Clinical Worksheet

Clinical Worksheet Date: 05/03/2021 Student Name: Carly Gee Assigned vSim: Christopher Parrish Initials: CP Age: 18 M/F: M Code Status: full Diagnosis: cystic fibrosis Length of Stay: 1 day Allergies: NKA HCP: N/A Consults: nutrition Isolation: Standard Fall Risk: yes Transfer: Stand- by IV Type: N/A Location: N/A Fluid/Rate: NG tube fluid rate 60 mL/hr Critical Labs: Albumin, Creatinine, Protein, Vitamin D Other Services: OT Consults Needed: Dietary Why is your patient in the hospital (Answer in your own words and include the History of present Illness): Patient has been admitted to the hospital after visiting with his PCP due to losing a total of 13.2 pounds and fatigue. Health History/Comorbities (that relate to this hospitalization): Hx of cystic fibrosis since childhood and fatigue. Shift Goals/ Patient Education Needs: 1. Assess vitals 2. Educate pt on intake and output 3. Monitor and record NG tube feedings 4. Educate pt on nutrition Path to Discharge: Help patient get nutritional status back underway without the feeding tube. Explain the importance of proper nutrition and maintaining a proper sleep schedule, as well as monitoring daily weight. Path to Death or Injury: client will neglect diet and will begin to deteriorate due to lack of inadequate nutrition This study source was downloaded by from CourseH on :22:01 GMT -05:00 This study resource was shared via CourseH