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CPNE PCS
SKIN ASSESSMENT
| Question | Answer |
|---|---|
| SKIN ASSESSMEMT | C TIME X2, COLOR,TEMP,MOISTURE,EDEMA FOR 2 AREAS |
| RESPIRATORY ASSESSMENT | EPS SALT, ELEVATE HOB,PATTERN/RATE,SHALLOW,SOUNDS,ACCESSORY MUSCLES,LABORED/UN,TOLERATED ASSESSMENT |
| NEUROLOGICAL ASSESSMENT | COPS, C FOR INFANT <1,TO CHECK FONTANEL UPRIGHT,ORIENTATION PPT OR VAT,PUPIL PERRL,STRENGTH BILATERAL EXTREMITIES |
| PERIPHERAL VASCULAR ASSESSMENT | GET P PMS, GLOVES IN OPEN WND,EDEMA,TEMP,PULSES,PERFUSION(CCC COLOR,CAP REFILL,CLUBBING)MOTOR,SENSATION |
| ABDOMINAL ASSESSMENT | PPPP SODA POP,PRIVACY,PEE,POSTION,PAIN,SUCTION OFF,OBSERVE(DISTENTION)DON GLOVE?,AUSCULTATE 4 QUADRANTS,PALPATE 1-2CMS,ON SUCTION,PER MD ORDER MEASURE GIRTH |
| MOBILITY | NEST-TO DO(NONSKID,EQUIPMENT,SUPP DEVICES,TOLERATE WABLER-TO CHART(WHAT DID,ASSIST DEVICES,BALANCE,LEVEL OF MOBILITY,EXTRANEOUS MOVEMENT,REPONSE TO PT |
| MUSCULAR SKELETAL MGMT(AIR) | ASSESS PALP IR,PRESENCE OR ABSENCE OF ABNORMALITIES,PAIN W MOVEMENT,INTERVENTION,RESPONSE |
| OXYGEN MGMT | FAN SHOP, FLOW RATE,ACTIVITY,NOSE,SAFETY,HUMIDIFICATION,O2 STATUS(CCC O2 SAT)POSITION |
| COMFORT MANAGEMENT(AIR) | ASSESS INTERVENE MD BMW CAR, MEDICATE,DISTRACT/RELAX,BACKRUB,MOUTH CARE,WASH FACE,CHANGE/STRAIGHTEN LINEN,APPLY HEAT/COLD,REPOSITION,RESPONSE |
| PAIN MGMT(AIR) | ASSESS,INTERVENE,MR BIRD, MEDICATE,REASSESS PAIN LEVEL,BACK RUB,INSTILL HEAT/COLD,REPOSITION,DISTRACT/RELAX,REASSESS |
| RESPIRATORY MANAGEMENT:GRAPES THEN (AIR) | GRAPES, GLOVES ON,RECEPTACLE,ARRANGE TISSUE,POSITION PT,ELEVATE HOB IF NO CONTRAIN,SPLINT W/PILLOW, ASSESS EPS SALT, INTERVENE DB/DB/C/CP-SUCTION SIRP, BULB SYRINGE DIA, REASSESS EPS SALT |
| PATIENT TEACHING | AIR ASSESS READINESS TO LEARN,LEARNING NEEDS OR BARRIERS, INTERVENE (PROVIDE INFO) REASSESS ASK QUESTIONS TO FIND OUT IF PT LEARNED NEW INFORMATION |
| WOUND MGMT (AIR) | ASSESS TALL-TYPE,APPEARANCE,LOCATION,LOOK FOR DRAINAGE(TYPE-CALLIPPP-CONTUSION,ABRASION,LACERATION,INCISION,PUNCTURE,PENETRATING,PRESSURE ULCER)INTERVENE REPONSE |
| IRRIGATION(MGMT AIR) | ASSESS,INTERVENE(STRIP-SOLUTION,TEMP,RECEPTACLE,IRRIGATE(AMOUNT RETURN FLD), PROTECT SDG CHG DRDCALL, RESPONSE |
| DRAINAGE&SPECIMEN COLLECTION | DACT(DRAINAGE,ASSESS,CLEANSE,TUBE) SOLD SPECIMEN COLLECTION,OBTAIN,LABEL,DESIGNATED CONTAINER,PLACE |
Created by:
ggioustovia
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