Académique Documents
Professionnel Documents
Culture Documents
COLLEGE OF NURSING
Assessment
In
School-Aged
Child
(3rd year- block 5)
SUBMITTED BY:
DEL ROSARIO, Shiera Marie
MARIANO, Wendel Mark
RAHMAN, Sarah Silvia
SAMSON, Joel
VIAJE, Samantha
SUBMITTED TO:
Dra. Anna Katharina Peña
ASSESSMENT TOOL
1
(SCHOOLER)
I. PERSONAL HISTORY:
A. FAMILY HISTORY- Family tree
Villanueva
Family
Joel Helen
Villanueva Villanueva
46 yrs. old 44 yrs. old
B. BIRTH/HEALTH HISTORY-
2
: The child is fully immunized.
: Had mumps and chicken fox at 6 years old.
: No history of previous hospitalization and accidental injuries.
B. Vital Signs
1. Temp. 36.5 °C 36.5 - 37.5 C The child’s vital sign
2. PR 74 bpm 70 – 100 bpm is within the normal
3. RR 25 cpm 20 – 30 cpm range.
4. BP 90/60 mmHg 100/70 mmHg
SKIN Skin color is brown, Uniform color, light The child’s skin is
no allergies and skin brown color and no normal.
returns back quickly allergies noted and
when pinched. warm to touch
EARS Auricle color is same Ears are The Child’s ears are
as facial skin color. symmetrically within the normal
3
Ears are aligned; align with findings.
symmetrically outer cantus of the
aligned. eye.
MOUTH Lips are color pink, Lips are color pink, The child’s mouth is
pink gums, white Gums are slightly pink within the normal
teeth and tounge and her tongue is findings.
move freely. pinkish and no
infection or no
infection and
tonsillitis noted.
Extremities (Lower) Equal in size both Equal in size both Both extremities are
sides of the body, no sides of the body, no within the normal
deformities, no deformities, no findings.
contracturs, or contracturs, or
swelling. swelling. With range
Joints are smoothly of motion within
movable. Elbows are normal limits. Joints
symmetrical. are smoothly
moveable and are
easy and has strength
felt on grasp. Elbows
are symmetrical and
movement done with
ease.
4
moveable and are
easy and has strength
felt on grasp. Elbows
are symmetrical and
movement done with
ease.
D. PHYSIOLOGIC CHANGES
5
Central task (+) resolution (-) resolution
Industry vs. inferiority Learns to create, manipulate Loss of hope, sense of being
and develop. mediocre.
The child is active physically and verbally, able to make friends and have a lot of
friends in the community.
The child is receiving an average grades ranging from 77 to 80.
He is not participating in any extra curricular activities.
The parent’s states that their son’s teacher does not have any problem with the
child.
The parent’s states that the child has no special problem.
The child considers a ghost as his greatest fear.
The child attends to school regularly, and has a perect attendace. Shows interest in
other subjects.
The child’s concept about life is that “life is hard”.
The child doesn’t fear death.
6. Language skills
6
The child is able to communicate with other people.
Can understand verbal instructions.
Speaks clearly.
Stage Characteristics
Mythical- literal Accepts existence of a deity.
Religious and moral beliefs are symbolized by
stories.
Appreciate others’ viewpoints.
Stage 4: Law and order orientation Individual feels “duty bound” to maintain
social order.
The child is being scolded by its parents whenever it commits mistake as a form of
discipline.
IV Neurological Assessment
7
1. Mental Status – Level of Consciousness
Knowledge
Abstract thinking
Association
judgement
The child has no problem with its body’s coordination and balance, he is able to perform
the heel to toe walking test and other coordination and balance test.
Scores:
0
+ 1 minimal
+ 2 Normal
+ 3 more active
+ 4 maximal