Nursing Body Systems Assessment Form
Please complete the following assessment of the patient's body systems. Select the most accurate option for each item.
General Appearance
*
Alert and oriented
Drowsy
Confused
Unresponsive
Vital Signs Assessment
*
Rows
Normal
Abnormal
Not Assessed
Temperature
1
2
3
Pulse
4
5
6
Respirations
7
8
9
Blood Pressure
10
11
12
Cardiovascular System
*
No abnormality
1
2
3
4
Severe abnormality
5
1 is No abnormality, 5 is Severe abnormality
Respiratory System
*
No abnormality
1
2
3
4
Severe abnormality
5
1 is No abnormality, 5 is Severe abnormality
Neurological System
*
No abnormality
1
2
3
4
Severe abnormality
5
1 is No abnormality, 5 is Severe abnormality
Gastrointestinal System
*
No abnormality
1
2
3
4
Severe abnormality
5
1 is No abnormality, 5 is Severe abnormality
Musculoskeletal System
*
No abnormality
1
2
3
4
Severe abnormality
5
1 is No abnormality, 5 is Severe abnormality
Integumentary System
*
No abnormality
1
2
3
4
Severe abnormality
5
1 is No abnormality, 5 is Severe abnormality
Pain Assessment (0 = No pain, 10 = Worst pain)
*
Comments or Additional Observations
Submit Assessment
Should be Empty: