Assessment Tool on Child Health Nursing

8/6/2019 Assessment Tool on Child Health Nursing

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ASSESSMENT TOOL ON CHILD HEALTH NURSING

1) BASE LINE DATA:

NAME : ____________________ I.P. No: _____________

AGE : ____________________ WARD: _____________

SEX : ____________________ BED No: _____________

RELIGION : _________________ UNIT : _______________

NATIONALITY : _____________ DOCTOR : _____________________

EDUCATION : _______________ D.O.A : __________________

ADDRESS : No. of times Admitted : ___________

___________________________ a) Frequency of Hospitalization _______

___________________________ b) Duration of Hospitalization ________

___________________________

___________________________

___________________________

___________________________

PHONE No. : __________________ Diagnosis: _____________________

HOSPITAL : __________________

II) CHIEF COMPLAINTS:

1)

2)

3)

4)

5)


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III) HISTORY OF PRESENT ILLNESS:

a) Onset: ___________ Sudden ____________ Graduate __________

b) Duration: __________ Days ______ Weeks ______ Months ________

Year ____________ Frequency _______________

IV) CARDINAL SYMPTOMS:

a) Onset : ____________ Sudden_____________ Gradual __________

b) Onset : __________ Duration __________ Characteristics __________

c) Onset : __________ Duration __________ Characteristics __________

d) Onset : __________ Duration __________ Characteristics __________

e) Onset : __________ Duration __________ Characteristics __________

IMMUNIZATION RECORD FOR CHILD:

AGE DPT POLIO HEP-B DT TT BCG MEASELS VIT-A DOSE REMARKS


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ASSESSMENT OF CHILDHOOD ILLNESS:

Medical Problems associated with : Infancy or Toddler:

Disease Condition: Diarrhoea _______ Mumps _______ Measles ________

Poliomyelitis _______ Whooping Cough ______ Febrile Convulsions _______

Skin infections ______ Nutritional diseases ____ Period of suffering

_________

Few days _______ 15 days ______ 3-4 Weeks ______ Months ___________

TREATMENT:

Homeopathy____ Allopathy ____ Unani ______ Any other ______ Home

remedies if yes, specify __________

V) PAST HEALTH HISTORY:

a) Previous Health Status: Healthy ____________

Frequency suffered with Health problems _______________

b) Previous Hospitalization if any: Yes __________ No _________

If yes, specify cause: _________________

Treatment taken : Regular _______ Irregular ________ Outcome _________

Follow up care ___________

c) History of surgery: Yes ___________ No_____________

If yes, specify type of surgery ____________ cause _______________

Post operative period ______________ Out come o surgery ____________d) History of Tracumatic Injuries: Yes ____________ No_________

If yes, specify ________________ Treatment taken _________________

e) Delayed mile stones:

Growth retardation ______________

History of any congenital malformations


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I)

A) HEAD FOR HYDROCEPHALUS:

Head circumference ____________

Bulging fontanels: Yes _____ No _____ Open __________ Closed ________

Anterior Fontanels: Open ________ Closed________ If closed when _______

Posterior Fontanels: Open ________ Closed________ If closed when _______

Basing Fore head: Yes __________________ No _______________

Scalp Shiny: Yes ___________ NO _____________

Eyes: Symmetric _________ Asymmetric __________ Sunset eyes ________

Strabiamus _________________ Nystagmus _______________

Vomiting: Yes ______________ No ______________

B) MICROCEPHALY: Yes _______ No ________

Head Circumference: Yes___________ No__________

II) G.I. MALFORMATION:

a) Cleft Lip: Yes ___________ No ___________

If yes, specify: Unilateral __________ Bilateral ____________

b) Cleft Palate: Yes ____________ No ___________

If yes; Cleft of Uvula ___________ Cleft of soft palate __________Cleft of hard palate ____________ Cleft of soft and hard palate __________

Poor Sucking: Yes _____________ No _______________

Eating Difficulty : Yes ___________ No __________

Nasal Speech : Yes ___________ No _____________

c) Trachea Esophageal Fistula:

