Case Study

Metro Manila Developmental Screening Test

(MMDST)
In partial
fulfilment on
NCM 101
(School Health Nursing)

Presented by:

BSN3b1-Group 2

Cabacungan, Jhe Zelle Grace A.

Caragay, Elaine Joy
Carranza, Ma. Jeaniel
Daelo, Jezaline
Danguilan, Maureen Jane O.
David, Neluz Kim M.
De Vera, Sandra B.
Fetilo, Melvin Czar C.
Lopez, Paul John V.
Valdez, Phoebe M.
Valera, Patrick James O.

Presented to:

Professor Cielo Teresa B. Rezada

(Clinical Instructor)
 I. INTRODUCTION

A. Background of the Study

School Health Nursing is a specialized practice of professional nursing that

advances the wellbeing, academic success, and life-long achievement of students. To

that end, school nurses try to facilitate positive student responses to normal human

development; promote health and safety in the school environment; intervene with

actual and potential health problems; provide case management services; and actively

collaborate with others to build student and family capacity for adaptation, self-

management, self-advocacy, and learning.

A school nurse must also be prepared with the extensive skills in physical

assessment, interviewing, and well-child counseling and care. In this role a nurse

interviews parents as part of an intensive health history and performs a physical

assessment of the child. (Maternal & Child Health Nursing by Adele Pillitteri vol. 1 third

edition p.23)

Included in the skills of a school nurse is well-child counseling mainly by

screening. Screening is the presumptive identification of an unrecognized disease or

defect by the use of test, examinations or other measures that can be applied rapidly.

Screening tests are performed on persons without any clinical sign of disease. The

intention of screening is to identify disease at an early state, thus enabling earlier

intervention and management. (Metro Manila Developmental screening Test Manual,

Second Edition)

One such screening test is the Metro Manila Developmental Screening Test a

test that is used to detect developmental disabilities in children aged two weeks to six

and a half years old. The MMDST is a clinically useful tool used in the early detection of

serious developmental delays developed by Dr. Phoebe D. Williams. It was modified

and standardized from the widely recognize Denver Developmental Screening test by

[Link] k. Frankenburg and his associates. Today William’s MMDST remains to be

the recognized developmental screening test among Filipinos.

MMDST was developed for health professionals such as nurses, doctors, and

other health workers so that slow development may be recognized, referrals made, and

appropriate therapy prescribed as soon as possible. Just like DDST it is not an

intelligence test. It is intended as a screening instrument to determine whether a child’s

development is within normal range and designed to detect developmental delays in

children. It evaluates the four aspects of a child’s development namely, personal-social,

fine motor-adaptive, language and gross motor behavior.

B. Objectives

The students aim to obtain the following objectives:

General:

To assess and conduct a test using the Metro Manila Developmental Screening

Test (MMDST) on the chosen client

Specific:

a.) To have better understanding on how to perform the Metro Manila Developmental

Screening Test (MMDST) by screening preschool children

b.) To apply and develop the knowledge and skills about the developmental milestones

of a child in the scope of the school health nursing.

c.)To enhance the capabilities of handling students especially the preschool children

during the school health nursing exposure

d.) To understand and learn the client’s condition with the use of pediatric nursing

assessment together with the direct observation to the child’s behavior.

e.) To determine if the client’s developmental milestone is within normal range or has

developmental delay by analyzing the normal and abnormal findings of the assessment

and also the Metro Manila Developmental Screening Test.

C. Scope and Delimitation

The study was under the field of school health nursing which was conducted on

September 13-15 and 20-22, 2010 at New Era University in Quezon City. The third year

nursing students were able to gain knowledge and experience through the activities

concerning the preschool children during the exposure which were used to make this

study possible. This study covers the client’s developmental milestone, Metro Manila

Developmental Screening Test, pediatric nursing assessment, physical assessment I

and II and the present health history including the child’s Functional Health Pattern. The

baseline information gathered were from the child herself, personal interview with the

primary care giver, the teacher and the observations of the researchers to the child.
D. Theoretical Framework

a. Havigburst’s Age Periods and Development Tasks

Robert Havigburst believes that learning is basic to life and that people continue

to learn throughout life. He describes growth and development as occurring during six

stages,each associated with from six to ten tasks to learned. A developmental task is “a

task which arises at or about a certain period in the life of an individual, successful

achievement of which leads to his happiness and to success with later tasks, while

failure lead to unhappiness in the individual, disapproval by society, and difficulty with

the tasks”.
 A preschooler is in the middle childhood period. The child was expected to

develop these developmental tasks: learn physical skills necessary for ordinary games;

build wholesome attitudes toward oneself as a growing organism; learn to get along with

age-mates; learn an appropriate masculine or feminine social role; develop fundamental

skills in reading, writing, and calculating; develop concepts necessary for everyday

living; develop conscience, morality, and a scale of values; achieve personal

independence; and develop attitudes toward social groups and institutions.

(Fundamentals of Nursing by Kozier 4th Edition, page 585)

b. Freud’s Theory of Psychosexual Development

According to the theory of psychosexual development by Sigmund Freud, the

personality develops in the five overlapping stages from birth to adulthood. The libido

changes its location of emphasis within the body from one stage to another. Therefore,

a particular body area has special significance to a client at the particular stage. If the

individual does not achieve a satisfactory resolution at each stage, the personality

becomes fixated at that stage.

A preschooler is in the phallic stage (4-5 years). The child’s genitals are the

center of pleasure. The child identifies with the parent of the opposite sex and later

takes on a love relationship outside the family. Encourage identification. During the

phallic stage, sexual and aggressive feelings associated with the genitals come into

focus. Masturbation offers pleasure at this time, and the child experiences the Oedipus

or Electra complex. The Oedipus complex refers to the male child’s attraction for his

mother and his hostility attitudes toward his father. The Electra complex is the female
child’s attraction for her father and her hostile attitudes toward her mother. Fixation at

the phallic phase can result in such traits as problems with sexual identity and problems

with authority.

(Fundamentals of Nursing by Kozier 4th Edition, page 586-587)

c. Sullivan’s Stages of Interpersonal Development

Harry Stack Sullivan delineates six stages of interpersonal development that

span the period from infancy to adulthood. He sees the growth of the personality from a

socio-psychologic viewpoint. Although he does not reject the role of heredity (biology) in

the development, he believes that sociologic factors have greater influence. Sullivan

defines interpersonal behavior as “all that can be observed as personality”. He views

interpersonal development as a series of stages.

A preschooler is in juvenile stage (first 5-6 years). The child becomes social,

competitive, and cooperative and learns to supervise own behavior by external controls.

(Fundamentals of Nursing by Kozier 4th Edition, page 587)

d. Erikson’s Developmental Stages

Erikson envisions life as a sequence of levels of achievement. Each stage

signals a task can be complete, partial, or unsuccessful. Erikson believes that the

greater the task achievement, the healthier the personality of the person, failure to

achieve a task influences the person’s ability to achieve the next task. These

developmental tasks can be viewed as a series of crises, and successful resolution of

these crises is supportive to the person’s ego. Failure to resolve the crises is damaging
to the ego. After attaining one stage, the person may fall back and need to approach it

again.

A preschooler is in late childhood (3-5 years). The central task is initiative versus

guilt. Indications that the crises was resolved was learning the degree to which

assertiveness and purpose influence the environment and begging ability to evaluate

one’s own behavior. Indications that the crises was not resolved was lack of self-

confidence, pessimism, fear of wrongdoing, and over control and over restriction of own

activity.

(Fundamentals of Nursing by Kozier 4th Edition, page 587-588)

e. Piaget’s Phases of Cognitive Development

According to Jean Piaget, cognitive development is an orderly, sequential

process in which a variety of new experiences (stimuli) must exist before intellectual

abilities can develop. Piaget’s cognitive development process is divided into five major

phases. A person develops through each of these phases, each phase has its own

unique characteristics.

A preschooler is in intuitive thought (4-7 years). Significant behavior that were

develop at this phase are egocentric thinking diminishes, thinks of one idea at a time,

includes others in the environment, and words express thoughts.

(Fundamentals of Nursing by Kozier 4th Edition, page 591-592)

 f. Kohlberg’s Stages of Moral Development

Kohlberg suggests three levels of moral development that encompass six stages.

He focuses on the reasons for the making of a decision, not on the morality of the

decision itself.

A preschooler is in Level I Preconventional Stage 2 instrumental-relativist

orientation. Wherein the action is taken to please another and gain approval.

(Fundamentals of Nursing by Kozier 4th Edition, page 593-594)

g. Fowler’s Stages of Spiritual Development

James Fowler believes that faith, or the spiritual dimension, is a force that gives

meaning to a person’s life. Fowler uses the term faith as a form of knowing, a way of

being in relation to “an ultimate environment”. To Fowler, faith is a relational

phenomenon; it is “an active ‘made-of-being-in-relation’ to another or others in which we

invest commitment, belief, love, risk and hope”.

A preschooler is in intuitive-projective (4-6 year). A combination of images and

beliefs given by trusted others, mixed with the child’s own experience and imagination.

(Fundamentals of Nursing by Kozier 4th Edition, page 596-597)

E. Developmental Milestone

Preschool Physical Development

 runs, jumps, climbs, balances with assurance - by 5, gross motor skills are well

developed.

 likes risks, tests of physical strength and skill - loves acrobatics and outdoor

equipment.

 increasing finger control - can pick up small objects, cut on a line with scissors,

hold pencil in adult grasp, string small beads (Most children in this age group can

begin using toys with smaller components. If child is still mouthing objects, select

toys without small parts.)

 expert builder - loves small construction materials and also vigorous activity with

big blocks, large construction materials.

 by 5, rudimentary interest in ball games with simple rules and scoring.

Preschool Mental Development

 familiar with common shapes, primary colors.

 interest in simple number activities, alphabet play, copying letters,

matching/sorting.

 by 5, sorts and matches using more than one quality at a time.

 around 4, begins to be purposeful and goal directed, to make use of a plan.

 interest in producing designs, including puzzles, and in constructing play worlds.

 first representational pictures.

 prefers realism.

 interest in nature, science, animals, time, how things work.

 peak interest in dramatic play - recreates adult occupations, uses costumes and

props.

Preschool Social Development

 beginning to share and take turns, learning concept of fair play.

 by 5, play is cooperative, practical, conforming.

 interested in group pretend play.

 not ready for competitive play because hates to lose.

 enjoys simple board games based on chance, not strategy.

 more sex differentiation in play roles, interests.

 enjoys looking at books and listening to stories from books.

Preschool Language Development

 favorite word – “why”

 3 years old – vocabulary of 900 words

 4 years old – vocabulary of 1500 words

 5 years old – vocabulary of 2100 words

 II. BIOGRAPHIC DATA

Name: Child A. B. V.

Address: Diliman, Quezon City

Date of Birth: May 12, 2006

Age: 4 years and 4 months

Gender: Female

Race: Filipino

Mother’s Name: Mrs. O.V., 31 years old Occupation: housekeeper

Father’s Name: Mr. A. V., 34 years old Occupation: engineer

Religious Orientation: Iglesia Ni Cristo

III. PEDIATRIC ASSESSMENT

A. Parental view of presenting problem and/or medical diagnosis

According to the mother, the child had no presenting problem or medical

diagnosis. The child was healthy.

B. General Observations
 The child was dressed neatly in her uniform. Her hair was properly fixed into a

pony. She was jolly and mingles well with her classmates. She is a smart kid who

listens to the lessons and follows the instructions of their teacher in the class.

You can see a good parent-child interaction within the child and her parents. The

mother usually was the one accompanying the child in school. The child also has good

relationship with her elder sister. She was her best playmate in their house.

The mother assured that they have safe home environment for their two children.

Evidence is that child A.B.V. never came to school with any injury.

C. Significant Past Medical History

The family of child A.B.V. was a nuclear type of family. The child lives with her

father, mother, and elder sister. Mr. A.V. and Mrs. O.V. don’t have any illness at their

age right now.

Mrs. O.V. became pregnant with child A.B.V. at the age of 26 with normal weight

gain and gynecologic difficulty like nausea, vomiting, and edema on the feet. The

mother gave birth to the child in St. Luke’s Medical Center (SLMC) by a Normal

Spontaneous Delivery (NSD). The child was full term and her birth weight is 7.8 lbs.

Child A.B.V. was breastfed until the age of 3 years old then after that take

powdered milk named Lactum. She also takes Vitamin C-Ceelin, and Cherifer for her

food supplements. The child did not experience any feeding problems like vomiting,

diarrhea, and constipation. She was never hospitalized due to illness.

D. Early Developmental Milestones

Mrs. O.V. remembered some of the approximate age where child A.B.V.

achieved the early developmental milestones. The first smile of child A.B.V. was at 2

months old, followed objects with eyes at 1 month old, crawled at 9 months old, walked

alone at 11 months, and fed self with spoon at 2 years old. The child said her first word

before she turned 1 year old. She started to spoke sentences before she turned 2 years

old. She was trained or able to control her bowel/bladder movement by day at 3 years

old. Until now she can’t control her bladder at night and still wears diapers before

sleeping.

Child A.B.V. was like a “little scientist” according to the mother. She likes to

explore things and do things on her own. She was a fast learner and was able to do

things not all her age can. She gets along well with her “ate” who is 2 years older then

her. She also gets along with her peers. There are no problems on her that is related to

nutrition.

Interpretation:

Every child varies from the rate of development. The child is more advanced in

some aspects than other children. Her distinct characteristics best describes the rapid
growth & development which is greatly affected by chemical factors and also proper

child rearing.

Analysis:

The average infant progresses through systematic motor growth during the first

year that strongly reflects the principles of cephalocaudal development and gross to fine

motor development. Control proceeds from head to trunk to lower extremities in a

progressive, predictable sequence. Different infants accomplish different tasks at

different age. (Maternal & Child Health Nursing4th ed. by Pilliteri vol. 2, p797 )

E. Eating and Drinking Patterns

Child A.B.V. has a good appetite that she usually has 4 meals a day. The foods

she like eating are hotdogs, tocino, chicken, carrot, and malunggay. She dislikes foods

that are cooked in nilaga. She drinks 6-8 glasses of water a day – in the form of fruit

juice, milk, Milo, and ice tea. She has no allergies to food and medicine. As stated

earlier, the child has no problems related to nutrition.

Interpretation:
 It seems like the child is not eating enough vegetables which is an essential part

of her body growth. The child should also be trained to eat vegetables to meet the daily

requirement of her body during this stage of development.

Analysis:

A vegetarian diet is usually colorful and therefore appeals to preschoolers. Many

vegetables, fruits and gains are also good snacks and so are convenient for the child

who eats frequently during the day. If vegetarian diets are deficient in any aspects, they

usually lack calcium, vitamin B12, and vitamin D. (Maternal & Child Health Nursing4th

ed. by Pilliteri vol. 2, p856 )

F. Eliminating Patterns

According to the mother, the child urinates 4- 5 times a day because of her high

fluid intake. The child had no difficulties in stool elimination. She defecates once

everyday.

Interpretation:

Due to high intake of liquid the child also frequently voids. The child could

manage urinating independently which is a good thing but the mother should always

monitor the child so that accidents will be prevented.

Analysis:
 The preschooler is able to take responsibility for independent toileting. Parents

need to realize that accidents do occur and the child should never e punished or

chastised for this. Children often forget to wash their hands or flush the toilet and need

instruction in wiping themselves. (Fundamentals of Nursing by Kozier, p.1258)

G. Sleeping Pattern

The child’s usual pattern of sleep is from 8:30pm-8:30am. Her sleeping rituals or

routine before getting to sleep is drinking milk, taking vitamins and storytelling with her

mother. She was also taught by her mother to pray at night before going to sleep. There

were no problems with sleeping experienced by the child.

Interpretation:

She completes the appropriate hours of sleep for children of her age which is 10-

12 hours.

Analysis:

A helpful suggestion for parents is to screen out frightening stories or television

watching just prior to bedtime and continue familiar bedtime routines. (Maternal and

Child Health Nursing by Pillitteri 6th ed. vol. 2 p.870)

H. Independence-Dependence
 Mrs. O.V. rated child A.B.V.’s independence level as medium. She is the one

choosing her clothes and dressing herself but still with her mother’s supervision. She

was also able to bathe herself and brush her teeth. During her playtime with her sister,

she was the one reminding her older sister to organize their toys. It’s as if she was the

older sister. She was no longer a crybaby and she was always calm. When she has

homework, the mother no longer asks for her to do her homework. She had the initiative

to do it by herself. She doesn’t want her mother to always help or supervise when doing

her assignments.

During their classes, one instruction from the teacher and she already know what

to do. This is another good character of the child. She was good at following

instructions.

She was never hospitalized due to illness but when you discuss to her what if

she was brought to the hospital, she did not react like other kids who were really afraid

of going to the hospital. She was also a brave girl.

I. Temperaments

She was usually upset when her mother doesn’t let her to do things that she

thinks she can do. Another is when she don’t get the things she wanted. She was also

upset when her father was not at home.

J. Play
 The toys available at the child’s home are dolls, stuffed toys, and videogames.

They had a safe play area. Child A.B.V. and her sister usually play videogames and

“bahay-bahayan”. The child’s initiative and amount of creative play is high. The child

preferred a cooperative play with her sister.

Interpretation:

The child has appropriate toys under his age and cooperative play can be

observed to her since preschoolers are under cooperative and associative type of play.

Analysis:

Preschoolers are capable with sharing, they play with other children their age…

and time for socialization. (Maternal and Child Health Nursing by Pillitteri 6 th ed. vol. 2

p.867)

K. Discipline

Both the father and the mother are responsible in giving discipline to their

children. Their method of discipline is by assigning time for their children’s activities.

Like for example, there was a time for them to play, to study, to eat, and to sleep.

According to the mother, it was a very effective method of giving discipline to the child

because the children still have their freedom to have fun but they were also able to have

good grades in their studies. The child was not rebellious to how her parents discipline

her. The child loves her parents and her sister.

Interpretation:
 The child considers her family as her significant others and the most important

persons in her life that’s why she has no hesitation in following parent’s rules and

disciplinary actions and technique.

Analysis:

This kind of technique allows parents to discipline without using physical

punishment and allows a child to learn a new way of behavior without extreme stress.

(Maternal and Child Health Nursing by Pillitteri 6 th ed. vol. 2 p.871)

L. School History

The child started going to nursery at the age of 3 years old and kindergarten at

the age of 4 years old in New Era University. You can see that she was very interested

to learn. She was a bright child and she was the first honor in their class. The child did

not experience any school problems.

M. Present Medical History

Child A.B.V now weighs 13 kilograms; it was the right weight for her age and

height. Upon doing the head-to-toe assessment to the child, I could say that the child

was healthy. All her body parts are normal, she has no lesions, and she was alert and

attentive. The Physical Assessment will discuss further about the physical condition of

the child.
 The child was a fully-immunized child. She completed her vaccines like BCG,

OPV, DPT, Hepa-B, and Measles.

N. Current Developmental Level

From the conducted Metro Manila Developmental Screening Test, these are the

child's current developmental level wherein she passed and performed the different

tasks properly on the different aspects. These include:

a. Personal Social

The child can buttons up, dresses without supervision, and separates from

mother easily.

b. Fine Motor-Adaptive

The child was able to copy a cross (+), circle (O), and square (□). She was

also able to draw man in 6 parts and can pick longer lines.

c. Language

The child was able to state her first and last name, comprehends three

prepositions, and knows opposite analogies.

d. Gross Motor Skill

 The child was able to balance on one foot for 10 seconds, hops on one

foot, catches a bounced ball, and performs a heel-to-toe walk.

IV. FUNCTIONAL HEALTH PATTERN

Functional Health Pattern

Basic Human Health Function Interpretation Analysis

Health Perception and The child has a high Promoting health and
Management level of health and wellness includes such
The child eats the right foods for well-being, and areas as accident
her age. She doesn’t eat junk practices for prevention, dental
foods. She brushes her teeth maintaining health. health, good nutrition,
every after eating meals so cognitive stimulation,
presently she had no dental and sufficient sleep.
caries. Her mother discipline her
very well so injury was unlikely to (Fundamentals of
occur. Nursing by Kozier 8th
ed. vol. 1 p. 380)

Nutrition and Metabolism The child meet the As with all age groups,
The child usually eats 3-5 times a daily nutritional needs foods selected for
day which composes of a appropriate for her preschoolers should be
balance diet like meat, age. based on food pyramid
vegetables, fruits, soups, bread groups, making sure to
and rice. She drinks 6-8 glasses offer a variety.
of water a day.
(Maternal and Child
Health Nursing by
Pillitteri 6th ed. vol. 2 p.
870)

Elimination The child’s urination School-age children

The child urinates 4-5 times a and bowel elimination have bowel habits
day and her bowel elimination is is regular and she similar to those of
once a day. never experienced adults. Patterns of
diarrhea, constipation, defecation vary in
incontinence, and frequency, quantity and
retention. consistency. Some
school-age children
may delay defecation
because of an activity
such as play.
(Fundamentals of
Nursing by Kozier, et.
al, 8th edition, volume
two, page 1326).

Activity and Exercise She was able to The preschool period is

During free time, the child loves develop and practice an active phase, so
to play with her playmates her fine motor and children receive a great
especially her sister. She can gross motor deal of exercise.
also perform simple things like development.
bathing, brushing, clothing, and (Maternal and Child
feeding herself. She goes to Health Nursing by
school every weekdays and she Pillitteri 6th ed. vol. 2 p.
was able to participate in all 870)
activities in their class.

Sleep and Rest She completes the Many, particularly those

The child sleeps 12 hours every appropriate hours of who attend afternoon
night usually from 8:30pm to sleep for children of child care or preschool,
8:30am. She’s not always having her age which is 10- give up afternoon naps.
a nap time because her class 12 hours. If they nap at a
schedule is in the afternoon and preschool, they may
she was active and enjoys have some difficulty
playing on that time. going to sleep at the
usual bedtime
established at home.

(Maternal and Child

Health Nursing by
Pillitteri 6th ed. vol. 2
p.870)

Cognition and Perception The child was able to The preschooler’s

She was able to perform well in develop her language cognitive development,
school. She was smart and can and fine-motor skills. according to Piaget, is
easily follow what the teacher the phase of intuitive
instructs them to do. She likes to thought…Reading skills
read story books, write, and also start to develop at
draw. She can make her this age. Young
assignment on her own. children like fairy tales
and books about
animals and other
children.

(Fundamentals of
Nursing by Kozier 8th
ed. vol. 1 p. 379)

Self-Perception and Self-Concept She was on Although children

When she was arguing with her preoperational stage during this period do
mother, father, sister, or of Piaget’s Cognitive enter a second phase
playmates, she always insists Development. called intuitional
that she was right. thought, they lack the
insight to view
themselves in another’s
place (termed
centering).

(Maternal and Child

Health Nursing by
Pillitteri 6th ed. vol. 2
p.868)

Coping and Stress Tolerance The child already The preschooler uses
The child’s feelings and learns about her the same types of
emotions, according to the feelings and already coping mechanisms in
mother, are easily read. She is knows the words, cry, response to stress as
sad and often cries when she is sad, laugh and all the the toddler does,
scolded by parents while very feelings that are although protest
happy on the things that she related to them. behavior (kicking,
likes. When she experiences screaming) is less likely
such feelings like anger, she to occur in the older
learns how to control her feelings preschooler.
and behavior and usually tell her Preschooler usually has
parents about what she feels. greater ability to
verbalize stress.(Kozier
 and Erb’s,
Fundamentals of
Nursing, 8th Ed., Vol. 1,
p.379)

Values and Beliefs The child was Children of preschool

The child follows the teachings of obedient to her age determine right or
her parents. It was not difficult to parents. wrong based on their
discipline. She also attends parent’s rules…begin to
worship service every Sunday. have an elemental
concept of God if they
have been provided
some form of religious
training.

(Maternal and Child

Health Nursing by
Pillitteri 6th ed. vol. 2
p.868)

Hygiene
Child ABV can already wash and
dry hands adequately before and The child can now Some parents who
after meals, after going on a perform some enjoyed maintaining a
comfort room and after playing. hygienic measures rhythm of care for an
She can already bathe herself independently that infant and allowed for
alone but sometimes assisted by can help promote ritualistic behavior of a
her mother in cleaning body parts health because she toddler may have
that particularly needs special was already taught difficulty being the
attention. proper hygiene at an parents of a preschool
She can already brush her teeth early age. because more flexibility
independently. and creativity are
required.

(Maternal and Child

health Nursing by
Pillitteri 6th ed. vol. 2
p.871)
 V. PHYSICAL ASSESSMENT

Date Done: September 21, 2010

General Appearance

The client is very cooperative during the physical assessment, is well-oriented, has good
grooming, posture and gait, and is in good mood.

INTERPRETATION/
BODY PART NORMAL FINDINGS ACTUAL FINDINGS
ANALYSIS

Proportional to the size Proportional to the size NORMAL

SKULL of the body, round, with of the body, round and
prominences in the symmetrical in all
frontal area anteriorly planes, gently curved
and occipital area
posteriorly symmetrical
in all planes, gently
curved

White, clean, free from White, clean, no NORMAL

masses, lumps, scars, masses, lumps, scars,
SCALP
nits, dandruff and nits, dandruff and
lesions lesions presents

HAIR

Black evenly distributed, Hair have trace of NORMAL

covers the whole scalp, brown evenly
thick, shiny free from distributed, covers the
 split ends whole scalp, thick, shiny
free from split ends

Coarse or fine hair

Fine hair

Oblong, oval, square, or Oblong shaped, NORMAL

heart shaped; symmetrical, facial
symmetrical, facial expression compliments
expression that is with the mood, no
FACE dependent on the mood wrinkles presents no
or true feelings, free involuntary muscle
from wrinkles, no movements
involuntary muscle
movements

Parallel and evenly Parallel and evenly NORMAL

EYES placed, symmetrical, placed, symmetrical,
non-producing, with non-producing and with
scant amount of scant amount of
secretions secretions

Black, symmetrical, thin, Black, symmetrical, thin, NORMAL

can raise and lower can raise and lower
EYEBROWS eyebrows without eyebrows without
difficulty, hair evenly difficulty, hair evenly
distributed, skin intact & distributed, skin intact &
parallel with each other, parallel with each other
there are equal
movements.

EYELIDS Upper lid cover a small Upper lid cover a small NORMAL
portion of the iris, portion of the iris,
cornea and the sclera cornea and the sclera
when the eyes are when the eyes are open
open. When the eyes and meets completely
are closed, the lids meet when closed. It is
 completely Symmetrical symmetrical in color
color is the same as the same with the
surrounding skin and no surrounding skin
palpable mass

Clear, without scaling or Clear, without scaling or NORMAL

LID MARGIN secretions, lacrimal duct secretions, lacrimal duct
openings are evident at openings are evident at
the nasal ends the nasal ends

LOWER Salmon pink, shiny, Salmon pink, moist and NORMAL

PALPEBRAL moist, and transparent transparent
CONJUCTIVA

SCLERA White and clear White and clear NORMAL

IRIS Proportional to the size Proportional to the size NORMAL

of the eye, round, of the eyes, round, dark
black/brown and brown in color and
symmetrical symmetrical

From pinpoint to almost From pinpoint to almost NORMAL

the size of the iris, the size of the iris,
PUPILS round, symmetrical round, symmetrical

NORMAL

EYE MOVEMENT Able to move eyes in full Able to move in all

range of motion or able direction
 to move in all direction

20- distance from the Not done but the client NORMAL
VISUAL ACUITY client is able to read at the
distance of 15-20 feet
20- distance at which a from the board
normal eyes can read

Parallel, symmetrical, Parallel, symmetrical NORMAL

proportional to the size and proportional to size
of the head, bean- of the head, bean-
shaped, helix is the line shaped, same color as
EARS with the outer canthus of the surrounding area
the eye; skin is the and clean
same color as the
surrounding area, clean

Pinkish, clean, with Pinkish, clean, with NORMAL

EAR CANAL scant amount of scant amount of
cerumen and few cilia cerumen and few cilia

HEARING AQUITY The client was able to Able to hear whisper NORMAL
repeat the spoken spoken 2 feet away
words 2 feet away
 Midline, symmetrical, Midline, symmetrical, NORMAL
and patent and patent and the color
NOSE
is the same with the
surrounding skin

Clean, pinkish, with few Clean, pinkish, with few NORMAL

INTERNAL NARES cilia cilia

SEPTUM
Septum is straight Septum is straight NORMAL

LIPS Pinkish, symmetrical, lip Pinkish, symmetrical, lip NORMAL

margin well-defined, margin well-defined,
smooth and moist smooth and moist

TEETH There are 20 teeth, well- There are 20 deciduous NORMAL

aligned, free from caries teeth, no presence of
or filling, no halitosis caries and no halitosis

Large, medium, red or Medium in size, pink, NORMAL

pink, the lateral the lateral margins
TONGUE
margins, moist, shiny moist, shiny and freely
and freely movable movable

Midline, straight, and Midline, straight, and NORMAL

FRENULUM
thin thin

VOICE
 No hoarseness and The voice of the client is NORMAL
well- modulated well-modulated and no
hoarseness

Proportional to the size The neck is proportional NORMAL

of the body and head, to the size of the body
NECK symmetrical and and head, symmetrical
straight, no palpable and straight
lumps, masses, or
areas of tenderness

Freely movable without

difficulty
Can move freely without
difficulty
NORMAL

ARMS Skin color varies The color is fair same

(pinkish, tan, dark as the surrounding skin.
Hair is evenly NORMAL
brown), symmetrical,
fine hair evenly distributed, no visible
distributed. veins and scars
Presence/absence of
visible veins

Warm, dry and elastic,

no areas of tenderness. Warm, dry and elastic
Muscle appears equal and no areas of
with good muscle tone tenderness
NORMAL

Able to raise both arms

vertically, place behind
the neck The client can raise and
move both arms with
ease
NORMAL
HANDS AND Performs with relative Able to make fist and NORMAL
WRISTS ease. extend and spread the
fingers.

Skin varies (pinkish, tan, The color is fair and NORMAL

dark brown) same as the
surrounding skin. Hairs
Skin is smooth fine hair are evenly distributed.
evenly distributed, There are no visible
absence of varicose varicose veins or scars
LEGS
veins, muscles
symmetrical, length
symmetrical

Muscles appear equal,

warm and with good Muscles appear equal, NORMAL
muscle tone warm and with good
muscle tone

Performs with relative

Has no difficulty in
ease.
moving the legs
NORMAL