BINAL JOSHI PEDIATRIC NURSING M SC NURSING

SUBJECT: PEDIATRIC NURSING TOPIC: INFANT ASSESSMENT FORM

BIO DATA: NAME: AGE: SEX: DATE OF ADMISSION: DATE OF DISCHARGE:-OPD NUMBER: IPD NUMBER: BIRTH DATE: BLOOD GROUP: ADDRESS: DR: UNIT: RELIGION: NATIONALITY: FATHER: MOTHER: FAMILY INCOME: FOOD TYPE: YEAR/MONTH: WARD:

HISTORY Birth history Immunization history

ANTHROPOMETRIC MEASUREMENTS Biological Measurement: No 1 2 3 4 5 6 Measurement Height Weight Head circumference Chest circumference Arm circumference Vital sign : Temp Pulse Respiration B.P Child value Normal value 52 to 56cm 7 to 8kg 42 to 43cm 40 to 45cm 14cm 98.6 F 80-150/min 30/min 90/56 Mm of hg Remark

Percentage of malnutrition: actual weight100/ideal weight : : PEM GRADE: DEVELOPMENTAL HISTORY

NORMAL OBSERVATION Gross motor : Fine motor: Psychological: Psychosexual: Spiritual: Intellectual or cognitive Moral: LANGUAGE: Receptive language:

CHILDS OBSERVATION

INFERENCE

Expressive language: Play stimulation: EXAMINATION OF THE CHILD: General appearance Nourishment: Body Build Activity: Mental Status: Movement:

1. Skin Color: Texture: Lesions: Temperature: Birthmarks 2. Head Size: Shape: Hairs: Distribution: Color: Texture: 3. Scalp Fontanel: Hair: 4. Face: Eyes: Location: Eyebrows: Eyelids: Eyeballs: Conjunctiva: Sclera: Pupil: Reaction to light: Ears: Location: Hearing: Discharge: Nose: External nares: Nostril: Mouth and Pharynx: Lips: Odor from the mouth: Teeth: Tongue: Mucus membrane: Throat and pharynx:

5. Neck: Skin folds: Lymph node: 6. Chest: Size: Shape: Breath sounds: Respiratory rate: Respiratory rhythm: 4. Heart: Heart Sound: Heart Rate: 5. Abdomen: Distension: Palpable Mass: Bowel Sounds:

6. Umbilical cord Number of vessels at birth Appearance

7. Extrimities: Hands: Legs: Appearance Length Movement Alignment Length Movements Muscle tone Fingers

Muscle tone Toes Number Webbing Position

8. Nails: Clubbing: Flattened: Capillary Refilling:

9. Back 10. Genital FEMALE 1. Labia Size Appearance 2. Vaginal discharge (In Pre Term) Color Type MALES Testes in scrotum Urethral meatus at end of penis Circumcised VOIDINGS Amount Frequency 11. Rectum: a. Patency b. Stools 1. Color 2. Consistency

3. Frequency 12. REFLEXES a. 1. 2. 3. 4. 5. 6. 7. 8. 9. b. 1. 2. 3. 4. Local Blink Pupillary Dolls eyes Rooting Sucking/swallowing Gag Yawn Grasp Babinski Generalized Moro Tonic neck ) Dance/Walking Crawling

13. CRY Frequency Pitch IMMUNIZATION STATUS: REACTION TOWARDS HOSPITALIZATION: PARENT-INFANT INTERACTION: EATING-SLEEPING PATTERNS CHILDS RESPONSE DURING ASSESSMENT: