Perform a physical data collection and record results:
o Vital signs
o Head (including circumference on infant)
o Lungs/Respiratory
o Heart/Circulation
o Integument
o Abdomen
o Extremities (ROM, ambulation/mobility)
o NEURO
• Motor Development
FINE MOTOR
GROSS MOTOR
• Speech
• Engagement & Socialization
Identify the client’s expected stage of development & List 5 skills (physical and social) expected to be accomplished or performed at this age/stage:
o per Erickson’s Theory
o per Piaget’s Cognitive Development Stages:
Analyze the client’s actual profile of development – is it aligned with expected development per Erickson? What is not? BE SPECIFIC with 3 examples from your assessment that defend your position.
Identify what adaptations you needed to make in order to successfully interact and complete your H&P related to the developmental stage:
Identify any abnormals from history and from physical assessment:
Select a minimum of 5 relevant nursing diagnoses and interventions and develop a care plan for this child and parents. Include any safety issues, either actual or anticipated risks due to developmental stage (parental units and/or child), knowledge deficits, anticipatory needs related to development (immunizations, sports). Teaching needs?
