previous editions of the Pocket Guide helpful, and to other nurses who are . Page 12 Davis Company: Nursing Care Plans Across the Life Span, ed. 7. previous editions of the Pocket Guide helpful, and to other Gordon's Functional Health Patterns on the inside front cover. NURSE'S POCKET GUIDE. Nurse's Pocket Guide Diagnoses Prioritized Interventions and Rationales 14th Edition Medical Books PDF · March 20 at AM. Sorry, something went wrong while loading this conversation. English Rationales 14th Edition /. medicine4u.

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Nurse's Pocket Guide: Diagnoses, Prioritized Interventions and Rationales, 12th Edition Ebook. By Marilynn E. Doenges Language: English Publish Year: download Nurse's Pocket Guide Diagnoses, Prioritized Interventions, and Rationales Prioritized Interventions, and Rationales (Nurses Pocket Guide) 14th Edition, eBook features: . 5 star · 73% · 4 star · 12% · 3 star · 8% · 2 star · 3% · 1 star · 4% . Nurse's Pocket Guide: Diagnoses, Prioritized Interventions and Rationales 12nd Edition Request an eBook to review for your course. REQUEST The 12th Edition features the latest nursing diagnoses and updated interventions. And.

With these considerations in mind, record history data thoroughly and precisely. Continue your questioning until youre sat- isfied that youve recorded sufficient detail. Dont be satisfied with inadequate answers, such as a lot or a little; such subjective terms must be explained within the patients context to be meaningful. If taking notes seems to make the patient anxious, explain the importance of keeping a written record.

To facilitate accurate recording of the patients answers, familiarize yourself with standard history data abbreviations. When you complete the patients health history, it becomes part of the permanent written record. It will serve as a database with which you and other healthcare professionals can monitor the patients progress. Remember that history data must be specific and precise. Avoid generalities. Instead, provide pertinent, concise, detailed infor- mation that will help determine the direction and sequence of the physical examinationthe next phase in your patient assessment.

After taking the patients health history, the next step in the assessment process is the physical examination. During this assess- ment phase, you obtain objective data that usually confirm or rule out suspicions raised during the health history interview. Use four basic techniques to perform a physical examination: inspection, palpation, percussion, and auscultation IPPA. Using IPPA skills effectively lessens the chances that youll overlook something important during the physi- cal examination.

In addition, each examination technique collects data that validate and amplify data collected through other IPPA techniques. Accurate and complete physical assessments depend on two inter- related elements. One is the critical act of sensory perception, by which you receive and perceive external stimuli.

The other element is the conceptual, or cognitive, process by which you relate these stimuli to your knowledge base. This two-step process gives meaning to your assess- ment data. Develop a system for assessing patients that identifies their prob- lem areas in priority order.

By performing physical assessments sys- tematically and efficiently instead of in a random or indiscriminate manner, youll save time and identify priority problems quickly. First, choose an examination method. The most commonly used methods for completing a total systematic physical assessment are head-to-toe and major body systems.

The head-to-toe method is performed by systematically assessing the patient byas the name suggestsbeginning at the head and working toward the toes. Examine all parts of one body region before progressing to the next region to save time and to avoid tiring the patient or yourself. Proceed from left to right within each region so you can make sym- metrical comparisons; that is, when examining the head, proceed from the left side of the head to the right side.

After completing both sides of one body region, proceed to the next. The major body systems method of examination involves system- atically assessing the patient by examining each body system in pri- ority order or in an established sequence. Both the head-to-toe and major body systems methods are system- atic and provide a logical, organized framework for collecting physi- cal assessment data.

They also provide the same information; therefore, neither is more correct than the other. Choose the method or a variation of it that works well for you and is appropriate for your patient population. Follow this routine whenever you assess a patient, and try not to deviate from it.

You may want to plan your physical examination around the patients chief complaint or concern. To do this, begin by examining the body system or region that corresponds to the chief complaint. This allows you to identify priority problems promptly and reassures the patient that youre paying attention to his chief complaint. Record your examination results thoroughly, accurately, and clearly. Although some examiners dont like to use a printed form to record physical assessment findings, preferring to work with a blank paper, others believe that standardized data collection forms can make recording physical examination results easier.

These forms simplify comprehensive data collection and documentation by providing a concise format for outlining and recording pertinent information.

