West Visayas State University

COLLEGE OF NURSING
La Paz, Iloilo City

VISION
WVSU as one of the top 10 universities in Southeast Asia.

MISSION
To produce globally competitive individuals who are life-long learners.

PEDIATRIC NURSING PROCESS

I. BIOGRAPHICAL INFORMATION
Name of Child: Name of Informant:
Sex: Relationship with the Child:
Date of Birth: Date and Time of Interview:
Age:
Address:
Date and Time Admitted:
Chief Complaints:

Ward:
Religious Affiliation:
Name of Mother:
Educational Attainment: Age:
Occupation:
Name of Father:
Educational Attainment: Age:
Occupation:
 
Approximate Monthly Income of the Family:
a. Mother
b. Father
c. Others
TOTAL
Physician:
 
Impression/ Diagnosis:

Pre-op Diagnosis:

Post-op Diagnosis:
 
 
II. CLINICAL ASSESSMENT
Nursing History
  History of Present Illness
 
Usual Health Status:
 

Chronologic Story:
Past Medical History
Parasitism_________
AGE_____________
AGN_____________
Allergy___________
Tuberculosis_________ Anemia ________________
Measles_____________ Seizure_________________
BPN_______________ Emotional Disorder_______
Accidents___________ Others__________________

Family History
 
Birth order of patient:
Total no. of siblings:
No. of living siblings:
Serious diseases/illnesses of siblings:
Cause of death/serious illnesses of siblings:
 
Heredo-familial diseases
Tuberculosis____________ Hypertension__________
DM __________________ Cancer_______________
Asthma________________ Genetic Disorders______
Others_________________

Maternal and Perinatal History

 
Maternal age when child was born: 29 years old

Age of Gestation and Birth Weight

Pretterm
Full-term
Postterm

TYPE OF DELIVERY Home Attendant/Midwife Hospital

Spontaneous
Caesarian Section/Forceps

Complications related to pregnancy:

Parental views of pregnancy:

Patient's problem (1st month):

Child's ability to get along with people as viewed by parents:

Early child behavior patterns as viewed by parents:

Parent's attitude toward child rearing:

III. PATTERNS OF FUNCTIONING

Nutritional History and Eating Patterns

A. 0 up to 12 months
TYPE OF FEEDING Age Started Duration Interval
1. Breastfed
2. Bottle-fed
3. Mixed
4. Type and brand of milk
a. evaporated
b. condensed
c. powdered
d. others
dilution
Supplementary Foods
Age started(in months) Kind/Type and Amount Time
1–3
4–6
7–9
10 – 12
Allergies:
Problems related to nutrition:

Usual fluids taken and appropriate intake per 24 hours:

Problems during weaning:

Vitamins and minerals supplement: Type: Dosage/Amount:

Elimination Patterns
Frequency Problems/Difficulties Usual Remedy
Bowel Movement
Urination

Toilet Training
Age in Found in textbook As seen by Significance
months significant person
started
Bowel
 Bladder

Sleeping Patterns
Usual Patterns Usual Time Approximate Sleeping Bedtime Problems
total no. of Arrangement rituals with Sleeping
sleep/24
hours

Sleeping Time

Waking Time

Hygiene
Type of Bath Time of day Use of Cosmetics/Toiletries
Full Bath
Half Bath
Others
Immunization Status
st nd
Type 1 Age 2 Age 3rd Age Booster Age Booster Age
dose dose dose 1 2
BCG
DPT
OPV
Hepa B
Measles/MM
R
Others

Play

a. Appropriateness of available toys:

b. Availability and safety of play areas:

c. Favorite toys and activities:

d. Child Initiative and amount of creative play:

e. Preferred play: Solitary: ____ Parallel ____ Associative ____ Cooperative _____

f. Peer Interaction

IV. DEVELOPMENTAL ASSESSMENT

Developmental History
Applicable During Infancy (1 – 12 months)
PATTERNS OF AGE IN AGE IN MONTHS AS SEEN IN THE SIGNIFICANCE
DEVELOPMENT MONTHS FOUND IN PATIENT
WHEN TEXTBOOKS AND/OR
MANIFESTED VERBALIZED BY
INFORMANT
Smiles and
regards
Holds up head
when prone
Follow objects
with eyes
Turned self from
prone to supine
First eruption of
teeth
Sat with support

Crawls/Creeps

Cruises

Stands Alone
 Current Developmental Assessment
AREAS AGE OBSERVATIONS FOUND ACTUAL SIGNIFICANCE
IN TEXTBOOKS OBSERVATION
Gross motor

Fine Motor

Sensory

Psychosocial

Psychosexua
l

Spiritual

Cognitive

Moral
 Language
and Speech

V. PRESENT MEDICAL HISTORY

A. Measurements
Weight: Height: Head Circ:

B. Clinical Inspection
Date and Time Taken:
Vital Signs: Temp: Pulse Rate:
Respiratory Rate:
Pain Assessment:

VI. PHYSICAL ASSESSMENT

A. General Appearance

B. Skin, Hair and Nails

C. Head and Neck

D. Eyes, Ears, Nose and Throat

E. Breast and Regional Lymphatics

F. Thorax and Lungs

G. Heart/Cardiovascular System

H. Abdomen/GIT System
I. Upper and Lower Extremities/Musculoskeletal System

J. Genito-Urinary System

K. Neurologic System

Cranial Nerve How Elicited Normal Client’s Significance

Response Response
 Cranial Nerve How Elicited Normal Client’s Significance
Response Response

L. Hematopoietic System