Assessment
PART A
CNS
Fell unconscious
CVS
HEENT
Has history of falls
RESP
GI
GU
INTEG
Skin breakdown on coccyx
MS
REPRO
53 yr old male, has 3 children
PSYCH/SOCIAL
Best friend and good support died 2 months ago, scared to go home, lives in Regina, has wife. He expressed he
doesn’t know what diabetes. 53 years old.
METABOLIC/ENDO
Type 2 Diabetes Melitus
PART A
# _____
Priority Assessments:
# _____
Nursing Dx: __________________________
Nursing Dx: __________________________
Supporting Data:
Supporting Data:
# _____
Nursing Dx: __________________________
Supporting Data:
# _____
Client Initials: _______ Age: _______
Admitting Dx: ___________________
_______________________________
Nursing Dx: __________________________
Supporting Data:
Med/Surg Hx: ___________________
_______________________________
# _____
# _____
Nursing Dx: __________________________
Nursing Dx: __________________________
Supporting Data:
Supporting Data:
Parking Lot:
PART B
Nursing Diagnosis
Priority #
Client Goals
(Client will…….)
Nursing Interventions
(Nurse will…….)
Evaluation
(Was client goal met?)