They also remind you to include all essential assessment data. When documenting, describe exactly what youve inspected, pal- pated, percussed, or auscultated. Dont use general terms such as normal, abnormal, good, or poor. Instead, be specific. Include posi- tive and negative findings.

Try to document as soon as possible after completing your assessment. Remember that abbreviations aid con- ciseness. A nursing diagnosis provides the basis for selection of nursing interventions to achieve outcomes for which the nurse is accountable Herdman, , p.

The nursing diagnosis must be supported by clinical infor- mation obtained during patient assessment. Each nursing diagnosis describes a patient problem that a nurse can professionally and legally manage. Becoming familiar with nurs- ing diagnoses will enable you to better understand how nursing prac- tice is distinct from medical practice. Although the identification of problems commonly overlaps in nursing and medicine, the approach to treatment clearly differs.

Medicine focuses on curing disease; nurs- ing focuses on holistic care that includes care and comfort. Nurses can independently diagnose and treat the patients response to illness, certain health problems and risk for health problems, readiness to improve health behaviors, and the need to learn new health information. Nurses comfort, counsel, and care for patients and their families until theyre physically, emotionally, and spiritually ready to provide self-care. The nursing diagnosis expresses your professional judgment of the patients clinical status, responses to treatment, and nursing care needs.

You perform this step so that you can develop your care plan. In effect, the nursing diagnosis defines the practice of nursing. In addition to identifying the patients needs in coping with the effects of illness, consider what assistance the patient requires to grow and develop to the fullest extent possible. Your nursing diagnosis describes the cluster of signs and symptoms indicating an actual or potential health problem that you can identifyand that your care can resolve.

Nursing diagnoses that indicate potential health problems can be identified by the words risk for that appear in the diagnostic label. There are also nursing diagnoses that focus on prevention of health problems and enhanced wellness. Creating your nursing diagnosis is a logical extension of collecting assessment data.

In your patient assessment, you asked each history question, performed each physical examination technique, and con- sidered each laboratory test result because it provided evidence of how the patient could be helped by your care or because the data could affect nursing care.

To develop the nursing diagnosis, use the assessment data youve collected to develop a problem list. Less formal in structure than a fully developed nursing diagnosis, this list describes the patients problems or needs. Its easy to generate such a list if you use a con- ceptual model or an accepted set of criterion norms. Examples of such norms include normal physical and psychological development and the assessment parameters based on the NNN Taxonomy of Nursing Practice see Appendix A.

You can identify the patients problems and needs with simple phrases, such as poor circulation, high fever, or poor hydration. Next, prioritize the problems on the list and then develop the work- ing nursing diagnosis.

Some nurses are confused about how to document a nursing diag- nosis because they think the language is too complex. By remember- ing the following basic guidelines, however, you can ensure that your diagnostic statement is correct: Use proper terminology that reflects the patients nursing needs. Make your statement concise so its easily understood by other healthcare team members. Use the most precise words possible. Use a problem-and-cause format, stating the problem and its related cause.

NANDA-I diagnostic headings, when combined with suspected eti- ology, provide a clear picture of the patients needs. The category can reflect an actual or potential problem. Product details File Size: January 13, Sold by: English ASIN: Not enabled X-Ray: Not Enabled. Medical Books. Prime Student members.

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Read reviews that mention care plans nursing school pocket guide nursing diagnoses nursing student writing care nurses pocket easy to use highly recommend much easier interventions and rationales everything you need hard copy love this book great book brand new quick reference easy to carry diagnoses with interventions well organized.

Top Reviews Most recent Top Reviews. There was a problem filtering reviews right now. Please try again later. Paperback Verified download. This is a great nursing school resource.

I use this when writing my care Plans, and it has helped tremendously because the rationales are included for most of the interventions.

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Also, don't take "pocket size" too literally. This is definitely not that conveniently sized. I'm in nursing school and this book as been helpful finding nursing diagnosis' and has specific interventions.

It also has a ton of interventions that you can use as starting points to tailor to your specific patient. Pocket guide is organized in a way that makes it easy to find exactly what you are looking for. Nsg Dx are labeled by taxonomy and defined. The size is small enough to stuff in your bag and carry with you to clinicals.

I bought used in Good condition. The book has minimal shelf wear but otherwise is in great conditon. I highly recommend this pocket edition to nursing students. This book has helped me so much in nursing school!