Yes _________ No ___________


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Birth Weight ____________

Excessive Secretions: Yes ________ No __________

Constant Drooling: Yes __________ No _________

Intermittent Cyanosis: yes ________ No ________

Abdomen Distention: Yes ___________ No _______

Coughs/Chokes after food: Yes__________ No __________

Poor feeding: Yes _________ No ___________

d) Gastro Esophageal Reflex disorder:

Weight ______ Height _________

Poor weight gain: Yes ________ No ________

Dysphasia: Yes ___________ No ___________

Vomiting: Yes ________ No ___________

Abdomen pain: Yes __________ No ________

If yes duration _________ Type _____________ Characteristics ___________

e) Hirsch prangs disease: Yes __________ No ________

Meconium passed in the first 48 hours of life(delivery) _________________

Vomiting: Yes ________ No ________

Abdominal distention: ___________ No ____________

Constipation: Yes __________ No _________

f) Pyloric stenosis: Yes ______ No ________

Vomiting ________________

Loss of weight _____________

Constipation ______________

Visible Gastric Peristaltic waves _____________


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g) Anorectal Malformation:

Yes _________ No ____________ If yes specify ____________

Imperforate anus _________ Rectoperineal fistula ___________

Anal Atresia ____________

Persistent Diarrhoea ______________

III) CONGENITAL CARDIAC DEFECTS

A cyanotic heart disease ____________

Chest pain : Onset : Sudden ___________ Gradual __________

Duration ____________ Characteristics _____________

Radiation ______________

Aggravating factors ___________________________________________

Relieving factors ______________________________________________

Dyspnea : Onset : Sudden ____________ Gradual ______________

Duration : Hours ____ Days ____ Weeks ____ Months ____ Years _____

Dyspnea at rest ______________ Activity ____________

Aggravating factors ___________________________________________

Relieving factors _____________________________________________

Wheezing : Present __________ Absent _______________

Audible _________________ Heard only by stethoscope _______________

Wheezing present at whether change __________________

Cyanotic heart disease:

Dyspnea : Onset : Sudden _____________ Gradual ____________

Duration : Hours____ Days____ Weeks____ Months____ Years____

Dyspnea on rest________ Activity________

Aggravating factor ______________________________________________

Relieving factor _________________________________________________


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Achondroplasia : Yes ______ No ______

GENETIC DISORDERS:

a) Down Syndrome ____________

b) Edward Syndrome ___________

c) Patons Syndrome : Yes ______ No ______

d) Turners Syndrome : Yes ______ No ______

e) Kline filter Syndrome : Yes ________ No _______

V) PERINATAL HSTORY OF MOTHER:

General Health of Mother during Pregnancy

Good Average __________ Poor __________

Complication of pregnancy : Yes ______ No ______

If yes specify

1. _______________________

2. _______________________

3. _______________________

Antenatal Check ups : Regular ________ Irregular _____________

Nature of the delivery : Term ______ Preterm ______ Post dated ______

Normal ___________ Forceps _____________ Caesarian __________

Birth weight of the baby : __________________

Whether baby cried immediately : Yes ______ No ______Cyanosis at Birth : Yes ______ No ______

Jaundice : Yes ______ No ______

RESPIRATORY PROBLEMS:

Baby kept in NICU after birth : Yes ______ No ______

If yes, specify _____________________


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VI) Developmental History

NEONATE : a) Weight __________ Height ___________

Head circumference _____________ Chest Circumference ________________

Reflexes :

1) Sucking ___________

2) Routing ___________

3) More Reflex _____________ Yes ______ No ______

4) Tonic neck ____________ Present __________ Absent __________

5) Dancing Reflex : Present __________ Absent __________

6) Gag Reflex : Present __________ Absent __________

7) Plantar Reflex : Yes ______ No ______

8) Babinski Reflex : Present __________ Absent __________

FINE MOTOR:

