Initial Assessment Nursing Care
ADVERTISEMENT
1
2Acute care hospital
INITIAL ASSESSMENT
NURSING CARE
DT9109
1- PRELIMINARY DATA
Year
Month
Day
Time
. .
on
foot
Other :
ARRIVAL
alone
accompanied by :
spoken
understood
LANGUAGE
RELIGION
Catholic
Protestant
Other :
Name
Relationship
at work
res.
(
)
(
)
Tel.
PERSONS
TO BE
Name
Relationship
at work
res.
CONTACTED
(
)
(
)
Tel.
Reason for hospitalization
(according to user)
General aspect
(behaviour and appearance, weight variation, etc.)
Pulse
BP
T (°C)
Resp.
Height (m)
Weight (kg)
Right
Left
handed
handed
2- HEALTH PROBLEMS
PARAMETERS
ALTERATIONS NOTED
SPECIFICATIONS (therapeutic material used)
Respiration
(tract, characteristics, associated problems…)
no
yes
Digestion
(alimentary tract, mastication, deglutition, appetite…)
no
yes
Elimination
(tract, characteristics, control…)
no
yes
Skin/Appendages
(integrity, appearance, temperature…)
no
yes
Mobility
(integrity, endurance, comfort…)
no
yes
Cognition/Perception
(senses, language, writing, memory,
no
yes
concentration, orientation, judgment…)
Sleep
(quality, duration…)
no
yes
Sexuality/Reproduction
(integrity…)
no
yes
specify :
Other health problems and
Known allergy,
specify nature
prehospitalization treatment:
to drugs, other:
no
yes
no
yes
and reactions :
Special diet:
no
yes
specify:
MEDICATION
(taken before hospitalization, prescribed or not)
Name
Dosage
Usage known
Name
Dosage
Usage known
INITIAL ASSESSMENT – NURSING CARE
AH-410A DT (rev. 04-11)
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Medical