NAME CLINICAL PREPARATION SHEET QUINCY COLLEGE SCHOOL OF

CLINICALLY RELEVANT ANATOMY 123 ULNAR NERVE ENTRAPMENT
LONG ISLAND BHM CONCURRENT CLINICAL PLEASE COMPLETE
PSYCHOLOGY AND CLINICAL LANGUAGE SCIENCES UNIVERSITY OF READING

(INSERT AGENCY NAME) REPRODUCTIVE HEALTH PROGRAM CLINICAL POLICIES AND
006-17%20Clinical%20Psychiatrist%20%20Board%20%20037869
1 COURSE TITLE CLINICAL PRACTICUM IN AUDIOLOGY 2 2

Clinical Preparation Sheet

Name: _________________________________


Clinical Preparation Sheet


Quincy College

School of Allied Health

PNU- 145 and 146



Client Profile

Initials:_______ Sex: M___ F___ Age:_____Race: ________

Room #:______ Date of Admission:_____________

Advanced Care Directive: Y____ N____

Do Not Resuscitate: Y____ N____ Other:______________________

Religion: ________________ Primary Language:___________________

Allergies: Foods:__________________ Drugs:_____________________


Admitting Medical Diagnosis:

(Define One):







Past Medical History:

(List)





Nursing Assessment


System Assessment Findings_________

Cardiac: Vital Signs:

Temp: PO______ PR______ AX______ TM______

Pulse: Radial_________ Apical__________

Resp Rate: ________

BP ______/______ (left-right)

History of Chest Pain: Y____ N____

________________________________________________________________________

Respiratory: Rate, rhythm:_______________________

Oximetry:______% Room Air/Oxygen

SOB: Y____ N____

Cyanosis: Y____ N____

Lung Sounds:______________________________ ________________________________________________________________________

Peripheral Vascular: CSM:____________________________________

Edema:___________________________________

Pulses-Popliteal:__________ Pedal:____________

Calf Tenderness:_______________

G.I: Diet:________________________

PO Fluid intake: _____________________ (in MLs)

Tube Feeding: Y____ N____

Type of Tube: ____________

Type & amount of feeding:_______________________

Dentures: Upper/Lower/Both

Swallowing reflex: Present/Absent

Last BM:_________ mo/day/year

Bowel Sounds:___________________________

Ostomy: Yes____ No____

Weight:_______________ Date ____________

_______________________________________________________________

G.U.: O:______

Continent/Incontinent

Urine quality:__________________

Urostomy: Y:____ N:____

________________________________________________________________________

Integumentary: Skin quality:____________________________

Wound(s):______________________________________

Description:___________________________________

Location:_____________________________________

Size:_________________________________________

Exudate/drainage:______________________________

Dressing(s):___________________________________

____________________________________

________________________________________________________________________

Musculoskeletal: Activity level:____________________________

ADLs: Self/Partial/Complete Care

Gait:___________________________________

Balance: ________________________________

Strength:________________________________

Weight Bearing:__________________________

Pain:___________________________________

Joint Mobility:___________________________

Assistive Devices: ________________________




Neurologic/Sensory: Orientation:______________________________________

Sensory impairment:_____________________________

Hearing aid(s):______________________

Glasses:____________________________

Neurologic signs:_____________________________

Seizures: Y____N____

Behavior:____________ Memory:__________

Cognition:____________

Pain Rating:_____________________________

________________________________________________________________________


Biopsychosocial – Identify biopsychosocial factors influencing health care for this client:



Family __________ Culture _________ Emotional _________


Spiritual/ Religion __________ Language _____________ Racial ____________




Identify client’s self care requisites:






Identify Interdisciplinary therapy:






Developmental stage – State Erickson’s Stage of development for this age group. Identify the positive and negative aspects. Is the client in the positive or negative area and give rationale.





MEDICATIONS: List medication, classification & purpose as it relates to client’s medical diagnosis.

Drug Dose Route Schedule Classification Purpose

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

______________________________________________________________________________

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

TREATMENTS: (Dressings, etc.)

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


LABS:

Client Value Normal Range If abnormal, give reason

WBC__________ ( ) _______________________

Hgb___________ ( ) _______________________

Hct____________ ( ) _______________________

Na____________ ( ) _______________________

K_____________ ( ) _______________________

Cl_____________ ( ) _______________________

BUN___________ ( ) _______________________

Creatinine_______ ( ) ________________________

Glucose_________ ( ) _______________________

Other___________ ( ) ________________________

________________________________________________________________________








Nursing Care Plan


Select one appropriate NANDA nursing diagnoses based on your client’s Problems.

Provide an Etiology supporting the diagnosis and give evidence by documenting Symptoms the client demonstrates.


Choose (1) short term goal: Goals should utilize objective measurable terms. Give the goal a time frame in which the goal will be achieved.


Choose (3) nursing interventions you will incorporate in your client’s plan of care to achieve the goal.


Provide evaluation of each intervention stating to what degree the clients condition improved, worsened, or remained unchanged.

Diagnosis Short term goal Interventions (3) Evaluation ____


P






E






S





















Note: Etiology CAN NOT be a medical diagnosis

Nursing Progress Note: ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________,SPN

________________________________________________________________________

Identify skills performed today & student learning needs:







Student Signature____________________________________________ Date:___________


Submit this sheet to your clinical instructor EACH clinical day at the start of post conference.


7


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