Hold hands in tight position : Yes ________ No _________

Plamer Grasp : Reflex : Present __________ Absent __________

GROSS MOTOR:

Lies in flexed position __________ Yes _____ No _____ Age _____

Head sags when baby pulled from supine to sitting position:

Yes _____ No _____ Age _____Turns head to the side when prone : Yes _____ No _____ Age _____

Makes crawling movements, when prone on flat surface :

Yes _____ No _____ Age _____

Pushes with feet against a hard surface at more forward :

Yes _____ No _____ Age _____


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SENSORY:

Startled by sounds : Yes _____ No _____ Age _____

Fines on objects brought in front of eyes : Yes _____ No _____ Age _____

COGNITIVE DEVELOPMENT :

Perceives self and parents as one : Yes _____ No _____ Age _____

Responses are generally limited to discomfort : Yes _____ No _____ Age

_____

Gaining satisfaction from feeding and being held, rocked cuddled : Yes _____

No _____ Age _____

In need for sucking pleasure : Yes _____ No _____ Age _____

Quiets when picked up : Yes _____ No _____ Age _____

Develops bonding with parents : Yes _____ No _____ Age _____

VOCALIZATION: Yes _____ No _____ Age _____

Responds to human voices : Yes _____ No _____ Age _____

Open and closes mouth as adult speaks : Yes _____ No _____ Age _____

Cries when hungry/uncomfortable : _________________

Begins to coo : Yes _____ No _____ Age _____

Play : Soft cuddy toys : Yes _____ No _____ Age _____

INFANCY:

A) Weight ____________ Height ______________

Head circumference ____________ Chest circumference ______________

Reflexes: 1)

2)

3)


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Teething : Age of Eruptions : _________________

B) Fine Motor:

Group Reflex : Present _____________ Absent ____________

Pineer Grasp : Present _____________ Absent ____________

Preference of using dominant hand ________________

C) Gross Motor:

Rolling over : Yes _____ No _____ Age _____

Sitting : Yes _____ No _____ Age _____

Crawling : Yes _____ No _____ Age _____

Cripping : Yes _____ No _____ Age _____

Standing : Yes _____ No _____ Age _____

Walking : Yes _____ No _____ Age _____

Any other history of delayed

Mile stone : Yes _____ No _____

If Yes, Specify _________________________

d) Sensory:

Binocular Vision : Yes __________ No _____________

Turns head directly to source of sound : Yes _____ No _____ Age _____Increased Perception : Yes _____ No _____ Age _____

Turns head to follow sound : Yes _____ No _____ Age _____

Responds when called by name : Yes _____ No _____ Age _____

e) Cognitive Development:

Ability to bring hands to mouth : Yes _____ No _____ Age _____

Thumb sucking : Yes _____ No _____ Age _____


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Separation Anxiety : Yes _____ No _____ Age _____

Expression of emotions : Yes _____ No _____ Age _____

f) Vocalization :

Smile : Yes _____ No _____ Age _____

Ability to coo : Yes _____ No _____ Age _____

TODDLER:

a) Weight ___________ Height _____________

Head circumference : _________ Chest Circumference __________

Reflexes __________ Present __________ Absent __________

Teething __________ Present __________ Absent __________

b) The Fine Motor:

Grasp Reflex : Present _____________ Absent ______________

Frequency of using document hand __________________

c) Gross Motor

walking with support : Yes _____ No _____ Age _____

Running : Yes _____ No _____ Age _____

Walking upstairs : Yes _____ No _____ Age _____

Riding Tricycle : Yes _____ No _____ Age _____\

d) Language:

Two words with meaning : Yes _____ No _____ Age _____Ten words with meaning : Yes _____ No _____ Age _____

Simple sentences : Yes _____ No _____ Age _____

Telling a story : Yes _____ No _____ Age _____

e) Personal and special:

Plays a small ball game : Yes _____ No _____ Age _____

Knows Gender : Yes _____ No _____ Age _____


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PRE SCHOOL CHILDREN

a) Physical Development : Weight ____________ Height __________

Eruption of permanent teeth : Yes _____ No _____ Age _____

b) Gross Motor:

