Trinity Valley Community College



TRINITY VALLEY COMMUNITY COLLEGE ASSOCIATE DEGREE NURSING Student Name:_________________________________

CLINICAL II and TRANSITION CLINICAL

RUBRIC FOR PEDIATRIC ASSESSMENT

Total Points (Grade)______________________

|CONCEPT |EXEMPLARY |AVERAGE |UNSATISFACTORY |OMITTED |GRADE |

|HUMAN DEVELOPMENT |6 |4 |2 |0 | |

| |5 |3 |1 |Did not complete section.| |

| |Compared and contrasted the normal |Compared and contrasted the normal |Listed the normal growth/ development of | |___pts |

| |growth/development of pediatric patient to the |growth/development of pediatric patient to |pediatric patient to the “textbook picture” of | | |

| |“textbook picture” of the specific age group |the “textbook picture” of the specific age |the specific age group including activity | | |

| |including activity restrictions. Addressed all |group including activity restrictions but |restrictions but didn’t compare and contrast | | |

| |areas including 1) Gross motor; 2) Fine motor; 3) |omitted one or more areas. Examples were not|with an analysis. | | |

| |Language; 4) Socialization; 5) Cognition; 6) |very descriptive or were exactly what was | | | |

| |Sensory (Discussed all 5 senses - tactile, |written in the textbook. Comparison included| | | |

| |auditory, etc.). Gave specific descriptive |that child was meeting current level. | | | |

| |examples of child meeting or not meeting the tasks| | | | |

| |that did not copy what the textbook said. | | | | |

| |Comparison included more analysis than “meeting | | | | |

| |current level”. | | | | |

| |2 |1.5 |1 |0 | |

| |1.75 |1.25 |0.75 |Did not complete section.|____pts |

| |Completed 3 growth charts (available on-line) |At least one of the growth charts was not |More than one of the growth charts was not | | |

| |(stature for age, weight for age, and stature for |graphed correctly. Or analysis was given |graphed correctly. No analysis was given. | | |

| |weight or BMI) and graphed accurately. Analyzed |that included at least one incorrect | | | |

| |data correctly stating the percentiles from each |percentile. | | | |

| |chart. | | | | |

| |1 |0.75 |0.5 |0 | |

| |Correctly identified the major developmental task |Correctly identified the major developmental|Misidentified the major developmental task |Did not complete section.|____pts |

| |(Erikson) for this child. Stated whether child was|task (Erikson) for this child. Stated |(Erikson) for this child or did not state | | |

| |meeting or not meeting task and gave rationale. |whether child was meeting or not meeting |whether child was meeting or not meeting task. | | |

| | |task but didn’t give adequate rationale. | | | |

| |1 |0.75 |0.5 |0 | |

| |Identified at least 5 play/activities and 5 toys |Identified at least 3 play/activities and 3 |Identified play/activities and toys that would |Did not complete section.|____pts |

| |that would be appropriate for the child according |toys that would be appropriate for the child|not be appropriate for the child according to | | |

| |to the developmental level and physical |according to the developmental level and |the developmental level and physical | | |

| |condition/illness. |physical condition/illness. |condition/illness. Or identified less than 3 of| | |

| | | |each. | | |

|PERFUSION |1 |0.75 |0.5 |0 | |

|GAS EXCHANGE | | |More than one of the vital signs were not |Did not complete section.|____pts |

|THERMO-REGULATION |Listed patient’s vital signs and “normal” vital |At least one of the vital signs were not |analyzed correctly or there was no analysis | | |

| |signs for a child of the same age. Compared and |analyzed correctly. No explanation for |given. | | |

| |analyzed the vital signs correctly. If not within|abnormal vital sign was given. | | | |

| |normal limits gave suggested explanation for | | | | |

| |aberrancy. | | | | |

|INTERPERSONAL |1 |0.75 |0.5 |0 | |

|RELATIONSHIPS | |Described interactions between 1) child and |Omitted one or more of the required |Did not complete section.|____pts |

| |Described interactions between 1) child and |primary caregiver; 2) child and nursing |descriptions of interactions. | | |

| |primary caregiver; 2) child and nursing student; |student; and 3) primary caregiver and | | | |

| |and 3) primary caregiver and student. Was |student but was not descriptive and was too | | | |

| |descriptive and included at least 3 sentences for |brief. | | | |

| |each. | | | | |

|NUTRITION |2 |1.5 |1 |0 | |

| |1.75 |1.25 |0.75 |Did not complete section.|____pts |

| |Described typical nutritional intake of pediatric |Described typical nutritional intake of |Described typical nutritional intake of | | |

| |patient. Listed the recommended number of |pediatric patient. Listed the recommended |pediatric patient. Listed the recommended | | |

| |servings for each food group for this age child. |number of servings for each food group for |number of servings for each food group for this| | |

| |Determined number of servings child consumed and |this age child and determined number of |age child but did not determine number of | | |

| |compared with recommended number of servings. |servings child consumed and compared with |servings child consumed and compared with | | |

| |Included analysis of the findings. |recommended number of servings. Did not |recommended number of servings nor include | | |

| | |include analysis of the findings or analysis|analysis of the findings. Or determination of | | |

| | |was incorrect for at least one area. |servings consumed and analysis was incorrect. | | |

|IMMUNITY |2 |1.5 |1 |0 | |

| |1.75 |1.25 |0.75 |Did not complete section.|____pts |

| |Listed immunizations that are required for this |Listed immunizations that are required for |Listed immunizations that are required for this| | |

| |age child in provided table. Listed immunizations|this age child in provided table. Listed |age child in provided table. Listed | | |

| |that the child received at what age. Provided |immunizations that the child received at |immunizations that the child received at what | | |

| |analysis of current immunization status. |what age. Provided analysis of current |age. Did not provide analysis of current | | |

| |Identified and discussed primary caregiver’s |immunization status that was incorrect in at|immunization status in all areas. Did not | | |

| |knowledge of immunizations including side effects,|least one area. Did not adequately discuss |adequately discuss primary caregiver’s | | |

| |adverse effects and safety measures for patient |primary caregiver’s knowledge of |knowledge of immunizations including side | | |

| |and patient contacts and list at least one |immunizations including side effects, |effects, adverse effects and safety measures | | |

| |teaching need. |adverse effects and safety measures for |for patient and patient contacts and list at | | |

| | |patient and patient contacts and list at |least one teaching need. | | |

| | |least one teaching need. | | | |

|EVIDENCE-BASED PRACTICE |1 |0.75 |0.5 |0 | |

| |Discussed one evidence-based nursing practice |Discussed one evidence-based practice |Discussed practice guideline related to health |Did not complete section.|____pts |

| |guideline related to health promotion of children |guideline but it was not related to health |promotion that was not evidence-based. | | |

| |this age. Included reference |promotion. Reference included. |Reference not included. | | |

|HEALTH PROMOTION |1 |0.75 |0.5 |0 | |

| | |Identified at least 4 health promotion |Identified at least 2 health promotion |Did not complete section.|____pts |

| |Identified at least 6 health promotion activities |activities for this age child. |activities for this age child. | | |

| |for this age child. | | | | |

|SAFETY |1 |0.75 |0.5 |0 | |

| | |Identified at least 6 safety precautions for|Identified at least 3 safety precautions for |Did not complete section.|____pts |

| |Identified at least 10 safety precautions for this|this age child. |this age child. | | |

| |age child. | | | | |

|PROFESSION-ALISM |1 |0.75 |0.5 |0 | |

| |Accurate spelling, & grammar (< 2 errors per |Accurate spelling & grammar (< 5 errors per |Accurate spelling & grammar (> 5 errors per |No criteria sheet |___pts |

| |submission), and references cited correctly in APA|submission), but references not in APA |submission), and no references cited. | | |

| |format. |format. |Criteria sheet submitted. | | |

| |Criteria sheet submitted. |Criteria sheet submitted. | | | |

TRINITY VALLEY COMMUNITY COLLEGE

ASSOSCIATE DEGREE NURSING

PEDIATRIC ASSESSMENT – LEVEL II & TRANSITION

Student Name: ________________________________ Course: _________________

Patient’s Initials: ____Age: _____ Sex: _______ Date of Contact: ________________

(Must not be own child)

|Human Development |

|Growth & Development |

|Component Area |Textbook – What is |Client – What Client |Analysis – Compare & Contrast |

| |Expected for Age |Demonstrated | |

|Gross motor | | | |

| | | | |

| | | | |

|Fine motor | | | |

| | | | |

|Language | | | |

| | | | |

|Socialization | | | |

| | | | |

|Cognition | | | |

| | | | |

|Sensory - Vision | | | |

| | | | |

|Sensory – Auditory | | | |

| | | | |

|Sensory – Tactile | | | |

| | | | |

|Sensory – Taste | | | |

| | | | |

|Sensory – Smell | | | |

| | | | |

|Reference: |

|Summary of Analysis: |

| |

| |

| |

|I. Human Development - Growth Charts |

|Instructions |

|Measure client’s height and weight |

|Calculate client’s BMI |

|Download growth charts from CDC |

|Height for age |

|Weight for age |

|BMI (If child is over 2- otherwise do height for weight chart) |

|Graph client information on the growth chart and submit. Do not submit computer generated results |

|Analyze results and write summary – include description of percentiles |

|Client Height: |

|Client Weight: |

|Client BMI: |

| Summary of analysis of results: |

| |

| |

| |

| |

|I. Human Development - Erickson Stages of Development |

|Major developmental task |Give examples that show patient is |

| |meeting or not meeting the task |

| | |

| | |

|Is child meeting or not meeting task? | |

|I. Human Development - Play Activities |

|Instructions: |

|Identify play activities and toys that would be appropriate for this age child |

|Play activities |

| |

| |

|Toys |

| |

| |

|Reference: |

|II. Perfusion, Gas Exchange & Thermoregulation - Vital Signs |

| |Age Appropriate |Client’s Results |Analysis |

|Pulse | | | |

|Respirations | | | |

|Temperature | | | |

|Blood Pressure | | | |

|Reference: |

|Summary of analysis of results: |

| |

| |

|III. Interpersonal Relationships |

|Directions: Describe interactions: |

|Between child and primary caregiver | |

|Between primary caregiver and the nursing| |

|student | |

|Between child and the nursing student | |

|IV. Nutrition |

|Instructions: |

|Ask primary caregiver to describe average nutritional intake for child for a day or ask them to write down intake for a typical |

|day. |

|Go to and find out the recommended number of servings in each food group for this child |

|Determine the number of servings and calories the patient consumed |

|Determine the difference between the actual intake and the recommended intake |

|Write an analysis of the nutritional intake. |

|Breakfast: | |

|Snacks: | |

|Lunch: | |

|Snacks: | |

|Dinner: | |

|Snacks: | |

| |

|Food Group |# Servings Recommended for this |# Servings Patient Consumed in |Difference |

| |age child |average day |(+ or -) |

|Grains | | | |

|Proteins | | | |

|Fruits | | | |

|Vegetables | | | |

|Dairy | | | |

|Reference: |

|Analysis of results and recommendations: |

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| |

| |

| |

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| |

| |

| |

|V. Immunity |

|Immunizations Recommended (Use |Recommended Ages When They Should |Age When Client Received |Analysis |

|Texas website) |Be Received |Immunizations | |

|Hepatitis B | | | |

|Rotavirus | | | |

|Diphtheria, Pertussus, Tetanus | | | |

|Haemophilus influenza type B | | | |

|Pneumococcal | | | |

|Inactivated Polio | | | |

|Measles, Mumps, Rubella | | | |

|Varicella | | | |

|Reference (Use current Texas website and not textbook): |

|Summary of analysis of results: |

| |

| |

|Discuss primary caregiver’s knowledge of immunizations including side effects, adverse effects, and safety measures for patient and|

|patient contacts and analyze teaching needs: |

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| |

| |

| |

|VI. Evidence-based Nursing Practice |

|Instructions: Discuss one evidence-based nursing practice guideline related to health promotion of children this age |

|Evidence-based Nursing Practice Guideline: |

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| |

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| |

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| |

|Reference: |

|VII. Health Promotion |

|Instructions: Identify health promotion activities and safety precautions that would be appropriate for this age child |

|Health Promotion Activities |

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|Reference: |

|VIII. Safety |

|Instructions: Identify safety precautions that would be appropriate for this age child |

|Safety Precautions |

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|Reference: |

N:\Syllabus\CBC Curriulum\Clinical II & Transition Pediatric Assessment Reviewed 04/15

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