~ “CENTRO ESCULAR UNIVERSITY Mendinia, Manil. Colicge of Nursing Level Ill Perlsrmancy Checklist Pedia Physiczl Assossment Toul TODOLER AND PRE-SCHOOLER wame of Student: Year/Section/Group No.: — f s roe ‘ i . z Sex: See = VITAL SIGNS: TT ; ap: PR: - RRL TEMP, ___ (specify, A.GENERAL APPEARANCE: —— — sob : Small frame:__ Medium frame:___—_Ldrge framo:_t_ \p-Postu Upright) Stooped:__— Others: ¢. Gait: Smooth rhythmic: Staggering:__: Shuff d. Oress, Grooming Hygiene : Appropriately dressea:__—s Weelll groomed:__ inappropriately dressed. | Unkempt:____ Others. ¢. Oder (Body/Breath) 3 None: Alcoh al: A-vetone:___ Cigarette Smoke;____ Others; {. Obvious Physic.:! Deformity.” : : : alMeasursments: ‘Height: ___—- _ Weight: iecumference:__ Chest Circumigrence:. B. MENTAL STATUS: ____._ Others: _ a.Level of Conscicusness " Conscious: _ Lelliargiz:___ Stuporous:_ _ Semi ‘comatose: 1 |v. Orientation: “Time:__ Flace:*_ Person:__ Remarks;__ ¢, Emotional Status [Peasant Cooperative:_ Anxious:____ Angry icritable:___ |Withdrawn, Fearful; Resistive: — Euphoric:___ ‘Others: |. Language & Communic i . Use of simale words: Others: _ ©. Response to Stimuli: Uses ghrase Imitates words:____ Asks many questions:__ j Uses language aggressively Can identify objects:__ | Emotional Status(Shows Aff tion): j New awareness of strangers:__—- Finds sec ity in blankat, toys etc.__ i Mas increaseg attention span:____ Possess ve ly toys:__ | 9. Sensory Perception: . : *Visiun: Abile to fotiow directions of objects _ 8 Wants to explore everything he sees ___ Blinking reflex diminished — airing: Able to respond during conversativn __ Moro reflex diminished __- Responds when called by name ___ i “Taste: Sweet:___ Sour: _- Biller__ . i * Speech: Uses jargon: Poinis lo indicate wants; ‘ [ees phases, imitate words: Talks in short sentences: a aTyee’: — ~Whea ” “cyst: a ee ary Skin Lesions. 0. NAIL: t Nail textu:e: Smooth: Rigged: ¢. Nai bed Color: Others: u. Capillary Refill: Within 3 set eBeau's lines: Pit E.HEAD AND FAGE: tight brown. | Cyanoris: Reddisiy < 2-3 sec. coma. O___ “1, t Lesion ' | primary ‘gust... Alonhy:__ leer! Secale: ___:"' Keloid: ILenenificatior 5 " — ‘vascular Lesions: wy Icheery Angizmr | Spidur Angioma: ___ Eechymosis: pelechiae_ Spider vein: Ss Hernatoma: _ - jsize: _. Locaticn:_. : x in Lesion Pattern: Circular: Clustered: Sita ht-lined: . a. Nail plate shape: [Nurmal (160) Brittle Present: aSkull: Proportionate to body size:_ bSkull Contour: Smooth: « _ Irreguiar;___ Scalp: Tenderness:__ “Tesions:_ Scaly'__ Others: Consistency: Hard: Smooth:- Soft . Nodules:_ Masses: __ ~ Depressions: — Heir condition: Evenly / disiributes:_ Unevenly distributed:__ ' Thick:_. Fine: Brittle;__ Dull: Shiny:__ Infeglation___ jDlhers: g it. i. features: . “a t _ Iishope Round:______ Oval: __- Heart: “esa 8Symrnetry: Symmetrical: — — soll: __ —- hConsistency: Hard: “Smeath: — E Depressions: 2 Nodules’___* iAntarior f rT en Close __ —“Husd 199: iteag Control Erect, oP _(NeckjResistan! {0 ‘Tio novement: —— ce FACE ” a # . wag: Moo m= . IiShape: Round: ova: O98 : AsymmothiCal: eri Simmetry: Symmetricsi: _— —— sot. "Consistency: dard: __ SmeDOt z Depressions: =—— - MA -_—" 7 Nodules*___- __ eae SE — gira snusi__— ONS = ——™ * Bye condition: Straight normal: ‘Asyaumeltice Eyebrows: Symmetrical: _— Cine: = pd an iin: : Thick: ___-. on) wide sel: __ Pp oe citer can centhal dislance: Som (1-2 2 inch. TT iatlec! ive ClOSUlC: a o Black; ~~ Jaund icu: Ecchymoxis:___ * Dark Brown: P ‘lethore _ Eryihe Dy Thic Swealy: Oily: Tle Rough _ Non-elastic: —— Others: >2-3sec. +3. +2. Moles: ss Freckles: —_», Birthmarks: _ , f “Tumor: Pustule: Papul a _ Se a e: Rashes(diaper,rasivolhers): . _— } Others: : Clubbing im . Firm: Thi Thick: Others:__ _ Pale:, —s- Blues___s- Jaundice: 4 seu <3sec.