Show:
Patient background
Nursing Diagnosis 1
Nursing diagnosis 2
100
What is the patient's initials?
D.P
100
What was the theme of the nursing diagnosis?
Falls Risk-

"This patient is at risk for falls related to altered mobility"

100
What is the theme of the nursing diagnosis?
Pain

"Acute pain related to trauma from cholecystectomy surgery"

200
How old is the patient?

A. 73

B. 67

C. 77

D. 82

B. 67 Years Old
200
What are three nursing interventions mentioned for this patient?
1. Bed Alarm On

2. Bed in lowest position

3. Call bell within reach

4. Use of transfer belt

5. Side rails up (x3)

6. Ensuring brakes are on wheelchair

7. Education

8. Ensure patient knows their limitations

9. Remove hazards

200
How will we know if the patient met their goals?
Will be determined by pain rating, PQRST assessment, and patients overall comfort level
300
How many children does this patient have?
Two
300
Did this patient meet their short term goal?
No. The patient had a fall while hospitalized
300
What nursing interventions were useful with this patient?
PCA

Breakthrough pain PRN

Massage

Cold/Warm Compress

Repositioning/cushion support

Assess pain q2h

Assess using PQRST 

Education

400
What are the patient allergies?

a. Penicillin

b. Morphine, Lactose

c. No allergies

d. Mushrooms, Peanuts, and Penicillin

c. The patient has no known allergies
400
Did the patient meet their long term goal?
YES! The patient has not been hospitalized for a fall since discharge
500
What are three parts of the assessment data for this patient's nursing diagnosis?
Wheelchair bound

Limited mobility

Limited weight baring

Decreased strength

Obese

History of falls

Edema 

Pain 

Age