Medical-Surgical
Assessments
, ACUTE MEDICAL/SURGICAL ISBARR
IDENTIFICATION: Date: __________Time: _________
Room# Age: Sex: M/F
Weight: Height:
Physician: Nurse: Aid:
Family contact: Advanced Directive
SITUATION:
Date of Admission: Admitted From:
Admitting Diagnosis:
Status: Full Code DNR Other: _____________
Vital Signs: B/P: HR: RR: SpO2: Room Air O2 at_________L/min Via: ____________________
Temp: Temporal Oral Tympanic
BACKGROUND:
Allergies: Latex Other: NKDA
Past Medical/Surgical
History:_________________________________________________________________________________________________________
__________________
Isolation Precautions: Standard C-Diff Contact: _______________ Airborne Droplet
Safety Precautions: Aspiration Fall Seizures Other: _________________________________________
Additional Safety concerns/interventions: _________________________________________________________________________
Assistive Devices: None Walker Cane Wheelchair Other: ________________________________
Transfer Devices: ______________________________________________________________________________________________
Hearing Aids:(select one) Right Left Bilateral Dentures: (select one) Upper Lower Both
ADL Assist: Hygiene: Nutrition/Diet:
ASSESSMENTS:
Neurological Alert Oriented to: Person Place Time Situation
Respiratory Room Air O2 via: __________ at ____________ L/min
Cardiovascular Pacemaker Other:
Gastrointestinal
Genitourinary
Acute Medical/Surgical Assessment Page 2 of 13
Assessments
, ACUTE MEDICAL/SURGICAL ISBARR
IDENTIFICATION: Date: __________Time: _________
Room# Age: Sex: M/F
Weight: Height:
Physician: Nurse: Aid:
Family contact: Advanced Directive
SITUATION:
Date of Admission: Admitted From:
Admitting Diagnosis:
Status: Full Code DNR Other: _____________
Vital Signs: B/P: HR: RR: SpO2: Room Air O2 at_________L/min Via: ____________________
Temp: Temporal Oral Tympanic
BACKGROUND:
Allergies: Latex Other: NKDA
Past Medical/Surgical
History:_________________________________________________________________________________________________________
__________________
Isolation Precautions: Standard C-Diff Contact: _______________ Airborne Droplet
Safety Precautions: Aspiration Fall Seizures Other: _________________________________________
Additional Safety concerns/interventions: _________________________________________________________________________
Assistive Devices: None Walker Cane Wheelchair Other: ________________________________
Transfer Devices: ______________________________________________________________________________________________
Hearing Aids:(select one) Right Left Bilateral Dentures: (select one) Upper Lower Both
ADL Assist: Hygiene: Nutrition/Diet:
ASSESSMENTS:
Neurological Alert Oriented to: Person Place Time Situation
Respiratory Room Air O2 via: __________ at ____________ L/min
Cardiovascular Pacemaker Other:
Gastrointestinal
Genitourinary
Acute Medical/Surgical Assessment Page 2 of 13
