Pt/DOB: PMHx: Skin: WNL Temp: ois!"re: T"rgor: #olor: Br"ises: $as%es/$edness: Wo"nd &resen!? O!

%er: Braden: # und Care settings)

MDs:

Chest Tubes: $!/L!/ '( ) of !"bes: An!erior/&os!erior/La!eral #repi!"s: To Wa!erseal/Airlea* To ("+!ion: Drainage: Dressing: Las! +%anged?

ROM: WNL ,"ll Wea*ness: L!/$! Abnormal: #on!ra+!"res Defi+i!s

Armbands: DNR Falls Allergy:___________________________ ID bands: on, Name/DOB verified? Neur : WNL !": WNL Le!%argi+ Agi!a!ed Las! 1oid: Disorien!ed !o: - . I2O +a!% / ,oley Non'responsive !o: Verbal/tactile/pain 3rine: Abnormal (pee+%: Ne"ros 0____ O!%er:

(note site, type, drains, tx, vac

!astr intestinal: WNL Die!: Aspira!ion pre+4 Na"sea/vomi!ing Diarr%ea/+ons!ip4 Abdomen:

Res'irat r(: WNL $espira!ions: Brea!% (o"nds: L3L $ales LLL $%on+%i $3L #ra+*les $ L Diminis%ed $LL Bases $e!ra+!ions/6r"n!ing Nasal ,laring N&#/&rod #o"g%? O.______________ $T ://;/</=> #&T Sa*et(: Bed lo5, e!+ #all bell in rea+% $es!rain!s: -:- (i!!er @ ("i+ide ,all pre+a"i!ions? (eiA"re pre+a"!ions? AD/s: Ba!%/Daily +are In+on!inen! Brea*/L"n+%/Dinner (na+* ,eeder

Cardi )as&ular: 81D: Abnormal &"lse: 9dema: pi!!ing/non #alf !enderness:

WNL

Bo5el (o"nds: Las! B : Os!omy: L!/$! #olo/Ileos!omy (!oma

T"bes: N6T/O6T/Dob%off Da!e inser!ed: L!/$! nare &la+emen! 7d 6!"be/8!"be/&96 #lamped To ("+!ion: LIW( L#W( Drainage: T"be ,eed: Irriga!ion: $esid"al:

$% A&&ess: &I1/(L Lo+a!ion 6a"ge Da!e inser!ed

I1, &I1/(L .
Lo+a!ion 6a"ge Da!e Inser!ed

I1, &I##/#L/&or!
(L#/DL#/TL# &o5er? (i!e: Inser!ion dep!%: #ir+"mferen+e:

Tele: _________________ &erip%eral p"lses ? ./;/< #a!% Lab? Angioseal? L!/r! groin (!en!s? &a+ema*er: A/1/A1/D AI#D

Da!es:
Inser!ed Dressing +%anged Daily $evie5?

I1,

ROM: Nursin+ Care: $s lati n: A&ti)it(: assis!/ad lib Bedres!/brp/+%air/amb"la!e Turns: D/C 'lan: ed $e+ done? #%ar! #%e+*? Wo"nd pi+!"res? #ore eas? &ne"m/#>,/A I/(#I&

,-ui'ment: (#Ds/#& Bed: A!mos/$en!al Teleme!ry #on!in"o"s mo!ion #on!in"o"s p"lse o? B(#/#ane/Wal*er

T da(.s /abs:

T da(.s Tests:

,(B( A#/>( :;>/:<>/BID/___ T"rn :.>/,loa! >eels &T/OT/(L& 9val/TB

Time CDCC

ed/1(/,(B(/&ro+ed"re/T"rn/Off/assess

C=CC

CECC

-CCC

--CC

-.CC

-/CC

-;CC

-FCC

-<CC

-DCC

-=CC