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Pediatric Physical Assessment

This pediatric physical assessment form documents a patient's admission information, vital signs, developmental stage, physical exam findings, labs, diagnostic tests, discharge planning, nursing diagnoses, medications, and considerations for the patient's hospitalization based on their developmental age. Areas assessed include integumentary, neurological, respiratory, cardiovascular, gastrointestinal, and musculoskeletal systems. Safety concerns and appropriate play therapy are addressed.

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ilovemaine
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902 views5 pages

Pediatric Physical Assessment

This pediatric physical assessment form documents a patient's admission information, vital signs, developmental stage, physical exam findings, labs, diagnostic tests, discharge planning, nursing diagnoses, medications, and considerations for the patient's hospitalization based on their developmental age. Areas assessed include integumentary, neurological, respiratory, cardiovascular, gastrointestinal, and musculoskeletal systems. Safety concerns and appropriate play therapy are addressed.

Uploaded by

ilovemaine
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Department of Nursing Education

Pediatric Physical Assessment


Name:__________________________ Date:____________________________

Pt. Initials:_____Pt. Age:_______Family Member/CG Present:____________________

Admission
Diagnosis:_____________________________________________________________

Presenting Signs and


Symptoms for Admission:_________________________________________________

Erikson’s Stage of Development:____________________________________________

Ht._____ Wt._____ HR______ RR______ BP______ Temp______ Allergies_________

Pain Scale: (0-10) ______Verbal Report/Faces Scale/FLACC (circle how assessed)

Nutrition
Diet:______________________ IV Fluids (type and rate):_______________________
Recent wt. loss/gain:________ Birthweight _______ Lips/Gums/Teeth______________

Integumentary
Skin Color:______________ Texture:___________ Rashes:___________
Incisions:________________ IV site:____________ Ostomy:__________

Neurological/Head
LOC/State:_______________ Facial Symmetry___________________________
Sensory Deficit Aids:_____________________ Reflexes:______________________
Fontanels (anterior, posterior size and appearance if present)____________________
Eyes - Pupils:_______________ Discharge:__________ Clarity:___________
Strabismus_________________ Swelling:___________ Ptosis:____________
Ears – Shape:_______________ Symmetry:__________ Discharge:_________

Oxygenation
Respirations (rate, rhythm, depth)___________________________________________
Retractions:___________ Nasal Flaring:_____________ Grunting:_________
Breath Sounds:_________________________________________________________
O2 Therapy:______________________________ O2 Saturation:___________
Cough:______________________Sputum(describe):__________________________
Skin/Nail Bed Color:__________________MucousMembranes:__________________
Respiratory Therapy Treatments(type and frequency):_________________________

Nursing\Forms\Nursing Forms\Pediatric Physical Assessment


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Cardiovascular
Apical Heart Rate_________ Rhythm__________ Murmur_________
Capillary refill__________ Peripheral Pulses/location__________________________
Skin Turgor_______________ Edema___________________________

Musculoskeletal
ROM:_____________________________ Symmetry:_______________________
Activity Tolerance:___________________ Strength:_________________________

GI/GU/Abdomen
Abdomen Appearance:_________________ Bowel Sounds:____________________
Last BM/Usual Pattern:___________________________________________________
Urinary Output:_____________________ Urine Characteristics:_______________

Labs:

Diagnostic Tests/Procedures:

Nursing\Forms\Nursing Forms\Pediatric Physical Assessment


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Discharge Planning/Patient (&/or) Parent Teaching:

Problem Nursing Diagnosis

Nursing\Forms\Nursing Forms\Pediatric Physical Assessment


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Rationale for Choosing Nursing Diagnoses (2)

Pathophysiology Of Diagnosis:

Medications (May Attach Med Cards or Separate Sheet)

Nursing\Forms\Nursing Forms\Pediatric Physical Assessment


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Developmental Impact (Real or Potential) of Hospitalization

Appropriate Play Therapy During Hospitalization

Safety Considerations Based on Developmental Age

Nursing\Forms\Nursing Forms\Pediatric Physical Assessment


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