Age:____ Gender:____

Admitting dx:__________________________________________________________________________
Procedure:________________________________________________ Post op date:_________________
Priorities:_________________________________________________________
Did these change throughout the day? ____ why? ____________________________________________
Family history/cultural background/education/economic situation:______________
_____________________________________________________________________________________
Description of care/limitations to explore pts illness story:_____________________________________
LOC/Pain/comfort issues: ________________________________________________________________
Mental and emotional status: ____________________________________________________________
Patients perspective on their surgical experience:____________________________________________
Any new learning/new skills today:________________________________________________________
Theory related to patient:________________________________________________________________