Scribd Logo
Upload

Welcome to Scribd!

  • Short Form Assessment Tool

    Uploaded by

    clintandjanay
    3 views2 pages
    This document contains a short form assessment tool for a patient, collecting information such as the patient's name, room number, age, code status, allergies, and date of admission. It includes sections to document the patient's medical history, vital signs, neurological, cardiovascular, respiratory, gastrointestinal, genitourinary, and skin assessments. Nurses can also document the patient's care plan, interactions, labs, IVs, education provided, and to-do list on this single page assessment tool.

    Original Description:

    Original Title

    Short Form Assessment Tool.rtf

    Copyright

    © © All Rights Reserved

    Available Formats

    RTF, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    This document contains a short form assessment tool for a patient, collecting information such as the patient's name, room number, age, code status, allergies, and date of admission. It includes sections to document the patient's medical history, vital signs, neurological, cardiovascular, respiratory, gastrointestinal, genitourinary, and skin assessments. Nurses can also document the patient's care plan, interactions, labs, IVs, education provided, and to-do list on this single page assessment tool.

    Copyright:

    © All Rights Reserved
    Download as RTF, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    3 views2 pages

    Short Form Assessment Tool

    Uploaded by

    clintandjanay
    This document contains a short form assessment tool for a patient, collecting information such as the patient's name, room number, age, code status, allergies, and date of admission. It includes sections to document the patient's medical history, vital signs, neurological, cardiovascular, respiratory, gastrointestinal, genitourinary, and skin assessments. Nurses can also document the patient's care plan, interactions, labs, IVs, education provided, and to-do list on this single page assessment tool.

    Copyright:

    © All Rights Reserved
    Download as RTF, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 2

    Short Form Assessment Tool

    Student Name: ____________________ Room #: ___________ Age: _______________ Date:


    _______________________
    Code Status: ________________ Allergies: ___________________________ Isolation:
    ______________________________
    Date of Admission: _______________ Admitting Diagnosis:
    _____________________________________________________
    PMH: _________________________________________________________________________________________________
    NOTES/TO DO LIST/PLAN
    0800

    0900

    1000

    1100

    1200

    1300

    Narrative Documentation should be on the back of this page or attached to this form.
    Neuro/Musculo:
    A&O ______ Eyes _________ Neuro checks _______________ Grips _________
    ROM _________________ Gait ______________________ Morse Fall Risk _________
    Pain_________________________________________________________________
    (location, frequency, contributing factors, management)

    Other: ________________________________________________________________
    CV:
    Rate/Rhythm _______________ B/P __________ Temp ______ Cap Refill ___________
    Pulses: UE ______/______ LE______/______
    Edema: UE _____/_____ LE_____/______
    Other: ________________________________________________________________

    Resp:
    Rate _______ Breath sounds ___________/__________ O2 _________ RA ________
    SpO2% _____________ Secretions __________________ TC&DB ____________ ISP________
    Other: _____________________________________________________________
    GI:
    Diet ________ breakfast % eaten________ TPN ___________________________
    NPO/PEG/NGT/GJ
    If on Tube feed (type & rate) _________________________
    Bowel movements ____________Last BM __________ bowel incontinence____________
    FSBS (time and results) _____________________________________________________
    Other: _____________________________________________________________
    GU:
    Output: __________ Intake: ___________ Foley _________ Incontinent __________
    Describe urine ______________________________
    Other: ___________________________________________________________
    SKIN: Assessment (wounds/inc/ect.) ______________________________________
    ______________________________________________________________________
    Braden Risk___________
    Labs:

    IV:

    Interactions with HCT:


    Social/Family concerns or questions:
    Nursing Plan:
    Patient/Family Education:

    You might also like