SAN PEDRO COLLEGE Davao City NURSING DEPARTMENT ASSESSMENT GUIDE, (INFANT) PERSONALDATA — —| Name of Fatent ‘inhaay Rae ordin Rank of__ sF adres. nations Rien: Name of father “Age _____ fducatienal Atarnent Occupation Name of Mother. ——deevpation: ADMINISTER MMDST (Bases irene ‘A. MATERNAL /OBSTETRICS/PRE NATAL HISTORY: Ree Prenatal Checwups Complications dutvg presnaney lon taken during pregnancy Tre child underwent newborn screening: Complications __ Length of stey n Hospital: — Medications: TT Vaccines (include dates) Me Labor & Delivery 2 of hour of ator Use of Anesthesian ‘B.BIRTH HISTORY, Manner af delivery:0NSVD TGS (instrumentation Placertivieme Hospital Lyingsin Presentation __ Birth welght|__Birts Height ____ Other Measurements (in cms HC. _CC._ AC: ‘GREONATAL ‘DLINEANCY & CHILDHOOD: Others (pls specify Allergies. Congenital Problem Brevious Hosp taliations (why, wre, Treatment Outcome) Serious nares: (Fractures, neu injures wit ss of consciousness, motor vehicle ae Ident, buts laceration Medications “ ‘ENUTRITION: 1 Breostfed! Frequency:__(by demand or every__ hours) Sucking strength Problems: © Bottiefeed: Formula Mik’ Dilution Frecuency’ Food preferences: Meal Patterns & Apoet ie: Feeding Problems: Vitamics/Minerals/Focd Svoplements: Dentition: Age of onse Number of Teeth ‘EEN Patter: 8/43 Consistency Problems: Constipation Diarttea Others ‘GACTIVITY & SLEEP: Usual Sleeping Patter No.of Mrs:_Neps:_ Rituals Problems: Usual Daly Activities Plays Toys __— Solor:__Urination/day: _ Chilhood Diseases! Mung CiCticen Pox Polo (Messer “Pneumonia CMepati © Asthma ¢/Diphthen Immunizations: 1RCG ONepe COPY OPT CMe CMB OMepA LD Meomgnk oT Others (els spec] ‘HLGROWTH & DEVELOPMENT Physical Development . PAnthropometrc Measurements Ht: We: He:_ce > Cephalocaudal Appearance Personal hygiene > Reflexes Language Development Dlanguage/ Dialects ‘DWords uttered (Please include ather observation i terms of language development not included os part of MADST)SAN PEDRO COLLEGE Davao City NURSING DEPARTMENT ASSESSMENT GUIDE (TODDLER) PERSONAL DATA. Name of Patient: 7 : Age: _ Ordinal Rank: __of __ siblings Address: Nationality _______ Religion: Name of Father: __ Name of Mother: __. Educational Attainment: Occupation: Educational Attainment: _ Occupation ADMINISTER MMDST ASSESS / INTERVIEW ‘A. MATERNAL/OBSTETRICS/PRE-NATAL HISTORY: AOG:__ GP T__P__ aA Prenatal Check-ups:_ Complications during pregnancy TT Vaccines (include date: _— Medications taken during pregnancy: Labor & Delivery: __No. of hours of labor: Use of Anesthesia: B. Bi mR Manner of delivery: ONSVD OCS Cinstrumentation Place: Home CiHosp. ou Presentation: ___Birth weight: ___Birth Height:_ Other Measurements (in crns): HC: _CC:_ AC ‘C. NEONATAL: The child underwent newborn screening. Length of Stay in Hospital: Complications: dications: _ D. CHILDHOOD: Childhood Diseases: Mumps OChicker Pox (Polio LAMeastes Pneumonia (Hepatitis Asthma Diphtheria Others (pls. specify) immunizations: BCG CHepB OOPV & Measles HIB CHepA CMeningitis OTT Others (pls. specify) Allergies: __ Congenital Problems: Previous Hospitalizations (Why, Where, Treatment, Outcome): DPT Serious Injuries: (Froctures, head injuries with loss of consciousness, motor vehicle accidents, burns, or lacerations) Medications: E_ ELIMINATION: Toilet Training: Age of Bowel Control: _ Age of Daytime Bladder Control: _Age of Nighttime Bladder Control: Pattern: BM/day:__ Consistency: _ Amount:____Color: Urination/day: Accidents: Regressio _ Problems: (Constipation (Diarrhea CiEnuresis Others: a _ Able to verbalize need to defecate or void? a _ ____. Child's response / attitude NUTRITION © Breastfeed: Frequency: {by demand or every_"_ hours) Sucking strength: Problems: | Bottlefeed: Formula Milk: Dilution: _) Frequency: _ Problems: - Food preferences: Meal Patterns & Appetite: | Feeding Problems: Vitamins/Minerals/Food Supplements: Dentition: Age of onset:, S/sx of teething Number of Teeth: Specify Teeth: | GLACTIVITY & SLEEP: | Usual Sleeping Patterns: No. of Hrs: Naps: Rituals: Problems: j Usual Daily Activities: Plays: Toys: | MENT PHYSICAL DEVELOPMENT > Cephalocaudal Appearance — (include height and weight) > Personal hygiene LANGUAGE DEVELOPMENT D> anguage/ Dialects Words uttered | PSYCHOSOCIAL DEVELOPMENT , ‘> Describe child’s reaction and psychosocial behavior -Negativism -Curiosity _- Possessiveness =Temper Tantrums - Imitation __- Ritualism© Attitudes EVACTIVITIES, PLAY & SLEEP. © Dally Routines © Play activities © Gross © Fine © Toys © Playmates Sleep Pattern F. FEARS © Describe fears of the child © Reactions G. COGNITIVE DEVELOPMENT Assimilation ‘Accommodation Magical Thinking Role-fantary thinking Centering Reversibility Conservation Ego-centricism Pre-logical reasoning Can state cause and effect, ‘relationship H. SPIRITUAL DEVELOPMENT ‘© Describe child’s reaction to; © Parental behavior and attitude related to religion and spirituality © Attending masses / other religious activities, (© Conceptof Ged and faith |. MORAL DEVELOPMENT © “Concept of right and wrong. © Does the child react to situation based on egocentricity and narcissistic needs? ‘© Child's reaction on: © Telling Iles © Stealing © BullyingSAN PEDRO COLLEGE Davao city NURSING DEPARTMENT . ASSESSMENT GUIDE (PRESCHOOL) PERSONAL DATA Name ofPatient: Birthday: Ree: ‘Address: Nationality: Religion: Name of Father: Age: Educational Attainment: ‘Occupation: Name of Mother: Age Educational Attainment: Occupation: ‘Ordinal Ranks of, siblings DADMINISTER MMOST DASSESS / INTERVIEW PARAMETERS: ‘ACTUAL OBSERVATION RATIONALE ‘SOURCE ‘A PHYSICAL DESCRIPTION © Body build Cephalocaudal description Dentition & gums B. GROWTH B DEVELOPMENT ‘* Describe the following: ‘© Jumping skipping Running Throwing bali writing Handedness Drawing Coloring “Handling toys Holding scissors and pencil Self-care activities + Bathing + Washing & drying : hands Dressing (dress & undress) Button or a unbutton * Brushing teeth = Combing hair + Tie or lace shoes 0000000000 NUTRITION ‘© Observe if basic food intake are taken, ‘+ 2¢hour dietary recall © Eating habits . © Foods— likes and distikes and reasons behind '¢ Height and weight, 8M D. TOWET TRAINING '* Observe bowel and bladder Integrity ‘© Daytime and nighttime contro! 2 © Verbalization of need to void and defecate 2 Accidents and regressionSAN PEDRO COLLEGE Davao City NURSING DEPARTMENT ASSESSMENT GUIDE (SCHOOL-AGE) ‘A. PHYSICAL DEVELOPMENT _ * Observe and describe the following: © Cephalocaudal appearance © Body built B. DENTITION AND GUMS. * Observe and describe the following: © Color and completeness © Dental caries © Missing teeth C. PERSONAL CARE * Observe and describe the following: © Dresses © Bathes © Washes hands (sefore and after eating) Bladder and bowel control PERSONAL DATA Name of Patient a — Birthday: Ages Ordinal Rank: of ___ siblings Address Nationality. ______ Religion: Name of Father: _ Age: Educational Attainment: Occupation: sausensen Name of Mother: __ — Age: __ Educational Attainment:__ Occupation: — “DASSESS / INTERVIEW - __ PARAMETERS. RATIONALE 2 Cleans self after defecating or toilet accident D. ACTIVITY AND REST © Play activities © Toys + Sleep and relaxation E. NUTRITION © Food ~iikes and dislikes © © 24hour dietary recall © Eating habits * Favorite food and reasons behitd Eating behaviors and actions ‘Height and weight, BMI F. MENTAL DEVELOPMENT? CLASSROOM ACTIVITY __ CHILD'S REACTION "Atleast 5 * Oral recitation, group activities, bourd work, etc G. OBSERVABLE PROBLEMS ‘+ Explain in narrative form -* Identify five observable problems (cognitive, psychosocial, health) manifested such as: = Poor school performance - Anti-social behavior ~ Recurrent physical illness - Destructive behavior to others_ Concept of right and wrong ‘Actions based on approval of others? Obeying rule and roles Child's reaction on © Telling lies ©. Stealing © Bullying SPIRITUAL DEVELOPMENT "7 CHILD'S REACTION / ACTUAL BEHAVIOR CHILD'S REACTION / ACTUAL BEHAVIOR Describe child’s reaction to; © Parantal behavior and attitude related to religion and ality © Attending masses / other religious activities © Concept of God, faith, priest