Rides tricycle : Yes _____ No _____ Age _____

Climbs Stairs : Yes _____ No _____ Age _____

Jumps with both feed : Yes _____ No _____ Age _____

c) Fine Motor:

Coordinated finger movements : Present ___________ Absent ___________

d) Sensory :

Reading comprehension : Yes _____ No _____ Age _____

Visual Acuity : Complete _________ Partial _______ Absent ________

e) Language :

Vocabulary : Good __________ Average __________ Poor __________

Names primary colors ___________ ask meaning of words _____________

Repeat sentences of 12 syllables _________________________________Counts 1 to 10 _______________ Vocabulary of 21000 words ___________

f) Socialization :

Activities of daily living : Good ________ Average ________ Poor _______

Identifying Sex : Yes _____________ No _______________

g) Cognitive :


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Perception : Good __________ Average _________ Poor ____________

Judgment : Good __________ Average _________ Poor ____________

Family Relationship : Good ________ Average _______ Poor _________

Development delays : Speech : Normal ______ Shuttering ______ Language

delay _____ Starting spells _______

h) Play :

Tricycle : _______ Crayons paints _______ Hand Puppets _______ Bocks

Puzzles __________ Team Play __________ Trucks, Cars play ______

i) Shows differences in gender through play _____________

SCHOOL AGE CHILDREN : (6-9 years)

a) Physical development : Weight ____________ Height ____________

Dentition : Starts to lose temporary teeth : Yes _____ No _____ Age _____

Acquires first permanent molars, medical incisors, lateral incisors :

Yes _____ No _____ Age _____

b) Fine Motor :

Knows right from left hand : Yes _____ No _____ Age _____

Draws a person with 21-1 parts : Yes _____ No _____ Age _____

Print words and learning cursive writing : Yes _____ No _____ Age _____

Improved eye hand coordination : Yes _____ No _____ Age _____Psycho Sexual : Curiosity of sexual exploration continues _____________

c) Gross Motor :

Rides Bicycle : Yes _____ No _____ Age _____

Runs, Jumps, climbs, Hops : Yes _____ No _____ Age _____

Constantly in motion : Yes _____ No _____ Age _____

Improved coordination : Yes _____ No _____ Age _____


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d) Self Care :

Feeding skills : Like to eat with fingers : Yes _____ No _____ Age _____

Stuffs food into Mouth : Yes _____ No _____ Age _____

Talkative while eating : Yes _____ No _____ Age _____

Combing and Dressing Skills:

Needs to be reminded to wash hands : Yes _____ No _____ Age _____

Wears what ever selected by parents : Yes _____ No _____ Age _____

Can brush and comb hair : Yes _____ No _____ Age _____

e) Cognitive Development :

Increased attention span : Yes _____ No _____ Age _____

Described objects : Yes _____ No _____ Age _____

Can tell time : Yes _____ No _____ Age _____

Knows date, Month and Season : Yes _____ No _____ Age _____

Jealous of siblings : Yes _____ No _____ Age _____

Fears injury to body : Yes _____ No _____ Age _____

Takes small objects from others : Yes _____ No _____ Age _____

f) Vocalization :Follow series of 3 commands : Yes _____ No _____ Age _____

Responses to praises and recognition : Yes _____ No _____ Age _____

Repeat sentences of 10 12 words : Yes _____ No _____ Age _____

Has a vocabulary of 2500 words : Yes _____ No _____ Age _____

Develops telling jokes : Yes _____ No _____ Age _____

SCHOOL AGE CHILDREN : (9-12 YEARS)


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a) Height _______________ Weight __________________

Dentition : Acquires medical and lateral incisions : Yes____ No____ Age ____

b) Fine Motors :

Use both hands independently : Yes _____ No _____ Age _____

Draws person with 18-20 parts : Yes _____ No _____ Age _____

Prints fluently cursive writing improved : Yes _____ No _____ Age _____

c) Gross Motor :