It helps me to write effective care plans with appropriate nursing diagnosis with rationale. I like this book; however, the term "Pocket Guide" is misleading. Check blood levels of antiseizure medications. Move the patient very carefully using logroll technique. Use a spine board with restraints or other items, such as head blocks and pillows, to maintain position. Set up and assist with intubation.

Assist with placing patient in spinal traction. Administer IVF and medications e. Insert a nasogastric tube. Altered LOC, confusion, agitation.

Administer O2. Draw laboratory tests. Accompany the patient to CT scan. Assess if patient meets thrombolytic criteria. Prepare patient for thrombolytic or anticoagulant therapy. Transfer patient to a higher level of care.

Many more urine tests are available and are used to assess for diseases of systemic or other body systems diseases. This tab cites only the urine tests used specifically to assess the urinary system. A rise in BUN reflects a decrease in kidney function kidneys are less able to filter and excrete the urea. BUN is affected by other variables e. Therefore, creatinine is a better measure of renal function, and creatinine clearance is preferred among the three blood tests.

A rise in BUN without a rise in creatinine is most likely not related to a decline in renal functioning. It is generally produced at a constant rate by the body and then is excreted by the kidney.

It is used to estimate glomerular filtration rate. A rise in serum creatinine reflects a decrease in glomerular filtration rate kidneys are less able to filter and excrete the creatinine, therefore, blood levels rise. CrCl is used to determine safe dosing of nephrotoxic drugs. Urine creatinine is based on a hour urine collection; blood for serum creatinine is collected at the end of the hour period.

However, CrCl is usually estimated by using a formula based on age, mass, and serum creatinine. Normal values: In coordination with other organs lungs, adrenal glands, hypothalamus, endocrine system , the kidneys regulate acid-base balance, electrolyte concentrations, blood volume, and BP. The kidneys maintain BP through the renin-angiotensin system RAS and regulate hydration status by retaining sodium in response to aldosterone secretion.

Therefore, kidney disorders may be reflected in changes in BP, fluids and electrolytes, and acid-base balance. When assessing BP, calculate the pulse pressure, which is the difference between the systolic and diastolic pressures.

See Tab 3 for ABG interpretation. Briefly, the sodium bicarbonate value represents the metabolic componet of the ABG and is controlled by the kidneys. The angle created where the lowest ribs connect with the vertebral column. See p. Never given IM or subcutaneously—causes severe sloughing of tissue. Check calcium and magnesium levels. IV magnesium sulfate.

Monitor electrolyte levels. Potentiate digoxin toxicity; assess as indicated. Monitor ECG, if available, or assess pulse for irregular beats.

Assess reflexes and monitor Mg levels. Assess for changes in LOC. Assess reflexes. Hold medications containing magnesium, especially in patients with renal failure. Oral replacement with KPhos or Neutra-Phos if depletion is less severe.

Too rapid IV administration can cause severe hypocalcemia; assess for tetany. Make sure patient is comfortable and safe. Notify physician. Assess skin for color, moistness, temperature, integrity.

Assess mucous membranes. Assess for patent IV access. Monitor urine output for adequate hourly rate. Assess electrolytes, BUN, creatinine. Administer oxygen. Assess recent laboratory results BUN, creatinine, electrolytes. Assess musculoskeletal function.

Assess HR; note rhythm. Assess LOC and muscle strength. Assess cardiac rhythm if patient on telemetry. Assess for digitalis toxicity, if indicated. Assess recent laboratory results BUN, creatinine, electrolytes, magnesium level. Patient should be on telemetry if receiving treatment level amounts of potassium. A gradual drop in serum sodium may be tolerated because of neuronal adaptation. Check if blood for laboratory was drawn above a running IV site.

Must be administered slowly via an infusion pump.

Download Free Sparks and Taylor Nursing Diagnosis Pocket Guide Book in PDF

Too rapid correction can cause permanent neurological impairment. Categorized according to the associated intravascular volume: Most common cause of hyponatremia in surgical patients is infusion of hypotonic fluids.

Increase in serum ADH further impairs free water excretion. Infuse 0. Euvolemic hyponatremia Associated with SIADH arising from many clinical conditions including CNS disturbances, major surgery, trauma, pulmonary tumors, infection, stress, and certain medications e.

Treat underlying cause. Restrict free water. Stimulates the same pathophysiological mechanism of impaired water excretion as is found in hypovolemic hypotonic hyponatremia. Also called dilutional hyponatremia. Possible diuretics. Assess for bladder distention. Notify physician or NP of low urine output.