___ 23 seC.__. Others’, Absent: __ | “8 —- Dispreportionale to body a Bulging: _. GWeigs: Effective closure;Reddist:__ Others"_ 1a: Anicteic:___letere:__ ecormnctiva Clear Others: . Pink Whitisi: Discharge. pebral conjunctiva: Pr Bipebral slant (outer canthiis align 10 the tip of the pina) axcepl in Aion. ‘asian Otiner vace: tactimal Apparatus Ory; Mi ip.corneal sensitivily refiax: P.esent: __ Fae : {CORNEAITransparent: __. Opacities: __ Lesion _meupils: Size: Equal: _ Uneoual: _ i p,Color: Black: . Brown:_ ss: Bue: Others: ip shape: Round: Irregular: x {pEqualily: Equal: Unequal tq Color: Uniform: Inconsistent: *; Reaction to light and accommodation: + ' R Brisk:__ — Sluggish: No réaction: t Brisk Sluggish:____ No reactio: |. visual acuity near vision 12-14 inches away oe Able to recognize to object:____ Unable to recognize to object: ‘others:_____ st ae iL VISUAL ACUITY (8 yrs. Old)differentiation of co‘ors , very Good: Goed: ___ Fair. Poow___t A 7 [GEA 4 a,Auricle: J Others:, b. Symmetry: Symmetrical Assymet a7 Alignment of Pinna: Normal: __ __ Recoils when folded:____ Tenderness:___ | Inflanmation:__ Others. _ dMastcid process: Tender: Non-tencer. _ Edema: ¢. Auditory canal: . : _ | Appearance: Pink/same with tympanic membrane: __* Oth¢rs: }.Cerumen: Present: ___ Absent: _ - |j.Color (cerumen): Balck:____ Dark red: Discharge: Present. _ Absent:___ jH.NOSE: _ ~ : a 3 Color: Normal racial one:_._ . Cyanosis;. High sel: Lesio + Gray: .Brown:” aColor: Same as face: Others: b. hasal flaring: Pres: Absen c. Discharge: Presei Absety__ Tt wg . Asymmetrical. , _ dSymmetry: , Symmetrical: ___. Red Other: _ e.luternal mucosa: .Co!or: Pink: =. (Landmarks(turbinates & middle meatus): Visible:___ Nol Visible:__ 9 Sinuses: Tender:____—“Hon-tender: _ Edemo: __ . hSeplum: Midline: . Deviated:__ Prevforated:__ Others:|_ — _ a _ LMOUTH AND OF OPHARYNX: bo a.Symmnetry: Symmetrica!: ____ Asymmetrical: ___— OLips: ! si! Color = ry: Cracked:____ ! “Consistency: Moisi: __. Sunil. 16. Buc¢al mucosa:Culer __ besions!__ if Gums: Color; White: Pink: _ :Mouth Sores:_<__ Remarks: ongue: Vidline: Devi [Ccter Whie: Pink: Texte Rouigin as pSymmety: Symmelsi Movement’ Smooth: ty spe ‘Hard and soll palate:Color: white:___ Pink: Blush pack !Otoha.ynx:Color. While: Pink: Bluish: __ i HG aie ‘Mores: Color: _ Congested __Not con eS__ LT | Remarks: arance: Voluntary movements: Involuntary. movernents:__, Aor strength; With resistance:___ Without resistance:__ i Movement: Flexion: ___ Extension; ___ Lateral stduction:__ __ q potation: —_— ‘i | ‘Midline:__ Other: Symmm trical: _ Asymmetiical: ny Position: x, Midline:__ ~ Othar: ~~, Palpat lor Enlarged: S pnpibl Non-’alpabl “see les: Palpable:___ lon-alpable:_ ss * we foge aye ne: ah Mobily: Shape; Me a Non-Tender:____ ry ee A “size: Symmetry: Symrcetrical:___ Asymnpatrical: __ + p Contour: Flat:__ Round;___ Sagging:__ Others: so jeshape: Round: _ Other: . gColor: Pink: ____ — Red: - Black, Othet;__ [eckin Surface: Smooth:___ Retracticn:_____ Dimmpling:____ {lymph nodes: Palpable:__-—- Non-Palpable.____ Size:__: Consistency:___ Mobiliry:__ Shape: i. . | tender:____ Nom, Tend 3 i | AREOLA & NIPPLES: 2g : ‘a. | ' g.Color, Pink: . :. Dark erown a) Other be . Shape: Roun +, Ovals, Inverted:____ 23 e iDischarge:-:_ _ ‘Texture _—_ jBréast lyniphnodes: Axillary iymphnodes: a Size:_'_« Consistency: Mobility,_ Shape:___ : Tender, Non-Tenger: sat coe k Tenderness: -—— ° Nen! jon -tendei ‘ Lumps: __ Nedule: L.CHES STAND LUNGS on a ‘Va.lnspectior: : + : 4 '|Cotor: Same will sai tone: — Pi + Pallor___ Cyahosis:_. b. Shapa: AP 10 leteral ratio 1:2 __* — Funnel__ Rigeon:__ Clntercostal retraction: Present: Absent: '|Costal Angle: 45 degrees:__ >45d degress;__ ~ <45 degrees:___ @.Chest Wall: Remarks: eChesl Expansion: Anteri “Symmetrical: —— Asymmetrical: Posterior= — Syrnmetrical:___- Asymmetrical: | ARib Slope: < 9: > 90: °. i9Resgiratory rhyihm: Regular; ___.__. regular: hRespiratory depth: Shalow:___—- Deep: . ‘ ‘Respiratory pattern. Normul:__ Bradypnea:___ Tachypnea:__ leguiar: Irregular:____ 'Jse of Accesory muscles:___ - Oyspnea:__ tiHyperventilation: Hypoventilation:__ Cheyne-strokes: ___ it's: Kussmaul's:_” . kPalpation: Sensation: T2 1Wder:: |\Vocat {rgmnitus(vibrations bo. sides: ‘u.Tactile tremitus(vibrations): Norms ‘Lung expansion: Synimelrical: _-. -Asymvnetrical: ee5 3" ©.Percussion: Resonance:___ Hyperresonanca:___ “Hyporresonance: Tympany:__ Gullness _ Flat___ Others: {indicate location) p.Ausculatation:6ronchial: : Present:__ Absent: (indicate loca in) 1q.Breath Sounds: Normat:_ Wheezes:_ ales: _’ Greckle WERBTIO a 'M. HEART: (4 ylo= Left bs MCL, 4-5 yir= MCL, 7-8= Right MCL) apm: 4" ICS: __ S™ ICS: . p. Apical Pulse: Symmetrical: Equa’ rate: Equal svonaih. —__4. Rhy: Regular, - Tr 3 Treg vei 77 a } —— eo y' , jan integrity: Normal sacial tone: With lesions:__ with lesions: ' mur ed Symmetry’ — Flabby’ __Distended: Fiat; i q Rigidiboardlike: “Obrunded:_ -Others: — : Visible"___ Non-visibly:, uneeneneteeneee lool: Yellowish: Brown::__ : Dark Brown: . Green: Other, . - » Characteristic: Color: Consistency: stion: Bowel sounds: Normoactive: __ Hypoactive::_ Hyperactive: + seule sounds: ‘No bruits: With bruits: ‘percusvion(all 4 quadrants): ympany:_ Duliness:__, f Remar: $3 t j palpation(ight): Muscle guarding: Present: Absent!” brenderness: Tender:____—_-Nan-tender:___ Nyasses? Presant-——_ — _— Absent’. L size:_—_ Consisieicy:____ Mobility: —— Shape:___ . . tender___. Non-Ten'ler: —!* "a ‘painelion(deée’: ‘. ot ‘I Tenderness: Tender: __. Non-lender: 4} n Muscle Guarding?" Oiuntary: Involuntary: pMasses: Fresent: _- Absent: . a? et. Liver: Palpuble: Non-palpable:__- | foe UPPER EXTREMITIES; = SS Motor Strength, : : e . ‘Muscle tone:, : ¢. Lesions: 6. Deformity. : e. Peripheral Pulses: FulVequat:__ Full/unequals___ zee Bounding: __ Weak: Absent: oo . [. Lymn Nodes: Palpable:__ Non- -palpabls;__ Remarks: |, Size:_|__ Consistency::___ Mobility: Shape: rare Te reer Non-Tender:_ -° LOWER EXTREMITIES: a.Motor Strength._ +] b. Muscle tone: ¢. Lesions: 8. Deformity: .| ¢. Peripheral Pulses: Norma ___ Bounding: {.Lyrnph Nodes: Palpable: Non-palpabl _ Weak__ Absent Size: Consistency:___ Mobility: __—s Shapex__—— Terder,____ Non-Tendar._ = gBowleg: Present:____—s_ Absent:___ h. Knockknee: Presen| Absent:_-_ Me G FEMALE GENITALIA a.Tanner's Sexual Maturily: SYSQ@(V 25) pee | b. Clitons: __ C. Urehtral Orifice: fcc . istics: : _ 1. Urine: Color: ae Consistency:__ ____ Characteristics;_____ : jOthers:_ : : 4 ! |e. Bantholin™ s glands: a i | ° To : |HLMALE GENITALIA . ‘:Tanner’s Sexual Maturily: Stage 1-5 —— b. Penis: wesc soreeig ro ¢. Urehtral Orifice: esses har: cterislics: ~ 0. Urine: Color: — Consistency: __- Chari.cteristics______ Others; oe Fos : €. Scrotum: Timination, Remarks;&, - gieste ‘ a (GTM AND ANUS: ; .. ‘ rityfLesion.,_—__-____ 7 ees Present: , Absent: nderness: Present: . Absont:, Toilet tained: 9 YeS:__. No:___ . a pegree on dependency on toiletry: Total: Partial;____Indepandent: ; 18 Child use for elimination ispecily): i i se for elimination $2655) 5 — = ., * ‘ ‘ ’ YON gu : : i Ry! i srt yh : { hed it a fi a + i . . , Vi i . . NR