Performs tricks on bicycles : Yes _____ No _____ Age _____

Races : Yes _____ No _____ Age _____

Participates in organized sports : Yes _____ No _____ Age _____

Throws ball skillfully, overhand and understand :Yes____ No____ Age____

d) Self Care:

Feeding skills

Handles eating utensils skillfully : Yes _____ No _____ Age _____

Improved table manners : Yes _____ No _____ Age _____

Less talking when eating : Yes _____ No _____ Age _____

Critters table manners of parents : Yes _____ No _____ Age _____

Dressing and grooming skills : Yes _____ No _____ Age _____

Likes to some cloths continually : Yes _____ No _____ Age _____

Enjoys selecting own cloths : Yes _____ No _____ Age _____Leaves cloths, when they are removed : Yes _____ No _____ Age _____

Enjoys wearing current style of cloths : Yes _____ No _____ Age _____

Needs constant remanding of personal hygienic :Yes____ No____ Age____

e) Cognitive Development:-

Develops abstract and seductive reasoning : Yes _____ No _____ Age _____

Interested in why and Now : Yes _____ No _____ Age _____


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Short interest span : Yes _____ No _____ Age _____

Ethical sense and realistic : Yes _____ No _____ Age _____

Begins to tahink about vocation : Yes _____ No _____ Age _____

f) Vocalization:

Follows suggestions better than requests : Yes _____ No _____ Age _____

Is obedient : Yes _____ No _____ Age _____

Oral vocabulary of 7200 words : Yes _____ No _____ Age _____

Reading vocabulary of 50000 words : Yes _____ No _____ Age _____

Gives precise, dictionary definition of words : Yes_____ No_____ Age_____

Enjoys riddles : Yes _____ No _____ Age _____

g) Play:

Active play _________ Group play _________ Dramatic Play _________

Table games __________ Bicycle __________ Jump ropes __________

Ball/bats ____________ Dance:____________ Puzzles _____________

ADOLESENCE:

Physical Development : Weight ___________ Height _____________

Moral Development : Thinking : Abstract ________ Yes ______ No ________Cooperative: yes __________ No ___________

Emotional Development :

Secondary Sexual Characteristics present _________ Delayed __________

Others if any _________________________________________

Social Development:

Relation with Friends : Good _____________ Poor_____________

Attitude towards parents : Good _____________ Bad_____________


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Social isolation : Yes ______________ No _____________

Others if any _________________________________

Language Development:

Oral Speech Ability : Yes ________ No ___________

Abstract Reasoning : Yes _________ No ___________

Articulation : ______________________________

Spiritual Development :

Belief of God : Yes _________ No _____________

Family History :

1) Parents consanguineous marriage : Yes __________ No __________

2) Type of family : Nuclear ____________ Joint ____________

3) Position in the family : Son ________ Daughter _____ Relatives ______

4) No. of adults ________ No. of children ___________

5) Any known illness in the family _______________

a) ______________

b) ______________

ANY FAMILY HISTORY OF:

Births defects : Yes ___________ No __________If yes, state the relationship __________

Infants deaths : Yes ____________ No ___________

If Yes ___________ state the relationship ____________

Seizures disorders : Yes ___________ No ___________

If yes, state the relationship _______________

Cardiac Problems : Yes _____________ No ____________

If yes, state the relationship _______________


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If any other specify ________________

FAMILY TREE:

Key :

Male :

Female :

Disease :

Death :

Client :

SOCIO ECONOMIC STATUS HISTORY :

A) Education: Mother ______________ Father _____________

B) Occupation : Mother ____________ Father ______________

C) Income : Per Month ____________ Per anum ____________

D) Housing : Kutcha _________ Pucca ________ No. of rooms

________

E) Lighting : Ventilation poor _________ Good _____________

F) Water supply : Well ________ Bore Well ________ Public tap

__________

G) Individual tap supply _______________

H) Drainage : Closed _____________ Open _______________

DAILY LIVING ACTIVITIES:

