UNIVERSITY OF SOUTH FLORIDA COLLEGE OF NURSING

1tudent7 8elissa !o#

PATIENT ASSESSMENT TOOL . 1 PATIENT INFORMATION

&atient Initials7 C. 3. D ;ender7 8 &rimar# Language7 =nglish Level of =ducation7 Licensed &ractical 3urse (L&3% Occu$ation (if retired) what from?%7 L&3) 8orton &lant 3umber9ages children9siblings7 . children * older brother and * older sister 1erved9@eteran7 8arine Cor$s Living rrangements7 &atient is currentl# living alone in an a$artment. /e foresees an issue returning home to his a$artment without assistance as he is currentl# non weight bearing on both of his legs and his a$artment has stairs. /e is in $h#sical thera$# at the hos$ital but is not sure if he will full# recover. /e is unsure if he will be able to com$lete his DLs without assistance. ge7 '( 8arital 1tatus7 1ingle

ssignment Date7 *95595.*: genc#7 Ba#front 8edical Center

dmission Date7 *59*(95.*6 &rimar# 8edical Diagnosis with ICD<*. code7 "rauma< 8a>or Other 8edical Diagnoses7 (new on this admission% 2acial Laceration +(6.:. /ead In>ur# -'-..* Closed Dislocation of =lbow +65... Code 1tatus7 2ull Code dvanced Directives7 If no) do the# want to fill them out? "he $atient does not have advanced directives and he does not wish to fill an# out as all of his famil# members are deceased. /e was not interested. 1urger# Date7 *59*+95.*6 &rocedure7 O!I2< multi$le areas (see &8/9&1/% *9*.95.*6< O!I2 of three $art right distal radius fracture "#$e of Insurance7 8edicare

Culture9 =thnicit# 93ationalit#7 Caucasian !eligion7 &resb#terian

1 CHIEF COMPLAINT: I was out walking looking through windows of stores for Christmas items. I
began to cross the street when a truck ran me over.

3 HISTORY OF PRESENT ILLNESS: (Be sure to OLDC !" the s#m$toms in addition to the hos$ital course%
&atient is a '( #ear old male who arrived to the emergenc# de$artment via ba#flight after being struck b# a truck while crossing the road. "he $atient is unsure if he lost consciousness at the scene of the accident) and does not have much memor# of the incident. fter surger# on December *+ th) the $atient was trans$orted to the trauma unit. On ,anuar# -th) the $atient continued com$laining about $ain in his wrist. C" was done) and a fracture was found. "he $atient had another surger# on ,anuar# *.th. fter surger#) he was again $laced in the trauma unit where currentl# healing and waiting for $lacement. /e works with the $h#sical thera$ist on a dail# basis and is working toward recover#.

0niversit# of 1outh 2lorida College of 3ursing 4 !evision ugust 5.*6

 2 PAST MEDICAL HISTORY/PAST SURGICAL HISTORY Include hos$italiAations for an# medical illness or o$eration
Date *59*+95.*6 Operat !" !r I##"e$$ Incision9drainage of o$en fracture dislocation of the right ankle O$en incision9drainage of Lisfranc fracture dislocation of the left foot. O$en incision9drainage of fracture of left :th metatarsal O!I2 of a Beber C. 2ibula fracture with s#ndesmotic stabiliAation of right ankle. O!I29$inning of Lisfranc >oint) second tarsometatarsal >oint) third tarsometatarsal >oint and $inning of the fourth metatarsal fracture of the left foot. O!I2 of three $art right distal radius fracture utiliAing volar smith and ne$hew locking $late &aranoid 1chiAo$hrenia Bi$olar Disorder nCiet# De$ression
(angina) 8I) D@" etc.% /eart "rouble

*9*.95.*: 0nknown

Didne# &roblems

=nvironmental llergies

8ental &roblems /ealth

2ather 8other Brother 1ister

relationshi$ relationshi$ relationshi$

(5 +' ''+

Cause of Death (if a$$licable % 1troke Dementia 1troke ;unshot Bound

1tomach 0lcers

Bleeds =asil#

/#$ertension

;laucoma

Diabetes

2 FAMILY MEDICAL HISTORY

ge (in #ears%

lcoholism

rthritis

1eiAures

nemia

sthma

Cancer

Comments7 Include date of onset "he $atient does not know date of original onset of conditions. "he $atientEs father had a histor# of cancer on the li$ and ear. /e died of a stroke) but the $atient does not know an# details. "he $atientEs mother had a histor# of colon cancer and 8I. 1he >ust $assed a #ear ago. "he $atientEs brother had a histor# of skin cancer.

1 IMMUNI%ATION HISTORY (8a# state 0 for unknown) eCce$t for "etanus) 2lu) and &na% YES !outine childhood vaccinations !outine adult vaccinations for militar# or federal service dult Di$htheria (Date% U"&"!'" dult "etanus (Date% U"&"!'" InfluenAa (flu% (Date% &neumococcal ($neumonia% (Date% /ave #ou had an# other vaccines given for international travel or 0niversit# of 1outh 2lorida College of 3ursing 4 !evision ugust 5.*6

