College of Southern Nevada Nursing Department Clinical Worksheet

• :r College of Southern Nevada
Nursing Department Clinical Worksheet
Student's Name: Clinical Date:



Client lnitials: Admit Date: Room#: Age: Sex:

Ht. Wt. BMI: Weight in pounds________

Reason for Admission:



Admitting Diagnosis____________
Client Medical History:




Surgical History:




Allergies: _ Isolation: Diet: (If tube feeding-type and rate) _

Code Reason:
Activities:

Status:

Chronological Events/Concerns while in hospital:




Intake/Output: Pre-clinical Day : I=
O= _
Clinical Day: I=
O =

Fluid Restriction:
Foley Cath.: _
_ Tubes/Drains: _
Drains Output {Describe):

Pre-clinical Day:
Clinical Day:

Wound Care/Wound Description:




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IV Access: (Type, location, and assessment

findings)




Mainline IV Fluids (Type, rate, rationale):



Telemetry: rate:
------ rhythm:
02: Incentive Spirometer:

Chest Tubes (location, describe drainage, amount, gravity or wall suction):




Diabetic Monitoring: Frequency

Pre-clinical day Glucose level Time: _
Clinical Day Glucose level: before meal 1: Time: consumption: %
before meal 2: Time: consumption: %
Insulin Sliding Scale:




Vital Signs: Pre-clinical Day T P R B/P 02 sat: Pain
Clinical Day

T P R B/P 02 sat: Pain
T P R B/P 02sat: Pain

Diagnostic Tests: (Include date and results/impression)
Tes t:
Date:
ResuIt (s): _