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Nhh Check List

Nhh Check List

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Published by: John Philip M. Lacas RN on Aug 17, 2010
Copyright:Attribution Non-commercial

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03/04/2013

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Date
: _____________ BULACAN STATE UNIVERSITYCOLLEGE OF NURSING
NURSING HEALTH HISTORY
A.BIOGRAPHICAL DATA
 Name:____________________
Age:____________________
Gender:____________________
Address:____________________
Status:____________________
Occupation:_____________________ 
Religion:____________________
Education:____________________
 Nationality:_____________________ 
Health Source:____________________
Admitting Dx.:____________________
Final Dx.:____________________
Case No.:____________________
B.CHIEF COMPLAINT
Ano ang dahilan ng pag-kaka ospital? ______________________________________________________ C.
HISTORY OF PRESENT ILLNESS
Pagkakasunod-sunod ng mga pangyayari tungkol sanararamdaman? ______________________________________________________ 
Kailan nag-umpisa ang mga simtomas? ______________________________________________________ 
Gaano kadalas? ______________________________________________________ 
Ano ang ginawa para mawala ang mga ito? ______________________________________________________ 
 Nagpakunsulta ba?
Hindi Oo, Saan
:____________________ 
Gamot na ininom?
 
 ______________________________________________________ 
 Naapektohan ba ang mga pang-arawaraw na Gawain o aktibidad? ______________________________________________________ 
D.PAST HISTORY OF ILLNESS
Mumps Rubella Varicella
AMV BCG DPT OPV
 
HBV
Allergies?
Wala Meron, Saan: Gamot Pagkain
Aksidenta noong bata?
Wala Meron, Saan:
 Na-ospital naba?
Hindi Oo, Bakit:
Mga gamot na iniinom? ______________________________________________________ 
E.FAMILY HISTORY OF ILLNESS
Edad:___ Tatay :___________________ ___ Nanay :___________________ ___ Mga Kapatid:1.________________________ 2.________________________ 3.________________________ 4.________________________ 5.________________________ 
 Namatay at dahilan ng pagkamatay?
Sakit na namana sa mga nagulang? 
Arthritis DM HPN Others:F.HEALTH PERCEPTON AND HEALTH MANAGEMENT PATTERN
 Nagkasakit ba nung nakaraan?
Sipon Lagnat Ubo
Smoking Drinking Recreational Drugs
 Nasusunod ba ang mga payo ng doctor o nurse?
Oo Hindi
 
Ano ang mga bagay na ginagawa habang nas ospital? ________________________________________________________ 
Kadalasang ginagawa pag nagkakasakit? ________________________________________________________ 
May mga paniniwala ba na sinusunod? ________________________________________________________ 
G.NUTRITIONAL METABOLIC PATTERN
 Nagbibitanina ba?
Oo Hindi
Tumataba Pumapayat
Maakas Kumaon Mahinang kumain
Mapili ba sa pagkain?
Oo Hindi
Madali bang mag hilom ang sugat?
Oo Hindi
Problema sa balat?
Wala Meron, Ano:
Sirang ngipin?
Meron Wala
Foods ( 24h )DATEBREAKFASTLUNCHDINNE
Fluids ( 24h )DATEBREAKFASTLUNCHDINNE

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