|
Nurse met
|
gait
|
|
Orientation
• • •
|
clothing
|
|
eye contact
|
hygeine
|
|
Nurse observed
• • •
|
Rate of speech
|
|
affect
• • •
|
Mood
• • •
|
|
dx understanding
|
Individual's description of symptoms
|
|
SI/HI
|
|
|
|
|
|
Intervention MUST INPUT
|
AIMS TEST COMPLETED
|
|
Intervention BASIC
• • •
|
Intervention Administered inj
|
|
NO MEDICATION INTERVENTION
• • •
|
intervention injection site
|
|
ALL Intervention (select)
• • •
|
Intervention EPS side effect
• • •
|
|
|
|
|
Intervention DIABETES
• • •
|
Intervention FALL PREVENTION
• • •
|
|
Intervention HTN
• • •
|
Intervention HEALTHY WEIGHT
• • •
|
|
Intervention OBESITY
• • •
|
Intervention COPING
• • •
|
|
Intervention HEALTHY EATING
• • •
|
|
|
Intervention ASTHMA
• • •
|
Intervention PHARMACY
• • •
|
|
Intervention HF
• • •
|
Intervention COMM RESOURCES
• • •
|
|
Intervention CONSTIPATION
• • •
|
Intervention SOCIAL/ BOUNDARIES
• • •
|
|
Intervention LITHIUM/ LAB-WORK
• • •
|
Intervention FLUID & RESTRICTION
• • •
|
|
Intervention DIALYSIS
• • •
|
Intervention CAFFEINE
• • •
|
|
Intervention SOBRIETY & TOBACCO
• • •
|
Intervention MEDICAID TRANSPORT
• • •
|
|
Intervention SCHEDULED MD APPT
• • •
|
Intervention SAFETY PLAN
• • •
|
|
Intervention NA & AIMS
• • •
|
Intervention HYGIENE
• • •
|
|
Intervention EMPATHETIC RESPONSE
• • •
|
Intervention BMI
• • •
|
|
|
|
|
Intervention PAIN
• • •
|
|
|
|
|
|
VITAL SIGNS Blood pressure
/
|
|
|
|
|
|
TEMPERATURE
|
|
|
Pulse
|
|
|
RR
|
|
|
Height
|
|
|
Weight
|
BG
|
|
PAIN
|
appt date/ ETC...
|
|
Nurse scheduled doctors appt
• • •
|
NO MED SIDE EFFECTS
• • •
|
|
Medication SIDE EFFECTS
• • •
|
Diabetes RESPONSE
|
|
HIGH BLOOD PRESSURE
|
Asthma RESPONSE
|
|
MED compliance
|
Diuretic RESPONSE
|
|
MED Efficacy
|
|
|
FLUID INTAKE
|
Response Caffeine intake
|
|
DIET
|
MEALS
|
|
MEAL PLANNING
|
Exercise
|
|
Response BM
|
Response Coping skills
|
|
Response Tobacco
|
|
|
SLEEPING HABITS
|
1-800-quit-now
|
|
|
Response RN Asst/ AIMS test
|
|
ADD EXTRA INFO
|
SOBRIETY
|
|
|
**RECEPTIVE to RN visit
|
|
PLAN
|
|
|
Transitional
|
|
