Altered Growth and Development

(_)Actual (_) Potential

Related To:
[Check those that apply]

(_) Acute illness

(_) Traction or casts

(_) Prolonged pain

(_) Separation from significant other

(_) Chronic illness

(_) Parental knowledge deficit

(_) Prolonged bedrest (_) Other:_____________________________

(_) Neglect/isolation

____________________________________
____________________________________

As evidenced by:
[Check those that apply]

(_) __________________________________
Major:
_____________________________________
(Must be present)
_____________________________________
(_) __________________________________
Minor:
_____________________________________
(May be present)
_____________________________________

Date &

Plan and Outcome

Target

Nursing Interventions

Date

Sign.

[Check those that apply]

Date:

[Check those that apply]

Achieved:

The child/patient will:

(_) Assess present level of

(_) Demonstrate an increase in

personal, social, cognitive and

personal, social, language,

motor development.

cognition, or motor activities

(_) Assess etiological factors for

appropriate to age group.

alteration in growth and

Specify Behaviors:

development.
(_) On admission, evaluate
height and weight.
(_) Daily weights at___ a.m./p.m.
using the same scale.
(_) Provide opportunities for child
to meet age related
developmental tasks such as:

1.

_____________

2.

_____________

3.

_____________

4.

_____________

5.

_____________

(_) Teach parents appropriate

developmental tasks and
parental guidance information
such as:
1. ______________
2. ______________
3. ______________
4. ______________
5. ______________
(_) Other:________________
________________________
________________________
________________________