NCM 207 - RLE

SCHOOL NURSING
ROTATION

A HEALTH ASSESSMENT
ON INFANT CHILDREN

GROUP 4 SUBGROUP 2
 INFANT

INTRODUCTION MMDST

CLIENT AK
GENERAL OBJECTIVE

At the end of the 1 virtual meeting with the client,

the examiners will be able to administer the Metro
Manila Developmental Screening Test (MMDST)
and assess the infant.
SPECIFIC OBJECTIVE
The student nurses aim to:
• Establish rapport with the Client’s Parents and the Client
• Gather all the needed information from the Client’s Mother
• Perform all the possible Physical Assessment applicable for the online
setting
• Administer all the MMDST Test Items appropriate to the Client’s age.
• Identify the delays and advances of the Clients development with the
MMDST result
• Record the Client’s Personal Hygiene, Reflexes and Language
Development
PERSONAL DATA
Name: A. K.
Birthday: December 5, 2020
Age: 9 months and 26 days
Ordinal Rank: First (1 of 0 siblings)
Address: Tagum City Nationality: Filipino
Religion: Roman Catholic
Weight: 7 kg Height: 2.3 feet
Name of Father: A. J. K. Age: 28 y/o
Educational Attainment: College Graduate
Occupation: Business Owner
Name of Mother: K. D. K. Age: 27y/o
Educational Attainment: College Graduate
Occupation: Government Employee
 COMPUTATION
OF AGE
DOA (yyyy/mmmm/dd): 2021 10 01 (October 1, 2021)
DOB (yyyy/mmmm/dd): 2020 12 05 (December 05, 2021)
09 months and 26 days old

Legend: DOA – Date of Assessment DOB – Date of Birth

MMDST
MMDST
PERSONAL
SOCIAL
TEST ITEMS SCORE

Plays Pat-A-Cake PASSED

Imitates Housework FAILED
Uses spoon spilling little FAILED
Indicates wants (not cry) FAILED
FINE MOTOR
ADAPTIVE
TEST ITEM SCORE
Neat Pincer Grasp FAILED
Sit takes 2 cubes PASSED
Bangs 2 cubes held in hands PASSED
Reaches object PASSED
Transfers cube PASSED
Thumb Finger grasp FAILED
LANGUAGE
TEST ITEM SCORE
Dama or Mama specific PASSED
Imitates speech sounds PASSED
Points to one named body FAILED
part
Names 1 picture FAILED
Follows direction FAILED
GROSS MOTOR SKILSS

TEST ITEM SCORE

Stands momentarily FAILED
Bear some weight on legs PASSED
Walks holding on furniture PASSED
Sits without support PASSED
Stands holding on PASSED
Pulls self to stand FAILED
Gets to sitting PASSED
Sit head steady PASSED
Rolls over PASSED
 NORMAL
REASON: Although there were 2 sections with failed tasks,
the client was able to pass 3 items to the left.
 GENERAL
OBSERVATION
MATERNAL/ OBSTETRIC/
PRENATAL HISTORY

• G:1, P:1, T:1, P:0, A:0, L:1

• First check-up in the 2nd month
• Medications: Amlodipine
• Induced labor for 18 hours on the 38 week
th
BIRTH HISTORY

• Tagum Doctors Hospital

• Cesarean Section in vertex position
• 3.3 kg, 48 cm, 34 cm, 33 cm
NEONATAL

• The infant underwent a Newborn Screening

• ↑WBC
• 5 days
INFANCY AND CHILDHOOD

• Roseola (August 2021

• Medications: Ampicillin, Gentamycin, and sterile
water
• Complete Vaccination
NUTRITION

• Breastfeed: every 2-3 hours, good, inverted nipple

• Bottlefeed: every 2-3 hours, Similac, 1:1
• Food preferences: sweet potato, apple avocado, and
kalabasa
• Vitamins: Growee drops & Celine
• Dentition S/sx: 4 teeth, 6 months, salivating & biting
ELIMINATION

• BM: 2x/day, Soft, Greenish-brown\

• Urination: 5-6x/day
ACTIVITY AND SLEEP

• 8-9 hours; 11 pm to 7 am
• Naps: 1 hour - morning, 1-2 hours - late afternoon
• Rituals: Sucking on a pacifier
• Daily activities: stroll, play, watch
• Solitary play & Small stuffed toys
ANTHROPOMETRIC MEASUREMENTS

• HEIGHT: 70 CM
• WEIGHT: 7KG
• AC & CC: N/A
CEPHALOCAUDAL APPEARANCE

• GENERAL SURVEY
SKIN
• Mesomorph
• Fair
• Height: 70cm
• Smooth
• Weight: 7 kg
• Warm
• Temp.: 36.5*c
• Good turgor
• CR: 120 bpm
• Greenish Birthmark on
• RR: 26 cmp
the buttocks
• Mood: appropriate
HEAD
• Symmetrical
• Fontanelles: front- open
posterior- closed
• Scalp: clean w/o lesions
• Hair: straight, evenly
distributed
• Facial movement:
symmetrical
EYES
• Symmetrical
• Eyebrows: aligned
• Eyelashes: curled outward
• Cornea: smooth & shiny
• Conjunctiva: pinkish
• No discoloration, edema
and lesion
NOSE
• Symmetrical
• w/o lesions, drainage and
deformities
• Septum: midline
• Sinuses: not tender
• Mucosa: pinkish
• Nares: patent
MOUTH
• Lips: symmetrical, pink
and moist
• Always smiling
• Tongue: midline w/o
lesions
• Teeth: 2 upper lateral
incisor and 2 lower
central incisor
THORAX
• No heaves, % lifts
• Normal cardiac range
• Symmetrical
• Normal spine alignment
• Normal breathing pattern
ABDOMEN
• Slightly protuberant
• No tenderness
• No lesions, abdominal
distention or
discolorations
• Skin is warm to touch
PERSONAL HYGIENE

• Well- groomed & neat

• Clean environment
• Good Ventilation
• Took a bath in the morning
REFLEXES

• Blinking: present, less when watching something

• Swallowing: present as evidenced by consumption of
solid foods
LANGUAGE

• Mother and father: Bisaya

• Watches English shows
• Utter words: BABA, TATA, MAMA, & DAMA
 CONCLUSION

• OVERALL HEALTHY AND WITHIN THE APPROPTIATE

RATE OF GROWTH AND DEVELOPMENT FOR THE
CLIENT'S AGE
• NORMAL INTERPRETATION IN MMDST
• NORMAL FINDINGS IN ASSESSMENT
 CONCLUSION

HEALTH TEACHINGS
• Nutrition: introduction of 1 new food weekly
• Wean
• Walking exercises
 CONCLUSION

• Client-Finding
• Virtual set up limitations
• Parent Cooperation
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APPENDICES
THANK YOU !