________________________________________________________________
Instructor: Tammy Stoklas RN_____________________________________