What is the RELATIONSHIP of your patient’s past medical history (PMH) and current psychotrophic meds?(After PMH, put the medication number that correlates with that illness; This should also include hospital meds) PMH: Home and Pharm. Classification: Expected Outcome: Side Effects Hospital Meds: 1. 1. 1. 2. 2. 2. 3. 3. 3. 4. 4. 4. 5. 5. 5. 6. 6. 6. 7. 7. 7. Nutrition Diet Height Weight BMI Snacks Nutritional Assessment (What are the nutritional needs for your patient based on his/her health status diagnoses; this may differ from the actual ordered diet)? Lab Results: (Complete for day before/most recent and then day of clinical) What lab results are RELEVANT that must be recognized as clinically significant to the Complete Blood Count Norms Mm/dd/yy Mm/dd/yy High/Low/WNL? What lab (CBC:) results are WBC Hgb that must be Platelets recognized UDS clinically TSH significant the nurse?
What is the RELATIONSHIP of your patient’s past medical history (PMH) and current psychotrophic meds?(After PMH, put the medication number that correlates with that illness; This should also include hospital meds) PMH: Home and Hospital Meds: Pharm. Classification: Expected Outcome: Side Effects 1. 2. 3. 4. 5. 6. 7. 1. 2. 3. 4. 5. 6. 7. 1. 2. 3. 4. 5. 6. 7. Nutrition Diet Height Weight BMI Snacks Nutritional Assessment (What are the nutritional needs for your patient based on his/her health status diagnoses; this may differ from the actual ordered diet)? Lab Results: (Complete for day before/most recent and then day of clinical) What lab results are RELEVANT that must be recognized as clinically significant to the Complete Blood Count (CBC:) Norms Mm/dd/yy Mm/dd/yy High/Low/WNL? WBC Hgb Platelets UDS TSH What lab results are that must be recognized clinically significant the nurse?
nur4405-f18-rev2.docx