KINGDOM OF SAUDI ARABIA ‫المملكة العربية السعودية‬

Ministry of Higher Education ‫وزارة التعليم العال‬

University of Hail
College of Nursing ‫جامـعـة حـائل‬
‫كلية التمريض‬

CLINICAL LOG

Student Name

University Number

Instructor Name

Health Assessment
A. Demographic Data
Patient Name Ward

Age Marital Status Room

Gender Occupation Bed Number

B. Health Characteristics
Height(cm) Date of Admission

Weight(kg) Surgical Intervention

Body Mass Index Date of Surgery

Medical Diagnosis:
Definition

Causes

C. Hemodynamic Baseline
Temperature Blood Pressure

Pulse Rate Mean Arterial Pressure(MAP

Respiratory Rate Central Venous Pressure(CVP)

SPO2 Others:

D. Reason for Admission (Chief Complaint)

 KINGDOM OF SAUDI ARABIA ‫المملكة العربية السعودية‬
Ministry of Higher Education ‫وزارة التعليم العال‬
University of Hail
College of Nursing ‫جامـعـة حـائل‬
‫كلية التمريض‬

CLINICAL LOG

E. Past Medical or Surgical History

F. Physical Examination
Technique Findings
Inspection

Percussion

Palpation

Auscultation

G. Current Medications
Date Name of Drug Route, Dosage Classification Indication Side Effects Nursing
,Frequency Considerations
 KINGDOM OF SAUDI ARABIA
Ministry of Higher Education
University of Hail
College of Nursing
‫المملكة العربية السعودية‬
‫وزارة التعليم العال‬
‫جامـعـة حـائل‬
‫كلية التمريض‬

CLINICAL LOG

DRUG COMPUTATION
 KINGDOM OF SAUDI ARABIA ‫المملكة العربية السعودية‬
Ministry of Higher Education ‫وزارة التعليم العال‬
University of Hail
College of Nursing ‫جامـعـة حـائل‬
‫كلية التمريض‬

CLINICAL LOG
H. Laboratory Results & Diagnostic Procedures
Date Test Results Normal Value Interpretation Nursing
Considerations

H.1 DIAGNOSTIC/ IMAGING TEST

Date Test Results/ Interpretation Nursing Considerations

I. Intake and Output

Time Intake Output Others
Oral/N IV NGT BT Urine NGT Drainage

TOTAL
BALANCE
 KINGDOM OF SAUDI ARABIA ‫المملكة العربية السعودية‬
Ministry of Higher Education ‫وزارة التعليم العال‬
University of Hail
College of Nursing ‫جامـعـة حـائل‬
‫كلية التمريض‬

CLINICAL LOG

IV computation:

J. Health Teachings

K. Documentation

Teacher’s
Date/ Time FOCUS Nurse’s Notes
Remarks

Signature:
Title:
 KINGDOM OF SAUDI ARABIA ‫المملكة العربية السعودية‬
Ministry of Higher Education ‫وزارة التعليم العالي‬
University of Ha’il ‫جامـعـة حـائل كلية‬
College of Nursing ‫التمريض‬

L. Nursing Process
Assessment/Cues Nursing Diagnosis Objectives Interventions Rationale Evaluation
(Prioritize)
Subjective Data:

Objective Data:

5 Page
____________________________________________________
For Evaluators 3 Ideal The student's answer exceeds expectations. All information needed based on patient-specific health needs are provided.
only 2 Acceptable The student satisfactorily provided the information needed based on patient-specific health needs. The student answer/
entry is partially correct/ lacking or incomplete.
1 Poor The student did not provide an answer. Incorrect answer/ entry.

No. Items for Evaluation Score

1 A. DEMOGRAPHIC DATA
2 B. HEALTH CHARACTERISITICS
3 C. HEMODYNAMIC BALANCE
D. REASON FOR ADMISSION (CHIEF
4
COMPLAINT)
5 E. PAST MEDICAL OR SURGICAL HISTORY
6 F. PHYSICAL EXAMINATION
7 G. CURRENT MEDICATION
8 G.1 COMPUTATION
H. LABORATORY RESULTS AND DIAGNOSTIC
9
PROCEDURES
10 I. INTAKE AND OUTPUT
11 I.1 COMPUTATION
12 J. HEALTH TEACHING
13 K. DOCUMENTATION
14 L Nursing Process

RAW SCORE/ TOTAL # OF ITEMS x 15 =

Checked by:

____________________________________________
Field Teaching Staff Name and Signature / Date

6 Page