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Patient Assessment Sheets

Assignment 3 - Patient Assessment Sheet - page 1 - interview date: Admission date (hospital / rest home patients) Surname: Address: First Name: Mr. Mrs day: night: cell: Miss Dr other. Occupation: Support: Family / District Nurse / Care giver / other - details: contact name: smoker: n / Y how many?. Gave up after. Yrs.

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695 views4 pages

Patient Assessment Sheets

Assignment 3 - Patient Assessment Sheet - page 1 - interview date: Admission date (hospital / rest home patients) Surname: Address: First Name: Mr. Mrs day: night: cell: Miss Dr other. Occupation: Support: Family / District Nurse / Care giver / other - details: contact name: smoker: n / Y how many?. Gave up after. Yrs.

Uploaded by

blaktrac
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
  • Patient Details: Collects basic information about the patient including personal details, lifestyle, medical support, and health behaviors.
  • Current Medical Conditions: Records current medical conditions, history, and symptom control for the patient to provide an accurate assessment.
  • Lab Results / Observations: Details laboratory test results with normal ranges alongside patient data to monitor health indicators.
  • Current Prescription Medicines: Lists current, complementary, and recently discontinued medications to ensure comprehensive medication management.

Assignment 3 - Patient Assessment Sheet

PAGE 1

Interview date: Admission date (hospital/rest home patients) NB: put n/a for not applicable where appropriate Surname: Address: First Name: Mr. Mrs day: night: cell: Miss Dr other

Age:

Date of Birth:

Male / Female

Ethnicity:

Living: Alone / Spouse / Partner / Family / Residential Home / Other details: Occupation: Support: Family / District Nurse / Care giver/Other Details: Contact Name: Smoker: N / Y how many?. Gave up after .. yrs Doctor: Other Medical Support: Alcohol: N / Y .per week Tea N / Y qty BMI (wt in kg (height in metres)2) General health: Children: no.: Interests : good / average / poor Ages

Daily fluid intake: Water N / Y qty Coffee N / Y qty Height: Nutrition: Weight good / average / poor

(also assess other caffeinated drinks e.g. Coca Cola)

Pregnant / Breastfeeding? Exercise/Activity:? Sports Family History: Who: Allergies: Hobbies

Diabetes / Asthma / CHD / Epilepsy / Cancer/ Other ? Parent / Sibling / Grandparent / Child / Details ?

Medicines: Food: Other:

Adverse Drug Reactions: Drug Type of reaction (if known)

Continued over the page >>>

ASSIGNMENT 3 - PATIENT ASSESSMENT SHEET


Current Medical Conditions
Condition Cardiovascular disease e.g angina, CHD Gastrointestinal disease e.g GORD Respiratory disease e.g. asthma, COPD Musculoskeletal disease eg. Arthritis Pain CNS / neuro Psychiatric Other Previous Medical History (including surgery): Since When Details

PAGE

Degree of symptom Control

Issues related to taking medicinesReading labels on the medicines bottle Opening the containers Getting tablets out of the foil or bottleN Swallowing the tablets Remembering to take the medicines Compliance Issues?

Does the patient have difficulties: N Y Comment . N Y N N Y Comment

Comment Y Y Comment Comment

General comments / patient concerns /expectations about medicines:

LAB RESULTS / OBSERVATIONS


LAB RESULTS Range
135-146mmol/L 3.5-5.0 mmol/L 0.05-0.12 mmol/L 3.2-7.7 mmol/L 0.75-1.00mmol/L 2.17-2.64mmol/L 1.15-2.15mmol/L 35-47g/L 0-60U/L 40-110U/L < 40U/L < 45U/L 2-20 umol/L 125-170g/L 80-100fL 4-10 X10E9/L 2.0-7.5 X10E9/L 150-400 X10E9/L 1-30mm/hr 3.0 - 5.6 mmo/L(Fasting) 5.5 7 (age dependent) < 4mmol/l > 1 mmol/l < 4.5 < 2mmol/l < 2.5 mmol/l

Date

Value

Date

Value

Date

Value

Na K Cr Urea Mg Ca
Phosp Albumin GGT

ALP AST ALT Bilirubin Hb MCV WCC Neutro Platelets ESR Glucose HbA1c Cholesterol HDL Chol:HDL Triglycerides LDL other
OBSERVATIONS

BP HR Temp Peak flow other

Current Prescription Medicines

As at (date):

Drug

Form/Strength/ route

Dose

Freq

Date started

Purpose

Effectiveness

Comment

OTC / Complementary medicines


Medicine Form/Strength/ route Dose Freq Date started Purpose Effectiveness Comment

Recently discontinued medicines


Medicine Dose Freq Date started Purpose Date stopped Reason for stopping

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