NO

"umor

1troke

;out

occu$ational $ur$oses? &lease List 1 ALLERGIES OR ADVERSE REACTIONS

3 8= of Causative gent 3D 8edications

"#$e of !eaction (describe eC$licitl#%

Other (food) ta$e) lateC) d#e) etc.%

LateC

"he $atient breaks out in a rash wherever he comes in contact with lateC

( PATHOPHYSIOLOGY: (include & reference and in teCt citations% (8echanics of disease) risk factors) how to diagnose) how to treat) $rognosis) and include an# genetic factors im$acting the diagnosis) $rognosis or treatment%
ccording to /erAog (5.*:%) schiAo$hrenia is a mental disease that has three $redictable $hases that it $rogresses through. lthough the $hases of the disease are rather $redictable) the defining s#m$toms in an# of the given $hases as well as the length of the $hase can var# greatl#. "he $hases of the disease include the acute $hase) where the $atient ma# eC$erience the onset of disru$tive s#m$toms such as hallucinations) delusions) a$ath#) and withdrawal. In the second $hase) the stabiliAation $hase) s#m$toms from $hase one begin to diminish and $atients ma# begin to mold back to their $revious level of function. In the third stage) the maintenance $hase) the $atient is at or ver# close to their baseline functioning level. 1#m$toms will usuall# be gone) and the $atient can live safel# within the communit# once again (/erAog) 5.*:%. It is hard to sa# what the risk factors for schiAo$hrenia are because all scientists know for sure is that brain chemistr#) structure) and activit# are different in $ersons with schiAo$hrenia. "he etiolog# of the disease according to /erAog (5.*:%) is that schiAo$hrenia occurs when multi$le inherited gene abnormalities combine with non<genetic factors) such as viral infections) birth in>uries) and environmental stressors) which alter the structures of the brain) affecting the brains neurotransmitter s#stems and or in>uring the brain directl# (/erAog) 5.*:) $g. 5.5% 1chiAo$hrenia is a disease that is diagnosed over time. ll $eo$le diagnosed with schiAo$hrenia have at least one $s#chotic s#m$tom such as hallucinations) delusions) and9or disorganiAed s$eech (/erAog) 5.*:%. lthough schiAo$hrenia is not t#$icall# a$$arent or diagnosed in a $erson until the late teens or earl# twenties) it has been diagnosed in children and adolescents. Children who are later diagnosed ma# do $oorer in school than siblings) are less sociall# engaged) have a tendenc# to be more negative) and eChibit unusual motor develo$ment. dolescents who are later diagnosed with schiAo$hrenia often eC$erience the $rodromal (earl# s#m$toms% stage for a few months to a few #ears before develo$ing the disease. dolescents ma# eC$erience social withdrawal) irritabilit#) de$ression) and become antagonistic (/erAog) 5.*:%. "reatment for schiAo$hrenia includes a combination of interventions. 1ome interventions include $s#chiatric) medical) and neurological interventions) $s#cho$harmacolog#) su$$ort) $s#cho<education) and guidance) su$ervision and structure in a thera$eutic environment. =ffective long care treatment relies on medication administration and adherence) relationshi$s with trusted care $roviders) and communit# based thera$eutic services. 1ince schiAo$hrenia is a disease of the brain) it is im$ortant for the nurse to $ractice thera$eutic communication) $rovide education to the $atient and their famil#) and know how to work a$$ro$riatel# with an aggressive $atient. "reatment o$tions ma# var# between each $erson so it is im$ortant to assess each $atient individuall# and follow a treatment $lan that will be most beneficial to the $atient (/erAog) 5.*:) $g. 5**%. 2or man# of the $atients) their s#m$toms can be controlled through $s#chosocial interventions and medication thera$#. Bith famil# and communit# su$$ort) man# $atients with schiAo$hrenia eC$erience a good Fualit# of life. If well controlled) the# can successfull# hold a >ob and other roles. t times) associates ma# not even know the $erson has schiAo$hrenia. Of course) there are man# cases where schiAo$hrenia does not res$ond full# to treatment) so those $atient ma# reFuire eCtended hos$ital sta#s or institutionaliAation. 2actors associated with a less $ositive $rognosis include a

0niversit# of 1outh 2lorida College of 3ursing 4 !evision ugust 5.*6

slow) insidious onset) #ounger age at onset) longer duration between first s#m$toms and first treatment) longer $eriods of untreated illness and more negative s#m$toms which include flat affect) unmotivated) donEt care about h#giene) difficult to maintain a >ob (/erAog) 5.*:) $g. 5.:%.

( MEDICATIONS: GInclude both $rescri$tion and O"CH home (reconciliation%) routine) and &!3 medication. ;ive trade and
generic name.I
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I"5 *at !": S*6 =!p6re" a " a5+#t$ a"5 a5!#e$*e"t$ a-e 13@1A9 $6!rt ter) treat)e"t !7 a*+te )a" * !r ) 4e5 ep $!5e$ a$$!* ate5 ' t6 : p!#ar I 5 $!r5er ,!ra#.9 )a "te"a"*e treat)e"t !7 : p!#ar 5 $!r5er I ,IM. " a5+#t$ !"#29 *a" :e +$e5 ' t6 # t6 +) !r 8a#pr!ate !"#2 ,a5+#t$. S 5e e77e*t$/N+r$ "- *!"$ 5erat !"$: Ne+r!#ept * )a# -"a"t $2"5r!)e9 $+ * 5a# t6!+-6t$9 a--re$$ 8e :e6a8 !r9 5 == "e$$9 e4trap2ra) 5a# rea*t !"$9 6ea5a*6e9 "*rea$e5 5rea)$9 "*rea$e5 $#eep 5+rat !"$9 "$!)" a9 $e5at !"9 7at -+e9 "er8!+$"e$$9 tar5 8e 52$& "e$ a9 p6ar2"- t $9 r6 " t $9 8 $+a# 5 $tr+:a"*e$9 *!+-69 *!"$t pat !"9 5 arr6ea9 5r2 )!+t69 "a+$ea9 5e*rea$e5 # : 5!9 52$)e"!rr6ea9 )e"!rr6a- a9 t*6 "-/$& " ra$69 a-ra"+#!*2t!$ $. C!"$ 5erat !"$: M!" t!r pat e"t$ )e"ta# $tat+$ a"5 )!!5 :e7!re a"5 per !5 *a##2 5+r "- t6erap29 )!" t!r *#!$e#2 7!r "!ta:#e *6a"-e$ " :e6a8 !r t6at *a" "5 *ate t6e e)er-e"*e !7 '!r$te" "!7 $+ * 5a# t6!+-6t !r :e6a8 !r. A$$e$$ 'e -6t a"5 3MI " t a##2 a"5 t6r!+-6!+t t6erap29 )!" t!r 3P9 e"$+re )e5$ are $'a##!'e5 a"5 "!t B*6ee&e5C9 )!" t!r 7!r !"$et !7 EPS9 )!" t!r 7!r Tar5 8e 52$& "e$ a. M!" t!r 7!r 5e8e#!p)e"t !7 "e+r!#ept * )a# -"a"t $2"5r!)e. Na)e Ha#!per 5!# ,Ha#5!#. R!+te IV P+$6 P6ar)a*e+t *a# *#a$$: 3+t2r!p6e"!"e$ H!)e C!"*e"trat !" Fre1+e"*2 PRN H!$p ta# !r 3!t6 D!$a-e A)!+"t ()-

I"5 *at !": A*+te a"5 *6r!" * p$2*6!t * 5 $!r5er$9 $*6 =!p6re" * pat e"t$ '6! re1+ re #!"- ter) pare"tera# t6erap29 )a"a- "- a--re$$ 8e pat e"t$9 t!+rette$ $2"5r!)e9 $e8ere :e6a8 !r pr!:#e)$ " *6 #5re"9 *!"$ 5ere5 $e*!"5 # "e treat)e"t a7ter 7a #+re ' t6 at2p *a# a"t p$2*6!t *. S 5e e77e*t$/N+r$ "- *!"$ 5erat !"$: Se =+re$9 EPS9 :#+rre5 8 $ !"9 5r2 e2e$9 *!"$t pat !"9 5r2 )!+t69 a"!re4 a9 )p!te"*e9 +r "ar2 rete"t !"9 a-ra"+#!*2t!$ $9 "e+r!#ept * )a# -"a"t $2"5r!)e9 'e -6t -a "9 ECG *6a"-e$9 5 ap6!re$ $9 p6!t!$e"$ t 8 t29 ra$6e$. C!"$ 5erat !"$: A$$e$$ )e"ta# $tat+$9 a$$e$$ p!$ t 8e a"5 "e-at 8e $2)pt!)$ !7 $*6 =!p6re" a9 )!" t!r 3P9 !:$er8e pat e"t *are7+##2 '6e" a5) " $ter "- )e5$ t! e"$+re t $ a*t+a##2 ta&e"9 )!" t!r IDO a"5 'e -6t 5a #29 a$$e$$ 7#+ 5 "ta&e a"5 :!'e# 7+"*t !"9 )!" t!r pat e"t 7!r !"$et !7 a&at6 $ a9 )!" t!r 7!r tar5 8e 52$& "e$ a9 )!" t!r 7!r "e+r!#ept * )a# -"a"t $2"5r!)e. Na)e O42*!5!"e R!+te PO P6ar)a*e+t *a# *#a$$: Op ! 5 A-!" $t I"5 *at !": M!5erate t! $e8ere pa " S 5e e77e*t$/N+r$ "- *!"$ 5erat !"$: C!"7+$ !"9 $e5at !"9 5 == "e$$9 re$p rat!r2 5epre$$ !"9 *!"$t pat !"9 +"+$+a# 5rea)$9 :#+rre5 8 $ !"9 5 p#!p a9 !rt6!$tat * 62p!te"$ !"9 +r "ar2 rete"t !"9 p62$ *a# 5epe"5e"*e9 p$2*6!#!- *a# 5epe"5e"*e9 t!#era"*e. C!"$ 5erat !"$: A$$e$$ t2pe9 #!*at !"9 a"5 "te"$ t2 !7 pa " pr !r t! H!)e C!"*e"trat !" Fre1+e"*2 PRN@ <3 6r$ H!$p ta# !r 3!t6 D!$a-e A)!+"t 10 )-

0niversit# of 1outh 2lorida College of 3ursing 4 !evision ugust 5.*6

a"5 !"e 6!+r ,pea&. a7ter a5) " $trat !"9 pat e"t$ ta& "- *!"tr!##e5 re#ea$e ta:#et$ )a2 a#$! :e - 8e" $+pp#e)e"ta# $6!rt a*t !" !p ! 5 5!$e$ 7!r :rea&t6r!+-6 pa ". A$$e$$ 3P9 p+#$e9 a"5 re$p rat !"$ :e7!re a"5 per !5 *a##2 5+r "- a5) " $trat !" rate. I7 RR $ #e$$ t6a" 10 per ) "+te9 a$$e$$ #e8e# !7 $e5at !". Pr!#!"-e5 +$e )a2 #ea5 t! p62$ *a# a"5 p$2*6!#!- *a# 5epe"5e"*e a"5 t!#era"*e. A$$e$$ :!'e# 7+"*t !" r!+t "e#2.

( NUTRITION: Include t#$e of diet) 5: /! average home diet) and #our nutritional anal#sis with recommendations.
Diet ordered in hos$ital? !egular with =nsure "ID Diet $atient follows at home?7 3one s$ecificall# 5: /! average home diet7 Breakfast7 I cu$ of cheerios with whole milk) and a cu$ of Bhole milk to drink with it. Lunch7 "#$icall# 2ast food7 : $iece chicken nuggets) 8edium fries) and medium coke. Dinner7 &ot roast JoA meat with carrots) celer#) $otatoes) nd onions. 1nacks7 &atient states he does not snack throughout the da# LiFuids (include alcohol%7 * cu$ of whole milk) * can of coke) 5 cu$s of water) and no alcohol. nal#sis of home diet (Com$are to 8# &late and Consider co<morbidities and cultural considerations%7 "he $atient actuall# does not have an# co<morbid condition "hat he is being treated for. /e is in the hos$ital for a "rauma and is health# besides some mental illness Diagnoses. I would still though recommend a low fat) low 1odium diet to limit an# $ossible health com$lications in "he future. I would suggest for the $atient to continue =ating breakfast as he is but ma#be add a fruit such as a Banana or orange in the morning. 2or lunch) I would !ecommend a salad with light dressing and $rotein such as Chicken or fish for some energ#. /e could also have a sou$ Is the salad is not filling. 2inall#) for dinner) I would suggest baked chicken or fish) with a cu$ of vegetables and some grains such as rice. /e could use a more balanced diet with $ortions from each food grou$. I would also suggest for the $atient to re$lace the sodas with more water.
0se this link for the nutritional anal#sis b# com$aring the $atients 5: /! average home diet to the recommended $ortions) and use 8# &late as reference.

1 COPING ASSESSMENT/SUPPORT SYSTEM: (these are $rom$ts designed to hel$ guide #our discussion%
Bho hel$s #ou when #ou are ill? 3o one since m# 8om $assed awa# last #ear. /ow do #ou generall# co$e with stress? or Bhat do #ou do when #ou are u$set? I donEt deal with it easil#) I will eat a little more and I tend to kee$ it built u$ inside me until I eventuall# burst. It does sometimes hel$ me to have some Fuiet time to calm down and relaC. !ecent difficulties (2eelings of de$ression) anCiet#) being overwhelmed) relationshi$s) friends) social life% I have had bad anCiet# latel# related to m# famil# $assing) es$eciall# m# 8om< we were reall# close. I have also been feeling de$ressed due to m# recent in>uries and the loss of famil#. E2 DOMESTIC VIOLENCE ASSESSMENT

0niversit# of 1outh 2lorida College of 3ursing 4 !evision ugust 5.*6

'

Consider beginning with: Unfortunately many, children, as well as adult women and men have been or currently are unsafe in their relationships in their homes. I am going to ask some questions that help me to make sure that you are safe. /ave #ou ever felt unsafe in a close relationshi$? KKKK3oKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK /ave #ou ever been talked down to?KKLesKKKKKKKKKK /ave #ou ever been hit $unched or sla$$ed? KKKKKKKK3oKKKK /ave #ou been emotionall# or $h#sicall# harmed in other wa#s b# a $erson in a close relationshi$ with #ou? KKKKKKKKKKKKKKKKKKLesKKKKKKKKKKKKKKKKKKKKK If #es) have #ou sought hel$ for this? Les) a thera$ist re #ou currentl# in a safe relationshi$? "he $atient states he is not currentl# in a relationshi$ with an#one.

/ DEVELOPMENTAL CONSIDERATIONS:
=riksonEs stage of $s#chosocial develo$ment7
Inferiorit# Identit# vs. !ole Confusion9Diffusion "rust vs. 8istrust utonom# vs. Doubt M 1hame Initiative vs. ;uilt Industr# vs. Intimac# vs. Isolation ;enerativit# vs. 1elf absor$tion91tagnation =go Integrit# vs. Des$air

Check one boC and give the teCtbook definition (with citation and reference% of both $arts of =ricksonEs develo$mental stage for #our $atientEs age grou$7 In =riksonEs theor#) the seventh $s#chosocial task) in which $eo$le in midlife find meaning from

nurturing the neCt generation) caring for others) or enriching the life of others through their work. ccording to =rikson) when midlife adults have not achieved generativit#) the# feel stagnant) without a sense of $ur$ose in life (Belsk#) 5..(%
Describe the stage #our $atient is in and give the characteristics that the $atient eChibits that led #ou to #our determination7

I would describe the stage m# $atient is in as stagnation) for the sim$le fact that he has never been married) does not have children) and recentl# lost his last living famil# member. /e has talked about his 8otherEs $assing a few times and I feel that he is having trouble co$ing) as he described them as being ver# close. /e has talked about being de$ressed and ver# anCious latel#) which could be eC$ected because of his accident and the fact that he no longer has an# living famil#. "he im$ression that I got was that he was lonel# so it makes a lot of things harder. I also canEt imagine his mental illnesses of de$ression) bi$olar) anCiet#) and $aranoid schiAo$hrenia hel$ him feel $ositive about his current condition.
Describe what im$act of disease9condition or hos$italiAation has had on #our $atientEs develo$mental stage of life7

It is hard to describe what im$act the disease has made on m# $atient. If an#thing) I would think it has made things more difficult since now he is unable to walk) is going to be in the hos$ital for an eCtended $eriod of time) and does not have an# famil# su$$ort to hel$ with through this difficult time. I can see his accident making him fall into a de$ressive state) increased anCiet# wondering if he is going to ever walk again) as well as the increased stress $otentiall# causing a flare u$ of his schiAo$hrenia s#m$toms. /e is at a ver# vulnerable $oint in his life and I trul# ho$e he recovers oka#.

E3 CULTURAL ASSESSMENT:
Bhat do #ou think is the cause of #our illness? It was >ust an accident. Bhat does #our illness mean to #ou? I donEt know) I >ust have broken legs and a broken arm.

E3 SEFUALITY ASSESSMENT: ,t6e 7!##!' "- prompts )a2 6e#p t! -+ 5e 2!+r 5 $*+$$ !".
Consider beginning with: I am asking about your se!ual history in order to obtain information that will screen for possible se!ual health problems, these are usually related to either infection, changes with aging and"or quality of life. #ll of these questions are confidential and protected in your medical record /ave #ou ever been seCuall# active?K3oKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK Do #ou $refer women) men or both genders? BomenKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK re #ou aware of ever having a seCuall# transmitted infection? 39 (never had seC%KKKKKKKKKKKKKKKKKKKKKKKKKK /ave #ou or a $artner ever had an abnormal $a$ smear? 39 KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK

0niversit# of 1outh 2lorida College of 3ursing 4 !evision ugust 5.*6

/ave #ou or #our $artner received the ;ardasil (/&@% vaccination? 39 KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK re #ou currentl# seCuall# active? KKKK3oKKKKKKKKKKKKKKKKKKKKBhen seCuall# active) what measures do #ou take to $revent acFuiring a seCuall# transmitted disease or an unintended $regnanc#? K39 KKKKKKKKKKKKKKKKKKKKKKKKKKKK /ow long have #ou been with #our current $artner?KK39 KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK /ave an# medical or surgical conditions changed #our abilit# to have seCual activit#? KK39 KKKKKKKKKKKKKKKKKKKKKK Do #ou have an# concerns about seCual health or how to $revent seCuall# transmitted disease or unintended $regnanc#? 3o

0niversit# of 1outh 2lorida College of 3ursing 4 !evision ugust 5.*6

G1 SPIRITUALITY ASSESSMENT: (including but not limited to the following Fuestions%

Bhat im$ortance does religion or s$iritualit# have in #our life? K@er# im$ortant) I addend church ever# 1aturda#KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK Do #our religious beliefs influence #our current condition? KKK3oKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK

E3 SMO>ING9 CHEMICAL USE9 OCCUPATIONAL/ENVIRONMENTAL EFPOSURES:

*. Does the $atient currentl#) or has he9she ever smoked or used chewing tobacco? If so) what? /ow much?(s$ecif# dail# amount% Cigarettes ' $er da# &ack Lears7 ** Does an#one in the $atientEs household smoke tobacco? If so) what) and how much? 39 7 lives alone Ye$ 3o 2or how man# #ears? :5 #ears
(age *' thru current %

If a$$licable) when did the $atient Fuit? 39 /as the $atient ever tried to Fuit? Les

5. Does the $atient drink alcohol or has he9she ever drank alcohol? Les N! Bhat? /ow much? (give s$ecific volume% 39 7 does not drink 39

2or how man# #ears?

(age 39 thru %

If a$$licable) when did the $atient Fuit? "he $atient never drank alcohol. /e stated he tried it once a long time ago and did not like the taste so never did it. 6. /as the $atient ever used street drugs such as mari>uana) cocaine) heroin) or other? Les N! If so) what? /ow much? 2or how man# #ears? (age 39 thru 39 39 Is the $atient currentl# using these drugs? Les 3o 39 If not) when did he9she Fuit? 39

:. /ave #ou ever) or are #ou currentl# eC$osed to an# occu$ational or environmental /aAards9!isks 3o.

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 10 REVIEH OF SYSTEMS
Ge"era# C!"$t t+t !"
!ecent weight loss or gain

Ga$tr! "te$t "a#

3ausea) vomiting) or diarrhea Consti$ation Irritable Bowel ;=!D Cholec#stitis Indigestion ;astritis 9 0lcers /emorrhoids Blood in the stool Lellow >aundice /e$atitis &ancreatitis Colitis Diverticulitis $$endicitis bdominal bscess Last colonosco$#? Other7

I))+"!#!- *
Chills with severe shaking 3ight sweats 2ever /I@ or ID1 Lu$us !heumatoid rthritis 1arcoidosis "umor Life threatening allergic reaction =nlarged l#m$h nodes Other7

I"te-+)e"tar2
Changes in a$$earance of skin &roblems with nails Dandruff &soriasis /ives or rashes 1kin infections 0se of sunscreen 1&27 3o Bathing routine7 6C Beekl# Other7 Oil# skin from getting old.

HEENT
Difficult# seeing Cataracts or ;laucoma Difficult# hearing =ar infections 1inus $ain or infections 3ose bleeds &ost<nasal dri$ Oral9$har#ngeal infection Dental $roblems7 &t has no teeth !outine brushing of teeth 39 C9da# !outine dentist visits 39 C9#ear @ision screening Other7 ;lasses were broken in the accident

He)at!#!- */O"*!#!- *
nemia Bleeds easil# Bruises easil# Cancer Blood "ransfusions Blood t#$e if known7 Other7 &ossible anemia?

Ge" t!+r "ar2

nocturia d#suria 1ometimes hematuria7 a little $ink one time $ol#uria kidne# stones 3ormal freFuenc# of urination7 : C9da# Bladder or kidne# infections &atient was treated for a 0"I during this /os$ital sta#.

Meta:!# */E"5!*r "e

Diabetes "#$e7 /#$oth#roid 9/#$erth#roid Intolerance to hot or cold Osteo$orosis Other7

P+#)!"ar2
Difficult# Breathing Cough < dr# or $roductive sthma Bronchitis =m$h#sema &neumonia 2eb and ,une 5.*6 "uberculosis =nvironmental allergies last CN!? Other7

Ce"tra# Ner8!+$ S2$te)

HOMEN ONLY Infection of the female genitalia 8onthl# self breast eCam 2reFuenc# of $a$9$elvic eCam Date of last g#n eCam? menstrual c#cle regular irregular menarche age? meno$ause age? Date of last 8ammogram M!esult7 Date of D=N Bone Densit# M !esult7 MEN ONLY Infection of male genitalia9$rostate? 2reFuenc# of $rostate eCam? Date of last $rostate eCam? B&/ 0rinar# !etention C@ DiAAiness 1evere /eadaches 8igraines 1eiAures "icks or "remors =nce$halitis 8eningitis Other7

Car5 !8a$*+#ar
/#$ertension /#$erli$idemia Chest $ain 9 ngina 8#ocardial Infarction C D9&@D C/2 8urmur "hrombus !heumatic 2ever 8#ocarditis rrh#thmias Last =D; screening) when? Other7

Me"ta# I##"e$$
De$ression 1chiAo$hrenia7 &aranoid nCiet# Bi$olar Other7

M+$*+#!$&e#eta#
In>uries or 2ractures Beakness &ain ;out Osteom#elitis rthritis Other7

C6 #56!!5 D $ea$e$
8easles 8um$s &olio 1carlet 2ever Chicken &oC Other7 &atient re$orted 8easles and 8um$s< unsure how to validate.

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Is there an# $roblem that is not mentioned that #our $atient sought medical attention for with an#one? 3o.

n# other Fuestions or comments that #our $atient would like #ou to know? 3o.

0niversit# of 1outh 2lorida College of 3ursing 4 !evision ugust 5.*6

*.

G10 PHYSICAL EFAMINATION:(Describe abnormal assessment below non checked boCes%

;eneral 1urve#7 "em$erature7 (route taken?% -+.- Oral /eight7 J+ Inches &ulse7 (+ !es$irations7 *( Beight7 *+. B8I7 5(.6( &ain7 (include rating M location% Blood J9*. !ight wrist &ressure7 *6*9J. Left rm
(include location%

1$O5 -' Is the $atient on !oom ir or O57 ! Overall $$earance7 GDress9grooming9$h#sical handica$s9e#e contactI clean) hair combed) dress a$$ro$riate for setting and tem$erature) maintains e#e contact) no obvious handica$s &atient reFuested a shave and had a bed bath. =#e contact was made during conversation) but was Fuite drows# from the $ain 8eds and /aldol. Overall Behavior7 Ge.g.7 a$$ro$riate9restless9odd mannerisms9agitated9lethargic9otherI awake) calm) relaCed) interacts well with others) >udgment intact &atient lethargic due to medication 1$eech7 Ge.g.7 clear9mumbles 9ra$id 9slurred9silent9otherI clear) cris$ diction< 1$eech slightl# slurred from meds) but before being medicated his words were clear and had cris$ diction. 8ood and ffect7 $leasant coo$erative cheerful talkative Fuiet boisterous flat a$athetic biAarre agitated anCious tearful withdrawn aggressive hostile loud Other7 Before meds) ver# talkative and cheerful. /e is a $leasant $atient to talk to. I"te-+)e"tar2 1kin is warm) dr#) and intact (eCce$t for scars from surger#% 1kin turgor elastic 3o rashes) lesions) or deformities< scars from accident 3ails without clubbing Ca$illar# refill O 6 seconds /air evenl# distributed) clean) without vermin

&eri$heral I@ site "#$e7 55 gauge Location7 Left ntecubital Date inserted7 *9*695.*: no redness) edema) or discharge 2luids infusing? no #es < what? 1aline lock &eri$heral I@ site "#$e7 Location7 Date inserted7 no redness) edema) or discharge 2luids infusing? no #es < what? Central access device "#$e7 Location7 Date inserted7 2luids infusing? no #es < what? HEENT: 2acial features s#mmetric 3o $ain in sinus region 3o $ain) clicking of "8, "rachea midline "h#roid not enlarged 3o $al$able l#m$h nodes sclera white and con>unctiva clearH without discharge =#ebrows) e#elids) orbital area) e#elashes) and lacrimal glands s#mmetric without edema or tenderness &=!!L $u$il siAe 9 : mm &eri$heral vision intact =O8 intact through J cardinal fields without n#stagmus =ars s#mmetric without lesions or discharge Bhis$er test heard7 right ear< J inches M left ear< J inches 3ose without lesions or discharge Li$s) buccal mucosa) floor of mouth) M tongue $ink M moist without lesions Dentition7 &atient has no teeth. Comments7

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**

P+#)!"ar2/T6!ra4:

!es$irations regular and unlabored "ransverse to & ratio 57* Chest eC$ansion s#mmetric Lungs clear to auscultation in all fields without adventitious sounds CL 4 Clear &ercussion resonant throughout all lung fields) dull towards $osterior bases B/ 4 BheeAes 1$utum $roduction7 thick thin mount7 scant small moderate large C! < Crackles Color7 white $ale #ellow #ellow dark #ellow green gra# light tan brown red !/ 4 !honchi 3o s$utum $roduction
D 4 Diminished 1 4 1tridor b < bsent

Car5 !8a$*+#ar: 3o lifts) heaves) or thrills &8I felt at7 'th intercostal s$ace) midclavicular line /eart sounds7 1* 15 Re-+#ar Irregular 3o murmurs) clicks) or adventitious heart sounds 3o ,@D Calf $ain bilaterall# negative &ulses bilaterall# eFual Grating scale7 .<absent) *<barel# $al$able) 5<weak) 3@"!r)a#) :<boundingI $ical $ulse7 5P Carotid7 5P Brachial7 5P !adial7 (on left% 5P 2emoral7 3ot assessed &o$liteal7 5P D&7 &"7 3o tem$oral or carotid bruits =dema7 *P Grating scale7 .<none) P* (*<5mm%) P5 (6<:mm%) P6 ('<Jmm%) P:((<+mm% I Location of edema7 right hand $itting "!"@p tt "=Ctremities warm with ca$illar# refill less than 6 seconds &atient had a s$lint on right wrist due to recent surger#) so radial $ulse could not be assessed. GI/GU: Bowel sounds active C : FuadrantsH no bruits auscultated 3o organomegal# &ercussion dull over liver and s$leen and t#m$anic over stomach and intestine bdomen non<tender to $al$ation 0rine out$ut7 Clear Cloud# Color7 #ellow &revious 5: hour out$ut7 39 mLs 39 2ole# Catheter 0rinal or Bed$an Bathroom &rivileges ' t6!+t a$$ $ta"*e or with assistance C@ $unch without rebound tenderness Last B87 (date * 95* 9 5.*: % F!r)e5 1emi<formed 0nformed 1oft /ard LiFuid Bater# Color7 Light brown Me5 +) 3r!'" Dark Brown Lellow ;reen Bhite Coffee ;round 8aroon Bright !ed
/emoccult $ositive 9 negative (leave blank if not done% 3egative

;enitalia7 Clean) moist) without discharge) lesions or odor Other 4 Describe7

3ot assessed) $atient alert) oriented) denies $roblems

M+$*+#!$&e#eta#: 2ull !O8 intact in all eCtremities without cre$itus 1trength bilaterall# eFual at KKK6KKKK !0= KK'KKKKK L0= KKK:KKKK !L=

M KKKK:KKK in LL=

Grating scale7 .<absent) *<trace) 5<not against gravit#) 6<against gravit# but not against resistance) :<against some resistance) '<against full resistanceI

vertebral column without k#$hosis or scoliosis 3eurovascular status intact7 $eri$heral $ulses $al$able) no $ain) $allor) $aral#sis or $aresthesia !ight u$$er eCtremit# not eFual to left u$$er eCtremit# due to recent surger#. Ne+r!#!- *a#: &atient awake) alert) oriented to $erson) $lace) time) and date ConfusedH if confused attach mini mental eCam C3 5<*5 grossl# intact 1ensation intact to touch) $ain) and vibration !ombergEs 3egative 1tereognosis) gra$hesthesia) and $ro$rioce$tion intact ;ait smooth) regular with s#mmetric length of the stride D"!7 Grating scale7 .<absent) P* sluggish9diminished) P5 active9eC$ected) P6 slightl# h#$eractive) P: /#$eractive) with intermittent or transient clonusI
"rice$s7 Bice$s7 Brachioradial7 &atellar7 chilles7 nkle clonus7 $ositive negative Babinski7 $ositive negative

1ensation to vibration not assessed) but touch and $ain was assessed and sensation was intact. 0nable to assess &atients gate) he is currentl# non weight bearing due to in>uries) he is working with &" on a dail# basis. I did not have a refleC hammer to assess dee$ tendon refleCes.

G10 PERTINENT LA3 VALUES AND DIAGNOSTIC TEST RESULTS (include $ertinent normals as well as abnormals) include rationale and anal#sis. List dates with all labs and diagnostic tests%7

La: BBC *6.+ / *..J (.' 3ormal (:.'<**% !BC :.56.-: :.6' 3ormal :.*<'.( /gb *5.5 *..+ *5.. 3ormal in 8en7 *:<*+ /ct 6J.+ 66.5

Date$ (*59*+95.*6% (.*9.-95.*:% (*9*-95.*:%

(*59*+95.*6% (*9.-95.*:% (*9*-95.*:%

(*59*+95.*6% (.*9.-95.*:% (*9*-95.*:%

Tre"5 0$on admit) the $atients BBC were $rett# high. /owever) after surger# and as time $rogresses during his sta# the hos$ital) the $atientEs BBC count has been steadil# reducing to a controlled normal range. !ed blood cells carr# oC#gen from the lungs to the rest of the bod#. "he# also carr# carbon dioCide back to the lungs so it can be eChaled. If the !BC count is low (anemia%) the bod# ma# not be getting the oC#gen it needs. (Com$lete Blood Count) 5.*.% "he hemoglobin test measures the amount of hemoglobin in blood and is a good measure of the bloodQs abilit# to carr# oC#gen throughout the bod#. (Com$lete Blood Count) 5.*.%

A"a#2$ $ 3umber of infection fighting cells. /igh BBC indicates the $resence of an infection or inflammation. 1ince his BBC count has lowered to a normal range) I am not concerned of an# underl#ing infection. "he !BC count tells me that the $atients !BC is closer to the low than normal side. "hese results are showing that the $atient could $otentiall# be anemic and further testing could be done.

(*59*+95.*6% (.*9.-95.*:% (*9*-95.*:% 6J.J

3ormal7 6-<:&latelet Count 5*5-6 6:(*59*+95.*6% (.*9.-95.*:% (*9*-95.*:%

"he $atientEs hemoglobin scores have been u$ and down since he arrived at the hos$ital. Bhen the hemoglobin is low) the $atient is not carr#ing oC#gen as efficient as it should) $otentiall# causing anemia. "his test measures the gain) the $atients /ct amount of s$ace (volume% scores have been u$ and red blood cells take u$ in down since he arrived at the blood. "he value is the hos$ital. Bith the /ct given as a $ercentage of and hemoglobin both red blood cells in a being in the low range) it volume of is a good indicator that blood. (Com$lete Blood the $atient is slightl# Count) 5.*.% anemic. Bhen bleeding occurs) "he $atientEs initial the $latelets come $latelet counts were together and form a within normal range u$on stick# $lug that hel$s sto$ admission but still on the the bleeding. If there are low side. /is counts too few $latelets) began to trend u$ward in uncontrolled bleeding a health# range. I am not

3ormal7 *'.<:..

ma# be a $roblem) or if too man#) blood clots ma# be an issue. (Com$lete Blood Count) 5.*.%

worried about blood clots) or uncontrolled bleeding as long as he uses his 1CDEs and is given his lovenoC a$$ro$riatel#.

CT L!'er r -6t e4tre) t2: trauma) rt ankle without contrast. Im$ression7 2ractures of the tibia and fibula CT L!'er #e7t e4tre) t2: "rauma) left foot without contrast. Im$ression7 Comminuted dis$laced fractures Involving the $roCimal first through fourth metatarsals. 1ignificant dis$lacement of the first metatarsal 2racture su$eriorl# is noted. 1mall avulsion fracture off the su$erior anterior calcaneus. 3ondis$laced fracture "hrough the $osterior tibia. R -6t e#:!': "wo views. Im$ression7 2racture dislocation S6!+#5er: "hree views of the right shoulder. Im$ression7 3o acute fractures or dislocations or the right shoulder. !ight clavicle is intact. R -6t Hr $t: !ight wrist fracture dislocation noted on *9.*95.*: C" due to $atient com$laints of $ain. 1urger# Bas $erformed on *9*.9*: to fiC the fracture. CT P!$t Op: &ost o$ C" scans were done on the r -6t a"&#e7 successful reduction of the mediall# dislocated Distal right tibia with res$ect to the talar dome. R -6t e#:!'7 successful reduction of the right elbow dislocation 1mall bone fragment noted ventral to the distal right humorous consistent with a fracture fragment of 0ncertain origin. 1oft tissue swelling of the right elbow. Le7t F!!t7 Interval $lacement of three $ins within the Left foot. "here is now near<anatomic alignment of the left metatarsals with the tarsal bone. E2 CURRENT HEALTHCARE TREATMENTS AND PROCEDURES: (Diet) vitals) activit#) scheduled diagnostic tests) consults) accu checks) etc. lso $rovide rationale and freFuenc# if a$$licable.% "he $atient is currentl# on a regular diet) with =nsure three times $er da#. /e is eating well. /is vitals /ave all been within normal limits since after the surgeries. /e is healing well and has not had an# Com$lications from the surgeries. "he $atient does not currentl# have an# diagnostic tests scheduled) ,ust regular monitoring of labs. /e has had a consult with $s#ch due to his mental illness record) as well as "he Cha$lain. "he $atient is current working with &" dail# to hel$ gain back strength in is legs and wrist.

I NURSING DIAGNOSES (actual and $otential < listed in order of $riorit#%

*. Im$aired $h#sical mobilit# related to musculoskeletal im$airment as evidenced b# the $atientEs $h#sical trauma of the Lower eCtremities. 5. !isk for decreased gastrointestinal motilit# related to immobilit# 6. !isk for com$romised human dignit# related to stigmatiAing label :. '.

G 1( CARE PLAN N+r$ "- D a-"!$ $: !isk for decreased gastrointestinal motilit# related to immobilit# N+r$ "- I"ter8e"t !"$ t! A*6 e8e Rat !"a#e 7!r I"ter8e"t !"$ E8a#+at !" !7 G!a# !" Da2 *are $ G!a# Pr!8 5e Re7ere"*e$ Pr!8 5e5 /ave abdomen circumference *. ssess for abdominal distention) *. bdominal distention is often &atient did not com$lain of normal for clientEs bod#) free of and $resence of abnormal $ain. found with decreased gastric abdominal $ain when $al$ated abdominal distention 5. Ins$ect the abdomen) auscultate motilit#) and abdominal $ain is during m# $h#sical assessment) and for bowel sounds noting found in both increased and $atientEs abdomen did not a$$ear characteristics and freFuenc#) decreased gastric motilit#. distended. $al$ate) and $ercuss the abdomen. 5. &h#sical assessment of the 6. !eview diet histor#. Obtain abdomen can be hel$ful to find nutritional consult) considering abnormalities or changes diets lower or higher in liFuids or associated with an either increased solids) es$eciall# fats) de$ending or decreased gastric motilit#. on gastric motilit#. R6. 2or the $erson with diminished gastric em$t#ing) s9he ma# be advised to avoid fatt# meals while more liFuid intake of nutrients ma# be advised. &atient will defecate formed) soft *. /ave the client kee$ a diar# of R*. It is alwa#s a good idea to kee$ &atient had a formed bowel stool ever# da# to ever# third da# time food and fluid was consumed a track of dietar# and bowel habits) movement the da# before I as it com$ares to $atterns of es$eciall# if the $atient is not interviewed him for the & " and defecation) including) but not defecating regularl#) or if their he re$orted it was normal for him. I limited to) consistenc#) amount) stool has not been normal for them. was also told later in the da# that and freFuenc# of stool. 5. !ecogniAe that o$ioids and he had another successful formed 5. =valuate medications the client anticholinergics can cause gastric bowel movement without an# is taking slowing) along with aluminum com$lications. h#droCide antacids) beta adrenergic rece$tor agonists) calcium channel blockers) etc. Be able to eat food without nausea *. dminister $rokinetic *. !eglan has central antiemetic &atient has been able to eat his and vomiting medications as ordered effects and thus is useful for meals without eC$eriencing an# 5. If client is unable to eat or retain im$roving s#m$toms of stomach discomfort. /e has been food) consult with the registered $ost$randial fullness and nausea. drinking ensure as a dietar# dietitian and $h#sician) considering 5. 1ome clients reFuire su$$lement. Pat e"t G!a#$/O+t*!)e$