Insert urinary catheter, and monitor urine output hourly. Monitor BP, HR, capillary refill time, mental status. Obtain urine samples for analysis, culture, other studies. Administer diuretics. Transfer patient to ICU if invasive monitoring is required. Educate patient and family about dialysis. Remove catheter. Do not catheterize patient if suspected pelvic trauma or blood at meatus.

Inspect and palpate for distention or tenderness of the lower abdomen. Assess temperature; recent WBC count, if available. Assess voiding patterns, recent urological procedure or procedure requiring anesthesia, medications, history of BPH, urethral stricture, history of incontinence. Place indwelling urinary catheter. Teach self-intermittent catheterization. Instruct patient about urodynamic testing.

Straight catheters are inserted for only as much time as required to drain the bladder or obtain a urine specimen. Indwelling Catheter Also called Foley or retention catheter. Indwelling catheters have two lumens, one for urine drainage and one for inflation of the balloon near the tip. Three-way Foley catheters are used for continuous or intermittent bladder irrigation.

They have a third lumen for irrigation. Procedure 1. Prepare patient: Collect appropriate equipment. Place patient in supine position female: Open and set up catheter kit using sterile technique. Don sterile gloves, and set up sterile field. If placing indwelling catheter, test patency of balloon by filling balloon with 5 mL sterile water.

Check for leaks and proper inflation. Remove water. Lubricate end of catheter; saturate cotton balls with cleansing solution. With nondominant hand and using forceps to hold cotton balls: Use one swab per swipe total of five ; male—retract foreskin; swab in a circular motion from the meatus outward.

Repeat at least three times, using a different swab each time. Gently insert catheter about 2—3 inches for females and 6—9 inches for males until return of urine is noted. Attach catheter to drainage bag, using sterile technique. Hang drainage bag on bed frame below level of bladder. With dominant hand, gently pull catheter.

If you meet resistance, stop and reassess if balloon is completely deflated. If balloon appears to be deflated and catheter cannot be removed gently, notify physician or nursing supervisor for assistance. Measure spontaneous void amount. Palpate bladder to ascertain it is empty. Notify physician or NP of symptoms. Obtain clean catheter urine specimen. Offer acetaminophen if ordered and heating pad or hot water bottle to relieve suprapubic pain. Administer phenazopyridine PRN for dysuria.

Monitor temperature. Encourage fluids. Monitor for relief of symptoms or complications urosepsis, onset of upper UTI symptoms. Administer IVF. Obtain catheterized urine sample. Change or discontinue indwelling urinary catheter.

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A Female. B Male. Listen in all four quadrants; however, most clinicians think that it is difficult to pinpoint the origin of bowel sounds because they can be heard even when ausculatating the lungs.

Patients are not fed when bowel sounds are absent. The abdomen can be distended from constipation, excessive abdominal gas, severe bowel dysfunction, obstruction, or infection. For patients with ascites, mark the abdomen, and measure girth at the same level each day to assess if ascites is decreasing or increasing. Measurements only become meaningful once a baseline is established. Both skills take practice to be helpful in an assessment.

Refer to an assessment textbook for more information. Ask about normal bowel habits. Diarrhea, especially when accompanied by vomiting, can quickly cause electrolyte imbalances and dehydration. If constipation is chronic, discuss eating habits. Test the stool for blood when GI bleeding is suspected.

Suggest a consultation to the physician or NP. How long has it been; is there early satiety feeling full after eating small quantities ; is there nausea, vomiting or weight loss? If not, why not?

Ask about allergies. Assess recent bowel habits, recent laxative or enema use. Inspect abdomen; auscultate bowel sounds. Palpate abdomen for pulsations, tenderness, and rigidity. Assess from area of least tenderness to area of most tenderness. Check all recent laboratory values including WBC count. Test emesis for occult blood. Notify physician or NP of assessment findings. Document findings and phone call.

Monitor VS as frequently as indicated. Assess output from NGT if placed. Insert an IV and hang 0. Clarify with physician or NP on alternative route for administration of PO medications. Administer pain medication, antiemetics, antibiotics. Insert an NGT, or set up suction. Insert indwelling urinary catheter. Order or obtain laboratory tests. Facilitate diagnostic tests such as abdominal x-ray, CT, endoscopy, ultrasound, and diagnostic imaging.

