Pediatric Appendectomy Post-Operative Assessment Form
Patient Name
Medical Record Number
Date of Surgery
Age
Gender
Male
Female
Other
Assessment
Vital Signs
Pain Assessment
Wound Assessment
Drain Output (if applicable)
Oral Intake
Gastrointestinal Status
Bowel Sounds
Passing Flatus/Stool
Urinary Status
Voiding
Mobility/Activity
Ambulation
Medications
Complications/Concerns
Plan
Date of Assessment
Assessed By