BULACAN STATE UNIVERSITY
COLLEGE OF NURSING
City of Malolos, Bulacan
PEDIATRIC PHYSICAL ASSESSMENT CHECKLIST
Name of Patient: Rossdale Molina Name of Student: Iana Khrys T. Godoy
Date of Assessment: November 11, 2022 :
I. Vital Signs
A. Temperature: 36.6 C Site: Axillia
B. Pulse: 92 bpm
C. Resp. Rate: 24 cpm
II. General
A. Level of Consciousness:
Alert Lethargic Obtunded Stupor Coma
B. Mood:
Pleasant Irritable Calm Happy Anxious
C. Affect:
Surprise Anger Sadness Joy FearfulDisgust
D. Height 3 feet 5 inches
E. Weight 22.8 kilograms Fear Flat
III. Integument
A. Color Pink Jaundice Pallor Erythema Cyanotic Aprop To Race
B. Hair Distribution Even Uneven
C. Moisture Wet Moist Dry Clammy
D. Temperature Hot Warm Cool Cold
E. Texture Smooth Rough
F. Turgor 1 seconds Good Poor
G. Edema None Little Yes Location:
H. Lesions No Yes Location:
Shape: Size:
Type: Color:
I. Birthmarks Hemangioma Nevi Mongolian Spots
J. Nails Clubbing Pink Cyanotic
K. Capillary Refill 1 seconds Brisk Sluggish Rapid
IV. Head
A. Size: 52 cm Normocephaly Microcephaly Macrocephaly
B. Shape Normocephaly Plagiocephaly Brachycephaly Scaphocephaly
B. Fontanelle(s)
Anterior Close Open Tense Soft Dipped
Posterior Close Open Tense Soft Dipped
V. Eyes
A. General Strabismus Doll’s Eye
B. Pupils: Size: 4 Mm Equal Round Raxn To Light Accom
C. Iris: Color Brown Pink Opaque Sun Setting
D. Conjunctiva Clear Erythema
E. Sclera Clear Jaundice Blue
F. Cornea Clear Opaque Erythema
G. Vision Nearsighted Farsighted Glasses Contacts
H. Blink Reflex Yes No
VI. Ears
A. Position of ears Normal Low Set Ears High Set Ears
B. Pain Left Ear Right Ear None
C. Wax Build Up Left Ear Right Ear None
VII. Nose
A. Drainage Yes No
B. Blockages Yes No
C. Sense of Smell Yes No
D. Flaring Yes No
E. Congestion Yes No
F. Mucous Membranes Moist Pink Pallor Erythema
VIII. Mouth and Throat
A. Mucous Membranes Pink Pallor Erythema Jaundice
B. Tongue Shape Symmetric Asymmetric
C. Tongue Movement Symmetric Asymmetric Freely Movable Protruding
D. Saliva Amount Normal Scanty Excessive
E. Teeth Number 21
F. Teeth Condition Intact Dental Caries
G. Gums Intact Erythema
H. Palate Intact Cleft Over arched
I. Tonsils Pink Exudates Grade 1 Grade 2 Grade 3 Grade 4
J. Gag Reflex Yes No
K. Swallowing Easy Difficult Painful
L. Lymph Nodes Normal Enlarged
IX. Chest
A. Breath Sounds Clear Wheezes Crackles Rhonchi Friction Rub
B. Respiration Even/Regular Irregular Labored Shallow Deep
Apnea Abdominal/Diaphragmatic
C. Chest Expansion Symmetrical Asymmetrical Retraction
D. Cough No Yes Productive Non-Productive
Sputum Color: Amount:
E. SOB Yes No Little Difficulty W/ Respirations
X. Cardiovascular
A. S2 “Dub” Clearly Audible Muffled Murmur
B. S1 “Lub” Clearly Audible Muffled Murmur
C. Heart Beat Regular Irregular
D. Apical Rate 92
E. Apical Rhythm Regular Irregular
XI. Abdomen
A. Shape Flat Round
B. Bowel Sounds Quadrant 1 Quadrant 2 Quadrant 3 Quadrant 4
Active Active Active Active
Hyperactive Hyperactive Hyperactive Hyperactive
Hypoactive Hypoactive Hypoactive Hypoactive
Faint Faint Faint Faint
Absent Absent Absent Absent
C. Palpation Soft Hard Firm Tender
Non-Tender Distended
D. Diet Breastfeeding Formula Feeding Mixed Feeding Solid Foods
E. Toleration Of Diet Good Average Poor
F. Change In Appetite Yes No
G. Recent Weight Change None Gain Loss
XII. Musculoskeletal
A. Back
Sacral Dimple Yes No
Posture Straight Kyphosis Lordosis Scoliosis
B. ROM
Upper Extremities Full Partial Active Passive Assistive
Lower Extremities Full Partial Active Passive Assistive
C. Gait Balanced Unbalanced Limping Shuffled