Explain procedure to the patient. Instruct patient to keep chin-to-chest posture during insertion. This helps to prevent accidental insertion into the trachea. Measure tube from tip of the nose to the ear lobe, then down to xyphoid. Mark this point on the tube with a piece of tape. Lubricate tube by applying water-soluble lubricant to tube. Never use petroleum-based jelly. Insert tube through nostril until the previously marked point on the tube is reached. Instruct patient to take small sips of water during insertion to help facilitate passing of the tube.

Withdraw tube immediately if patient becomes cyanotic or develops breathing problems. Be careful not to block the nostril. Tape tube 12—18 inches below insertion line. Confirm proper location of tube. Typically, gastric aspirates are cloudy and green, or tan, off-white, bloody, or brown in some cases.

Gastric aspirate can look like respiratory secretions.

A reading of 1—3 suggests placement in the stomach. Hearing a loud gurgle of air suggest placement in the stomach. If no bubbling is heard, remove tube, and reattempt. Assemble suction canister, liner, and attachment for wall suction.

If using portable suction, have ready at bedside. Change at least every other day. Removal 1. Explain procedure to patient. Don gloves. Remove tape from nose and face. Offer patient some tissues as he or she may gag slightly as the tube is withdrawn. Clamp or plug tube prevents fluid from entering lungs , and remove tube in one gentle, swift motion. Assess for signs of aspiration. Bowel sounds may be infrequent; listen for a full minute before concluding that bowel sounds are absent.

If no bowel sounds are heard, do not administer laxatives or PRN enemas; notify physician or nurse practitioner with findings. Explain how to use the enema if the patient chooses that option. Stimulant laxatives should be used infrequently. Provide comfort measures and perineal care. Obtain stool samples. Monitor nutritional status. Provide stomal care.

Obtain nutrition consult if indicated. Improper positioning of patient. Tube migration. Stomal erosion or widening.

Tube migration: Internal balloon deflates or external tube suture, bumper, or disc falls out. Internal balloon deflates or suture, bumper, or disc falls out.

Stomal infection: Leakage around tube. Inadequate stomal care.

Allergic reaction to soap. Feeding tubes must be replaced within a few hours. Delayed gastric emptying. Hold feeding if greater than mL, and call physician or NP. GI Feeding Tubes: Too rapid administration of feeding, lactose intolerance, fat malabsorption, contamination of food or feeding bag.

Hold feeding if greater than mL; call physician or NP. Feeding Tubes: If liquid form is not available, check with pharmacist to see if medication can be crushed. Gently depress, and withdraw syringe plunger to remove obstruction. If unsuccessful, leave instilled warm water in tube, clamp tube for 10—15 min, and try again.

Check blood pressure supine and standing if feasible , and document difference. Assess LOC. Connect to low intermittent suction. Assist with central line placement. Give IVF or blood products.

Administer H2 blockers. Set up gastric suction, and perform room temperature saline lavage. Obtain ECG, laboratory and diagnositic studies x-ray, endoscopy. Prepare for ICU transfer if hemodynamically unstable. Administer supplemental oxygen. Assess VS; check for orthostasis. Assess LOC and orientation; assess oxygen saturation. Assess skin color, moistness, and temperature; assess capillary refill.

Assess abdomen distention, tenderness, pain, bowel sounds. Insert large-bore IV access. Record frequency and character of stools. Assess for chest pain, SOB, headache, visual disturbances. Assess onset of symptoms and associated events e. Monitor serial electrolytes, nutritional status, and UO. Facilitate diagnostic studies.

LPN Notes: Nurse's Clinical Pocket Guide

Insert NGT if bowel obstruction is present. Insert NGT if bowel obstructed or vomiting continues. Administer antinausea medication as ordered. These hormones are instrumental in all aspects of homeostasis. The glands and the hormones they secrete include: Diagnostic testing is the cornerstone of endocrine assessment. Some physical signs and symptoms that may be the result of endocrine malfunction include: Dehydration leading to hypotension and shock.

Assess ABG results. Assess for other complications of diabetes e. Hang IVF. Administer IV insulin. Check MAR for regular insulin sliding scale based on blood glucose level. Administer appropriate dose of regular insulin, based on sliding scale. If patient is symptomatic, if MAR does not contain a sliding scale, or if blood glucose level exceeds parameters of sliding scale, notify physician or NP.

