Exam (elaborations) UNDERSTANDING Medical Surgical Nursing

Please answer the following questions to the best of your ability. 1. In general, how would you rate your overall health:  Excellent  Very Good  Good  Fair  Poor 2. In general, how would you rate your quality of life:  Excellent  Very Good  Good  Fair  Poor 3. In general, how would you rate your mental health, including your mood and your ability to think?  Excellent  Very Good  Good  Fair  Poor 4. In the past 7 days, how much did pain interfere with your day to day activities?  Not at all  A little bit  Somewhat  Quite a bit  Very Much 5. Over the last 2 weeks, how often have you been bothered by any of the following problems? Not at all Several days More than half the days Nearly every day Little interest or pleasure in doing things     Feeling down, depressed or hopeless     Place patient sticker here AnnualWellness Health Risk Assessment 3 Rev 9/5/17 6. Because of a health or physical problem, do you have any difficulty doing the following activities without special equipment or help from another person? I do not have difficulty Yes, I have difficulty I am not able to do this activity unassisted Bathing    Dressing and grooming    Eating    Using the toilet    Getting in and out of bed or chairs    Managing medications    Managing money    Household activities, like food prep, laundry, and housekeeping    Can you shop for groceries and clothes?    Can you get to places out of walking distance?    7. In the past 6 months, have you accidentally leaked urine?  No  Yes 8. A fall is when your body goes to the ground without being pushed. Did you fall in the past 12 months?  No  Yes 9. Walking Status:  Walk unassisted  Use a cane/walker  Use a wheelc