Student Nurse Health Assessment Skills Checklist Template

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Name:______________________________ Date: ________________
Student Nurse Health Assessment Skills Checklist
Please initial in the box corresponding with each item.
Blood Pressure
Done w/o prompt Done w/prompt
Not Done
Explain to child what you will be doing using kid-friendly
terminology.
Select accurate cuff size by assessing length/width of cuff to
length/width of arm.
Place cuff properly on right arm.
Support student’s arm with ante cubital fossa at heart level.
Consistently and accurately measure blood pressure.
Height
Done w/o prompt Done w/prompt
Not Done
Explain and have child remove shoes.
Have child stand on platform with heels against base, arms at
side, legs straight, shoulders relaxed, facing the examiner.
Use protective paper /chart on child’s head until it touches
crown of head firmly.
Have child take deep breath, relax shoulders, and hold it.
Lower saucer to rest on child’s head.
Take measurement in reference to the arrow. Round up to
nearest ¼ inch. Have child breathe. Record height in inches
clearly on chart.
Wipe off platform and saucer as needed between classes.
Weight
Done w/o prompt Done w/prompt
Not Done
Have child remove shoes.
Activate scale and waited until screen read “0 lb.”
Have child stand flat-footed, unassisted.
Record weight in pounds clearly as to readout on scale.
Vision—Plus Lens
Done w/o prompt Done w/prompt
Not Done
Have student wear his/her own glasses (if they do so normally).
Explain test in kid-friendly terminology.
Select correct strength lenses.
rd
Grades 1st,2nd &3
- 2.25 strength;
th
th
Grades 4
&5
1.75 strength (tape on side arm of glasses)
Have student stand on tape and read 20/30 line of HOTV chart.
Use terminology, “Are the letters on this line clear or are they
blurry?”
Mark “Y” or “N” whether or not the student could read at 20/30.
Mark “with correction” if student wore their own glasses.
T
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1
H
/KCUMB
HIS FORM MAY NOT BE REPRODUCED OR USED FOR OTHER PURPOSES WITHOUT WRITTEN PERMISSION FROM
CORE
FOR
EALTH
®
R
4/15/15 S
1
H
EVISED
CORE
FOR
EALTH

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