Reassess blood glusose level at appropriate intervals. Discuss diabetic management with health-care team. Consider nutrition consult. Take NS to keep the vein open with order until treatment-level IV orders are written.

Assess LOC at the same time. Note shallow, rapid respirations. Note dysrhythmias, tachycardia. This predisposes the patient to thrombosis. Facilitate blood tests and other diagnostic tests. Assist with intubation.

Assist with insertion of a central venous catheter. Teach patient about process of HHNC to avoid recurrence. Assess if patient has eaten. Assess other medications for potential to affect glucose control. Assess response to oral or IV administration of glucose. Administer glucagon or other medications if necessary. Obtain serial blood glucose levels. Assist with airway management and intubation if needed.

Manage seizure activity if needed. Will have high T4 and low TSH. Elevated free thyroxin level T4 , low TSH. SOB, chest pain. Check oxygen saturation by pulse oximetry. Assess patent IV access. Call physician or NP with findings. Document phone call and response. Assess for signs and symptoms of heart failure. Assess electrolyte levels, if recent ones are available. Assess for signs and symptoms consistent with hyperthyroidism: Administer electrolytes as ordered.

Administer medications as ordered, propylthiouracil PTU or methimazole MMI to control T4 production, hydrocortisone, and propranolol to control signs and symptoms. Aldosterone Cortisol Sex hormones Medulla: Assessment includes evaluation of dressings and wound drainage systems. If the patient uses an assistive device, asses if he or she is using it safely.

Neck and back can be included if appropriate. Focus on the extremity of interest, but initially compare with the contralateral arm, hand, leg, or foot. Have the patient close his or her eyes while you do this. See Pain Assessment in Basics tab. For example, tape covering a postoperative dressing can cause skin maceration and blistering. The tape is secured to the surface of the skin, but as the skin stretches with swelling, the tape causes a shear injury by pulling the skin.

This sometimes occurs in the total hip replacement dressing, especially in the older person who has fragile skin. Be extra vigilant if the patient is diabetic, as circulation to lower extremities is decreased. Assess the tightness of these dressings, which can become irritating and quite injurious. This envelope of tissue creates a compartment that contains muscles, nerves, veins, and arteries.

The increased pressure closes off capillaries, arterioles and, eventually, arteries, causing ischemia that will progress to necrosis if not treated. This discussion is focused on the arm or leg. The pain worsens with stretching of the involved muscles.

This pain is the first symptom to appear. Once the other Ps are evident, the process is well established, and tissue damage is probable. When pain is more severe than expected, immediately consider compartment syndrome, and notify physician or NP. Use a Doppler if not palpable. Note skin color and if pallor is present. Blanch the skin, and check capillary refill time. Assess nerves in the affected extremity.

Is there altered sensation or impaired mobility? Pain indicates ischemia, but if pallor or pulselessness develops, tissue necrosis and permanent damage will occur. The physician or NP must rapidly determine the treatment plan and if immediate surgery is necessary. Then perform a secondary survey to detect associated injuries. Necrotizing Fasciitis NF A very rapidly progressing infection by Streptococcus pyogenes of the deeper layers of skin and tissue, requiring immediate intervention.

Very high mortality rate. Obtain x-rays or CT. Start a heparin drip to decrease risk of vasculitis and thrombosis. Transfer the patient to ICU. Audible crack may be heard. Do not attempt to realign bone. Monitor for signs of respiratory depression or excessive sedation. Manage pain so that patient is comfortable but not sedated. Protect patient from additional injury. Obtain assistive devices for ambulation or self-care activities. Initiate discharge planning and collaborate with home care nurse for follow-up care and prevention.

Assess VS and pain level. Assess ability to move all extremities. Assess alignment and symmetry of extremities. Assess soft tissue and skin for abrasions, swelling, deformity. Assess for acute underlying condition, such as infection, transient ischemic attack, urinary tract infection, hypotension, or cardiac dysrhythmia.

Assess for orthostasis, problems with gait, changes in mental status, and recent changes in functional status. Review records for preexisting conditions, medication use, and previous falls. Assess medication administration record for polypharmacy or medication that may have contributed to fall.Control external bleeding with direct pressure. Is it similar to pain you have had before?

Obtain a lead ECG. If possible, consult with the patient and his family when establishing expected outcomes. Substernal anterior chest. Learn from them.

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