1) Bath : Daily ___________ No. of times ____________

2) Brushing : No of times ________ Types of Brush ____________

3) Voiding : Frequency ____________ Time ________: AM ____ PM ____

4) Constipation : _____________ Diarrhoea _________

5) Sleep : Usual bed time ________Time of awakening ________ House of

sleep ___________ midday rest __________ Nature of sleep __________


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Sound ___________ Disturbed ______________ Insomnia

________________

6) Bed time virtuals : Yes ________ No______ if yes, specify ________

DIETARY HISTORY:

A) Breast feeding _______ stating time _______ Duration of feeding

______

B) Bottle feeding : Yes _____ No _____ If yes duration of feeding

_________

C) Weaning : Type of foods ___________

Starting time ______________ No. of times food intake _____________

D) Vegetarian _____________ Non-vegetarian

___________________

If Non-vegetarian type _____________ Frequency ________________

E) Staple food : Rice ______ Wheat ______ Jowar ______ Others

______

F) Food preferences fruits : Yes ______ No ______ If yes specify

_________

Chocolates _______ Ice Creams ______ Sweets _______ Cakes _______

If any other specify ___________

Name of the food : Mostly _______ Sometimes _______ Consumed ________Occasional __________ Never __________

Name of the food Mostly Sometimes Occasionally Never


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PHYSICAL EXAMINATION :

General Appearance: Healthy_____Acutely ill_____Chronically ill_____

Stages of Comfort: Comfortable _______ Distressed ______ Apathy________

Lethargy ________ Restless ________ Pleasant : Mood Pleasant ________

Depressed _________ Cooperative _________ Non-Cooperative__________

Level of consciousness : Conscious _______ Drowsy ______ Semi conscious

________ Unconscious _________ Stupor __________

Mental Status: Fearful______ Anxious______ Irritation______ Angry______

Withdrawal ________ Agitation ________ Facial Expressions __________

Appropriate eye contact ________

Speech : Clear ___________ Blurred _____________ Fluent _____________

Measuring ______________ Aphasia ________________

Orientation: Place ___________ Time ____________ Person _____________

Personal Hygienic: Good _________ Clumsy ________ Appropriate ________

Inappropriate _______________ Body Odor _______________

Perspiration: Profuse __________ Moderate __________ Absent __________Position of Body: Symmetric _________ Asymmetric _________ Kyphosis

________ Lordosis ___________ Scoliosis __________

Body Built: Obese _________ Moderate _________ Thin _________ Height

___________ Weight __________

Recent Weight gain: Yes ________No ________ If yes, specify __________

Recent Weight loss: Yes ________No ________ If yes, specify __________


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Vital signs: _________ Temperature _________ pulse ________ Respiration

__________ B.P.__________

Inspection :Head for Hydrocephalus ________________

Head circumferences __________________

Bulging of fontanel : Yes ________No ________

Anterior fontanel : ____________ If closed _____________ Open

If closed when ______________

Posterior Fontanel: Open_________ Closed________ if closed when_________

Scalp: Hair distribution thick ___________ Scanty ____________

Texture: Soft __________ Silky ___________ Shine ness of scalp __________

Crushing ______________

Face: Normal __________ Pallone _________ Cyanosed _________ Flushed

________ Putty ________ Periorbital swelling ______ Moon face __________

Skin Colour: ____________ Normal Cyanotic: Yes ________ No ________

If yes central ____________ Peripheral __________

Nails: Normal ___________ Cyanosis ___________ Clubbing ___________

Vertical folds ___________

Eyes: Symmetric_________ Asymmetric__________ Dry_________ Moist

_________ Red________ Yellow________ Pale________ Discharge________

Exopthlmas ___________ Blurring _____________ Sunset eyes __________

Eye Lids:_________ Normal_________ Swelling__________ Style_________

Pupil : Reaching to light, constriction____________

Dilatation:

