Patient Initials: Student:

Rm #: Date(s) of Care:

PEDIATRIC CLINICAL PREP SHEET

Date of admission:
Age: Sex: Adm. Wt.
Allergies:
Diet:
Activity Order: / Chief complaint:
Admitting diagnosis:
Date and type of surgery:
IV type & site:
IV solution & rate:
Treatments:
Oxygen:
Labs:
Other: / PMH / Chronic conditions:
Other disciplines involved in care of client (e.g. respiratory, physical or occupational therapy, social service, etc.)

Significant abnormal lab values Why are they abnormal? How are they being corrected?

1.

2.

3.

Diagnostic Procedures Purpose (if unfamiliar to you) Patient Prep & Post Care Results

1.

2.

3.

Tubes, lines, drains or treatments Purpose (if unfamiliar to you) Nursing assessment/documentation

1.

2.

3.

Quick assessment
Airway
Breathing
Circulation
Intake
Output
Pain
Safety / End-of-Shift ülist
·  Charting
·  MARs
·  Signatures
·  I&Os
·  Goodbye to pt.
·  Report to RN
·  üPockets
·  No patient ID on papers
Growth & Development Assessment
Textbook / Observations of Your Patient
Physical
Motor
Social &
Language
(Eriksen)
Cognitive
(Piaget)
Other Developmental notes or observations (for use on NSM circle).
Post-Clinical

What teaching (formal or informal) did you perform [or did you witness] for this patient &/or the family?

·  If family not present – what things did you see that might be areas of teaching after assessing parent’s knowledge?

Areas I was strong in: / Areas needing improvement:

Cabrillo College ADN Program

C.Madsen/12/1/2005/rev Fall 09; Fall10 1