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Patients Initials__________________ Pt. Weight__________ Pt.

age_________ Students Name_____________________________


Date_________________
Allergies_______________________
PEDIATRICS PATIENT MEDICATION PROFILE

Medication/Doctor’s Normal Why is this child receiving this Assessment for therapeutic effects and side effects Gave?
Order Dose Range Medication?
Drug Name: Child:
Order:
safe dose
Classification: range: Is this a safe dose?
Drug Name:
Order: Child:

Classification: safe dose


range:
Is this a safe dose?
Drug Name:
Order: Child:

Classification: safe dose


range: Is this a safe dose?

Drug Name: Child:


Order:
safe dose Is this a safe dose?
Classification: range:
Drug Name: Child:
Order:

Classification: safe dose


range: Is this a safe dose?

Pediatric Development Assessment Form

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Student: Date of Admission: Today's Date
Patient's Initial: Age: Sex:
Diagnosis: Erikson's
Developmental Task:
Normals Yes No Comments
Physical:

Height:

Weight:

Dentition:

Temperature:

Pulse:

Respiratory:

B/P:

Fluid Requirement:

Gross Motor:

Fine Motor:

Locomotion:

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Normals Yes No Comments

Cognition:

Socialization:

Vocalization:

Play:

Introductory Data Pediatric Assessment Tool

Student: Date of Adm: Today's Date_________________


Pt's Initials Age Sex Diagnosis:___________________________________
Past Medical/Surgical History:
Patient's Chief Concern Today:
Medications Patient Currently Receiving:

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Basic Needs Objective Data Subjective Data Nursing Dx - Prioritize
A. Physiologic Respiratory rate at rest: Include subjective and
1. Oxygenation On exertion: objective indicators
Respiration Lung sounds:
Cough: nonproductive
productive (describe):
Pulse Ox.:
Retractions/Nasal Flaring:
Chest X-ray:

Cervical Lymph Nodes:


Rhinorrhea:
Circulation Apical Pulse:
B/P:
Color/cyanosis:
Hgb: Hct:
2. Rest Sleep: Sleep habits:

Bedtime rituals:

3. Mobility Is child walking?


Abnormalities of musculoskeletal structure:

Activity level:
4. Nutrition Height:
Weight:
Percentile on growth chart:
Ht. Wt.
Preferred foods:

Vitamin, Iron, or Fluoride supplements:

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Basic Needs Objective Data Subjective Data Nursing Dx - Prioritize

Appetite: Usual:
Current:
Type of diet at home:
At hospital:
Nausea/Vomiting

Bottle: Breast:
Cup: Sippy Cup:
Finger Foods:

5. Fluid & 24-hour fluid requirement:


Electrolyte Balance
Fluid Oral intake (Clinical)
IV (type and amount)
Total fluid intake previous 24 hours:
Vomiting/Diarrhea:(describe)
Recent weight gain:
Fluid & Electrolyte Recent weight loss:
Balance, Eyes: Sunken:
Fluid, Cont. Weary:
Tear production:
Fontanels: Flat:
Sunken:
Bulging:
Skin Turgor:
Mucous Membranes:
Electrolytes Na+
K
Cl
6. Regulation Seizures (describe)

Level of consciousness:
Pupils:
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Basic Needs Objective Data Subjective Data Nursing Dx - Prioritize
Head Circumference:
Percentile on growth chart:
7. Elimination Toiled Trained:
Bowel Last BM, Describe:
Bowel sounds:
Abd distention:
Passing flatus
Bladder Toilet trained:
Urine: Color, sensation and odor:
Amount: (24 hours)
Specific gravity:
8. Comfort Pain: Location:
Verbal and non-verbal behavior:
9. Sexuality Secondary sex characteristics:

Genitals: Discharge
Lesions
Testicles descended:
B. Safety and Security Lesions, incisions: (Use REEDA)
1. Physical Appearance of rash:
Mouth: Dentition:
2. Chemical/ Immunizations to date:
Microbial WBC:
Recent exposure to infectious diseases:
Allergies:
3. Thermal Temperature today:
Onset and history:

Cause:

C. Psychosocial Who is the usual caretaker?


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Basic Needs Objective Data Subjective Data Nursing Dx - Prioritize

1. Love and Child's response to significant others:


Belonging Response to separation:
Culture:
Religion:
Family composition:
2. Self-esteem Posture:
Mood:
Body Image:

Developmental task according to Erikson:

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COLLEGE LABORATORY

FOCUS: Care Plans for Nursing Care of Mothers and Children

OBJECTIVES: After this laboratory, the student will be able to:

1. Differentiate between a written care plan for Fundamentals of


Nursing Care and a written care plan for Nursing Care of Mothers
and Children.

2. Apply the format for a written care plan for Nursing Care of
Mothers and Children to a prenatal mother.

PREREQUISITE ACTIVITY:

Read Fundamentals Book on the nursing process.

LABORATORY ACTIVITY

1. Bring a blank care plan.

2. Write a hypothetical care plan for prenatal mother using column


two to explain the normal physiology or pathology of the stated
unmet need.

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Nursing Care Plan1

Student’s Name:_________________________Patient’s Initials:___________________

Date:___________Need:___________________________________________________

Nursing Diagnosis with R/T statement


Definition of Nursing Diagnosis:

Indicators: Subjective/Objective Explanation/Physiology

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Nursing Care Plan

Need:__________________________________________________________

Goal:__________________________________________________________

Evaluation of overall
goal:______________________________________________________

IMPLEMENTATION:_____________________________________________________
________________

Intervention Rationale Evaluation of Interventions

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