Lens: ___________ Transparent _____________ Opeque ____________


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Ears: _________ Symmetric_________ Asymmetric________ Pain ________

Discharge _____________ Duration _____________

Low set: _______________ Unequal positioning_____________ foreign bodies

____________ Tenderness____________ Impaction ______________

Hearing : Normal ________ partial deafness ____________ deafness, non neck,

septal deviation

Nose: Normal_________ Septal deviation___________ Rhinorehoea ________

Epistaxis _____________ Polyps ___________ Injuries ____________

Mouth: Old mucose : Normal _____________ Pallor Redness _____________

leukoplaquia ___________

Lips: Pink ________ Pale ________ Dry ________ Cyanosed __________

Crackles________ Cleft lip__________ Unilateral________ Bilateral________

Gums: Pink ________ Red ________ Swollen ________ Bleeding ________

Pus ____________

Teeth: Occlusion ________ Malocclusion ________ Permanent ________

Temporary ________ Pyorrhea ________

No. of teeth, upper and lower jaws __________, cavities __________

Tongue: Pink ________ Pale ________ Red ________ Cyanosis ________

Coated ________ Dry ________ Moist ________ Tongue tic ________

Palate: Normal ___________ Clieff palate ________ Hard Palate __________

Soft Palate __________

Neck: Normal __________ short, stiffness___________ Webbed___________Tonsils : Palpable_________ Non Palpable______ Lymphedinopathy________

Thyroid: Normal __________ Enlarged _________ Nodular __________

Trachea: Middle ___________ Mobile ____________ Shifted __________

Tracheoesophageal fistula _______________

Chest: Symmetric___________ Asymmetric___________ Shape___________

Normal _____________ Pigeon ____________ barred chest __________

Funned __________


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Breast: Symmetric____________, Asymmetric___________ Tender________

Non tender___________ Masses____________ Discharge________

Gynaecomastic_________

Abdomen: Shape_________ Flat________ Concave________ Round_______

Distended____________ Ascitis__________ Upshunt__________

Umbilical: Position color__________ Hernia__________ Discharge_________

Moist____________ Dry_____________

G.I. Tract: Appetite___________ Vomiting__________ Diarrhoea__________

Oesophagel atresia_________ anorexia__________ Abdominal pain_________

Constipation____________ Malena___________ Imperforate anus__________

Stool: Normal___________ Abnormal Characteristics_______________

Pin worms in stool______________ Perennial pruritis____________

Supra public pain_________ Yes______ No______ If yes, duration__________

Dysuria__________ Haematuria________ Anuria________ dribbling (or)

Incontinence ______________ Yes________ No________ Polyuria_________

Oliguria__________

Male genital birth defects ___________ If any _____________

Urethral meatus : Central________ Dorsal ________ Ventral ________

Scrotum tender : Non tender_________ swelling________ redness________

Illumination(or)Undascanded testis__________ Any congenital abnormalities/

defects ____________

Extremities: Symmetric________ Asymmetric________ Deforming________Oedema: Pitting or non pitting.

Palpation:

Abdomen: Soft mass palpate _________ Non palate ___________ Tenderness

_____________ Ascitis ________

Liver: Non palpable__________ Palpable________ Tender ________

Spleen: Non palpable__________ Palpable________ Tender ________


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Urinary Bladder: Distended _____________ Non distended _____________

Percussion:

Skull ________________ Malewens sign

Lungs _______________ Resonance, Dullness

Hyper _______________ Resonance flatness

Clear ________________ Tympanic

Abdomen_________ Dullness__________ Shifting dullness thrill__________

Bladder__________ Dullness____________ Tympanic____________

Ascultation:

Heart: S1___________ S2___________ S3_____________ S4____________

Murmurs: Present _________________ Absent ______________

Lungs: Normal breath sounds _____________ Crepitus_________

Ronchi________ Wheeze__________

Bowel sounds _______________ Present____________ Absent____________

Regular______________ Irregular_________________

Lab Investigation

Documents

Assessment Tool on Child Health Nursing