CEBU TECHNOLOGICAL UNIVERSITY

In consortium with
CEBU CITY MEDICAL CENTER- COLLEGE OF NURSING

NAME: TRIXY MARIE L. ECOT YEAR & SECTION: 2-B

SUBJECT/AREA: PEDIATRICS DATE: MAY 17, 2021

ASSESSMENT TOOL

I. DEMOGRAPHIC DATA

a. Name :
b. Age :
c. Sex :
d. Civil Status :
e. Educational Attainment :
f. Address :
g. Significant Other :
h. Medical Diagnosis :

II. CHIEF COMPLAINTS

III. HISTORY OF PRESENT ILLNESS

IV. GENOGRAM

V. LABORATORY/DIAGNOSTIC STUDIES

Diagnostic Test:
Date of Examination:
Laboratory Normal Value Result Nursing Significance

VI. ASSESSMENT
VII. ANATOMY AND PHYSIOLOGY

a. Macro Anatomy
b. Micro Anatomy
c. Physiology

LEVEL II CCMC-CN 1
 CEBU TECHNOLOGICAL UNIVERSITY
In consortium with
CEBU CITY MEDICAL CENTER- COLLEGE OF NURSING

VIII. PATHOPHYSIOLOGY

a. Definition:
b. Risk Factors:
c. Diagnostic Studies and Its Possible Results:
d. Medical-Surgical Management:
e. Pharmacological Management:
f. Diagram/Concept Map:

IX. SUMMARY OF FINDINGS

X. DRUG STUDY

Dosage,
Drug-to- Adver
Route, Mechani Nursing
Name Indicati Contraindica Drug se
and sm of Responsibi
of Drug on tion interacti Effect
Frequen Action lity
on s
cy
Generic
Name:
Brand
Name:
Therap
eutic
Classifi
cation:
MEDIC
ATION
TICKET

XI. NURSING CARE PLAN

NURSIN
NURSIN
SCIENT GOAL G
G RATION EVALU
DATE CUES IFIC OF INTER
DIAGN ALE ATION
BASIS CARE VENTI
OSIS
ON
Subjectiv
e cues:

LEVEL II CCMC-CN 2
 CEBU TECHNOLOGICAL UNIVERSITY
In consortium with
CEBU CITY MEDICAL CENTER- COLLEGE OF NURSING

Objectiv
e Cues:

XII. DISCHARGE PLAN

a. Demographic Data
I. Name
II. Age
III. Sex
IV. Civil Status
V. Educational Attainment
VI. Address
VII. Significant Other
VIII. Medical Diagnosis

b. General Objective
c. Specific Objectives
d. Medications
NAME OF THERAPEUTI SIDE HEALTH
DOSAGE FREQUENCY
DRUG C USE EFFECTS EDUCATION

e. Environment
f. Treatment
g. Health Teaching
h. Observable Signs and Symptoms
i. Diet
j. Spiritual Care

LEVEL II CCMC-CN 3