CONCEPT MAP WORKSHEET
DESCRIBE DISEASE PROCESS AFFECTING PATIENT
(INCLUDE PATHOPHYSIOLOGY OF DISEASE PROCESS)
DIAGNOSTIC TESTS
(REASON FOR TEST AND RESULTS)
PATIENT INFORMATION
ANTICIPATED NURSING INTERVENTIONS
ANTICIPATED PHYSICAL
FINDINGS
vSim ISBAR ACTIVITY
STUDENT WORKSHEET
INTRODUCTION
Your name, position (RN), unit you are
working on
SITUATION
Patient’s name, age, specific reason for visit
BACKGROUND
Patient’s primary diagnosis, date of
admission, current orders for patient
ASSESSMENT
Current pertinent assessment data using head
to toe approach, pertinent diagnostics, vital
signs
RECOMMENDATION
Any orders or recommendations you mayhave
for this patient
Patima Sonogo,
PATIENT EDUCATION WORKSHEET
NAME OF MEDICATION, CLASSIFICATION, AND INCLUDE PROTOTYPE
MEDICATION:
CLASSIFICATION:
PROTOTYPE:
SAFE DOSE OR DOSE RANGE, SAFE ROUTE
PURPOSE FOR TAKING THIS MEDICATION
PATIENT EDUCATION WHILE TAKING THIS MEDICATION
PATIENT EDUCATION WORKSHEET
NAME OF MEDICATION, CLASSIFICATION, AND INCLUDE PROTOTYPE
MEDICATION:
CLASSIFICATION:
PROTOTYPE:
SAFE DOSE OR DOSE RANGE, SAFE ROUTE
PURPOSE FOR TAKING THIS MEDICATION
PATIENT EDUCATION WHILE TAKING THIS MEDICATION
PATIENT EDUCATION WORKSHEET
NAME OF MEDICATION, CLASSIFICATION, AND INCLUDE PROTOTYPE
MEDICATION:
CLASSIFICATION:
PROTOTYPE:
SAFE DOSE OR DOSE RANGE, SAFE ROUTE
PURPOSE FOR TAKING THIS MEDICATION
PATIENT EDUCATION WHILE TAKING THIS MEDICATION
Clinical Worksheet
Date:
Initials:
Student Name:
Diagnosis:
HCP:
Assigned vSim:
Isolation:
IV Type:
Location:
Critical Labs:
Other Services:
Age:
Fall Risk:
M/F:
Length of Stay:
Consults:
Fluid/Rate:
Transfer:
Code Status:
Allergies:
Why is your patient in the hospital (Answer in your own words and include the History of present Illness)?:
Health History/Comorbities (that relate to this hospitalization):
Shift Goals/ Patient Education Needs:
1.
2.
3.
4.
5.
Path to Discharge:
Path to Death or Injury:
Consults Needed:
Alerts:
What are you on alert for with this patient? (Signs & Symptoms)
Management of Care: What needs to be done for this Patient Today?
1.
1.
2.
2.
3.
3.
4.
What Assessments will focus on for this patient?
(How will I identify the above signs &Symptoms?)
5.
1.
6.
2.
Priorities for Managing the Patient’s Care Today
3.
1.
2.
List Complications may occur related to dx, procedure, comorbidities:
3.
1.
4.
2.
3.
What aspects of the patient care can be Delegated and who can do it?
What nursing or medical interventions may prevent the above Alert or complications?
LPN
CNA
1.
2.
3.
4.