CLINICAL WORK SHEET

Student name: ___________________ Client initials:_______ Rm.# ______ Age ______ DOA _______
Allergies:* DNR status*
Medical Diagnosis: (inc. definition)*
istor! of illness:
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Drug Dose (ime Action0/se Nursing )m2lications
Diet0.eeding Assistance* )3 (t!2e4 rate4 site)*
!giene Needs* Mo#ilit! Needs*
(reatments* 5limination Needs*
239108798.doc
'riorit! Assessments0)nter$entions*
DA(A CO""5C()ON 6 DOC/M5N(A()ON
Assessments
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Acti$it! 6 Rest:
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Cardio$ascular:
Res2irator!:
Nutrition 6
.luid #alance:
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239108798.doc