further nutritional su$$ort in form su$$lementation with either enteral of enteral or $arenteral for the or $arenteral nutrition for survival. client with gastro$aresis. G2 DISCHARGE PLANNING: ($ut a R in front of an# $t education in above care $lan that #ou would include for discharge teaching% C!"$ 5er t6e 7!##!' "- "ee5$: S11 Consult RRDietar# Consult S&"9 O" S&astoral Care SDurable 8edical 3eeds RR290 a$$ointments S8ed Instruction9&rescri$tion S are an# of the $atientEs medications available at a discount $harmac#? SLes S 3o S!ehab9 // S&alliative Care

G 1( CARE PLAN N+r$ "- D a-"!$ $: !isk for other<directed violence related to $s#chotic s#m$tomatolog# Pat e"t G!a#$/O+t*!)e$ Identif# and talk about feelingsH eC$ress anger a$$ro$riatel# N+r$ "- I"ter8e"t !"$ t! A*6 e8e G!a# *. ssess causes of aggression7 social versus biological. 5. ssess the client for $h#siological signs and eCternal signs of anger. 6. 2orm a thera$eutic alliance with the client) remaining calm) identif#ing the source of anger as eCternal to both nurse and client) and using the thera$eutic relationshi$ to $revent the need for seclusion or restraint. :. Identif# with client the stimuli that initiate violence and the means of dealing with the stimuli. /ave the client kee$ an anger diar# and discuss alternative res$onses together. "each cognitive< behavioral techniFues. *. ssess for $resence of hallucinations 5. ssess the client for risk factors of violence7 &s#chiatric disorders ($articularl# $s#chosis) $aranoid or bi$olar disorders) substance abuse) &"1D) antisocial $ersonalit# or borderline $ersonalit# disorder% *. Inform the client of unit Rat !"a#e 7!r I"ter8e"t !"$ Pr!8 5e Re7ere"*e$ *. Dnowing the client) having eC$erience with similar clients) $a#ing attention) and $lanning interventions are eC$ert $ractices used b# nurses to $redict and res$ond to aggressive behavior effectivel#. 5. nger is an earl# warning sign of $ossible violent behavior. 6. One stud# concluded that) although most clientEs aggressiveness was verbal rather than $h#sical) the resulting fear could lead to increased use of seclusion or restraint. R:. 0se of a co$ing Fuestionnaire to assess client $references for dealing with agitation was $art of a successful $rogram to decrease restraint and seclusion at the $s#chiatric hos$ital. *. Command hallucinations ma# direct the client to behave violentl# 5. "hese risk factors have been im$licated in aggressive) agitated) or violent behaviors. E8a#+at !" !7 I"ter8e"t !"$ !" Da2 *are $ Pr!8 5e5 On the da# of m# assessment) the $atient dis$la#ed no signs of aggression) irritation) aggravation) or anCiet#. /e has been on !is$erdal and /aldol since his $s#chotic break a few da#s $rior to m# visit. /e was ver# friendl#) and re$eatedl# told me that he felt bad for frightening the staff but he does not remember what he said or did.

=C$ress decreased anCiet# and control of hallucinations as a$$licable

Identif# conseFuences of im$ulse

R*. Clients benefit from clear

"hroughout the da# the $atient would let me know when he was beginning to feel anCious. /e would ask me to check with the nurse if he could receive his /aldol. I was $leased that he was aware of his feelings and knew when to reFuest medications to $revent an# anCiet# attacks. Bhen the $atient had his mental

actions to self or others

eC$ectations for a$$ro$riate guidance and $ositive break earlier in the week) he had to behavior and the conseFuences of reinforcement regarding behavioral be $laced with a 5:9( sitter. It was not meeting these eC$ectations. eC$ectations and conseFuences) eC$lained to him that restraints =m$hasiAe that the client must $roviding much needed structure would be used if he was not able to com$l# with the rules of the unit. and em$hasiAing client be controlled or eChibited $otential ;ive $ositive reinforcement for res$onsibilit# for his or her own harm to himself or others. 1ince his com$liance. Increase surveillance behavior. original incident) he has not had of the hos$italiAed client at an# other break downs and has smoking) meal and medication been ver# $olite) friendl#) and times. com$liant. G DISCHARGE PLANNING: ($ut a R in front of an# $t education in above care $lan that #ou would include for discharge teaching% C!"$ 5er t6e 7!##!' "- "ee5$: RR11 Consult SDietar# Consult S&"9 O" S&astoral Care SDurable 8edical 3eeds RR290 a$$ointments RR8ed Instruction9&rescri$tion S are an# of the $atientEs medications available at a discount $harmac#? SLes S 3o S!ehab9 // S&alliative Care

!eferences ckle#) B. ,.) M Ladwig) ;.B. (5.**%. $ursing diagnosis handbook: #n evidence%based guide to planning Care (-th ed.%. 1t. Louis) 8O7 8osb#) =lsevier. Belsk#) ,. (5..(%. &!periencing the lifespan. ,. Ba#ne (=d.%. 3ew Lork) 3L7 Borth &ublishers Com$lete Blood Count (CBC%7 !esults and Inter$retation. (5.*.) ugust .6%.'eb(). !etrieved ,anuar# 5() 5.*:) from htt$799www.webmd.com9a<to<A<guides9com$lete<blood<count<cbc 2ood "racker. (n.d.%. (y*late. !etrieved ,anuar# 5+) 5.*:) from htt$s799www.su$ertracker.usda.gov9default.as$C /erAog) =. . (5.*:%. +arcarolis, foundations of psychiatric mental health nursing: a clinical approach. /alter) 8. ,. (ed.% ((th ed.%. 1t. Louis) 8o.7 =lsevier91aunders. 3ursing Central from 0nbound 8edicine. (n.d.%. $ursing central from unbound medicine. !etrieved ,anuar# 5() 5.*:) from htt$799nursing.unboundmedicine.com9nursingcentral