University of Bahrain

College of Health& Sport Sciences

Nursing Department
WHO Collaborating Center for Nursing Development

NUR 411 Infant Child and Adolescent Care

Weekly Case Report

Part I: Assessment Sheet for Infants and Children

Student Name Student No.

Pt. Initials Hospital record No. Ward

Gender: Chief Complain Diagnosis

Previous hospitalization and illness Date of admission

If yes. Type of
Allergy:  Yes  No
Allergy?
No. of teeth Feeding pattern Activity pattern
Growth milestone
 Yes  Yes  Yes Bladder  Yes
Sitting Standing Walking
 No  No  No Control  No
Growth Measurement
Length/ Head-
Chest
Weight Circumfere
height Circumference
nce
Mid-arm circumference
Stool Assessment
 Br  Y 
Frequency Amount  L M S Color
G Consistency F H W

Urine Assessment
 Normal  Oliguria  Normal
Frequency Amount: Color
 Anuria  Polyurea  Dark

Current medication:

Name Dose Frequency Route Action

*Special Care
 Day1 Day2 Day3 Day4
…/…../…… …/…../…… …/…../…… …/…../……
Oxygen Therapy
Time
Method of administration
Flow rate
Duration

Dressing
Time
Site
Type of wound
Solutions used
Wound abnormality

* Laboratory investigation:

Name Result Normal value

*Physiologic Parameters

Physiologic Day1 Day2 Day3 Day4

Measurements …/…../…… …/…../…… …/…../…… …/…../……
Temperature (0C)
Pulse
Respiration
Blood pressure
O2 Saturation if
applicable (%)

*Systematic Assessment (please write ONLY the abnormal findings related to each body system)

System Day1 Day2 Day3 Day4

…/…../…… …/…../…… …/…../…… …/…../……
General
Appearance
Skin
Head
Neck
Eyes
Ears
Mouth and Throat
Chest
Heart
Abdomen

(No. of peristalsis)
Genitalia
Anus
Extremities
Other Findings
 Part Two: Nursing Care Plan
I. Actual Problem
1.Assessment
Subjective Data Objective Data

2.Diagnosis
Statement of
Patient Problem
Nursing
Diagnosis
(NANDA)
3.Planning
Objectives
(NOC)
4.Implementation
Nursing Intervention (NIC) Rationale

5.Evaluation

Nursing Care Plan

II. Potential Problem (High-risk)
1.Assessment
Subjective Data Objective Data
2.Diagnosis
Statement of
Patient Problem
Nursing
Diagnosis
(NANDA)
3.Planning
Objectives
(NOC)
4.Implementation
Nursing Intervention (NIC) Rationale

5.Evaluation

Nursing Care Plan

III. Knowledge deficit (Health Education)
1.Assessment
Subjective Data Objective Data

2.Diagnosis
Statement of
Patient Problem
Nursing
Diagnosis
(NANDA)
3.Planning
Objectives
(NOC)
4.Implementation
Nursing Intervention (NIC)

5.Evaluation