Kardex form for patient assignments

1. ADN CLINICAL WORKSHEET Date______Student__________________________
CLIENT INITIALS______RM#______AGE_____GENDER_____WT______HT______OCCUPATION_______________________ETHNICGROUP_______________________
ADMIT DATE_______ADMIT DX_______________________________________ SURGICAL PROCEDURE: _______________________________________________________
SURGERY DATE_________POST-OP DATE OF CARE______________ALLERGIES____________________________________________________CODE STATUS_________
Research of Medical Dx. Research of Surgical Procedure and/or
Procedures/Diagnostics
Pertinent Past Medical History
Medical Orders Relevant to the Plan of Care
Admission V/S (baseline):
Previous Shift V/S (baseline):
IV Fluid/Rate (ml/hr): Oxygen: Resp. Tx. (type &
frequency):
Current Lab Orders (for
your day(s) of care):
V/S frequency:
Neuro checks (frequency):
Heplock or Saline lock flushActivities
Bedrest
HOB_____
Turn_____
Chair____amb._____
ROM____dangle_____
Physical Therapy
Treatment:
Traction lbs.:____
Diet Order:
Encourage/Restrict fluids
I & O frequency:
Foley
Straight cath.
Condom cath.
Dressing Changes: Suction &/or Drains
Gastric:
Wound:
Other:
Current Diagnostic Tests
(for your day(s) of care:
Glucoscan/Accucheck
frequency:
PAS stockings or TED hose
Bath type: _______________
Any Other Treatment
Specific to Your Pt.
Psycho-social and
Spiritual Issues
Tubefeeding:
Resid. 4:
PEG or NG
Post-Op Care
Cough/deep breath
frequency:
Incentive Spirometer
frequency: