CSU, STANISLAUS B.S.N. CLINICAL PLAN OF CARE

Patient Data

Student ALYSSA CARDINAL Date of Care: 2/26-2/27/15 Room Number: S4741 Code Status: Full Pt. Initials: D.S. Gender: MALE Age: 55 Height: 5’11” Weight: 82kg (180lb) BMI: 25.1 Spirituality: Non-specified Ethnicity: CAUCASIAN Admitting Diagnosis: ASPIRATION PNEUMONIA (r/t COPD exacerbation) Vital Signs (2/27 1215): Temp: 98.3 HR: 104 RR: 22 B/P: 135/80 O2 Sat: 98% RA (Trach collar) Pain Scale & Scale Type: 8/10 (0-10 scale) History related to this admission: COPD, ASTHMA Past Medical History: UPPER ESOPHAGUS METS TO A SUPRACLAVICULAR NODE (Dx 2014)- has undergone 3 cycles chemo/XRT, TRACHEOSTOMY, HTN, LUMBAGO, PAIN IN LIMBS, PVD-INTERMITENT CLAUDICATION, TOBACCO USER, DISORDER OF KIDNEY AND URETER (unspecified), COPD, HYPERLIPIDEMIA Surgical History & Date: • Difficult intubation (6/3/14) MD: Olgun, Esra Diet: Clear liquids (as tolerated); PEG feeding w/ Osmolite 1.2, 2016 calories, 93g protein Activity: bed rest with 1 person assist to bedside commode Foley: none Feeding Tube & Rate: PEG- Osmolite 70mL/hr Advance Directive: Yes ________ No ___X____ Drains/ Tubes: PEG, Trach (placed 10/10/14, SZ 6

Shiley) Isolation: no VS Freq: Q4H Glucose Monitoring: Q6h DVT Prophylaxis: Active ROM, SCDs (pt refuses), position changes Vascular Access: IV Site: Peripheral- rt hand IV Solution & Rate: NS 50mL/hr IV Site: Implanted port, rt infraclavicular fossa- (no access until blood cultures come back negative) PCA/Epidural: none Telemetry & Rhythm: 5 lead; 0300- sinus tachy- HR 116 Safety Considerations: Aspiration precautions, Fall risk, Pressure ulcer prevention Restraints: none Labs for day of clinical: CBC, phosph, Mg+ Dressing Changes & Frequency: PEG dressing change Qshift, Trach care Q12h Scheduled Procedures: sputum culture, stool

culture Procedures done this admission: EKG (2/27/15 )- rate 126, sinus tachy, normal intervals, no STEMI CXR (2/24 2225)- cardiomegaly, small pleural effusion, no pneumothorax CT w/ Contrast (2/25 12:04AM)- bilateral lung nodules and mass in RLL, metastatic disease, pleural space unremarkable, no significant effusion, no pneumonia, trace pericardial effusion, CA calcifications, no PE, trach tip in good location, old bilateral rib fractures, cyst in dome of rt lobe liver, small hiatal hernia; Echo w/Doppler (2/25 1600) r/t syncope

Oxygen: RA w/humidification via T-piece Respiratory Treatment: Yes; ipratropium/albuterol (Duoneb) Q6h Vent Settings: not on vent Advanced Hemodynamic Monitoring & Values: None IV Drips Medications Dosage & Rate: none (IV antibiotics listed in Meds)

Concept Mapping Student Name: _Alyssa Cardinal__

List NANDA nursing diagnosis, supporting data, and interventions. List Supporting Data under each nursing diagnosis to support each diagnosis, including lab data, medications, assessment findings in clockwise order. List Interventions for Each Nursing Diagnosis. All medical & nursing interventions should be found in one or more of the boxes. Evaluate Each Nursing Diagnosis on the following page.

2. Impaired Gas Exchange Data to Support: Dx of COPD, coarse crackles, resp labored with activity; RR=22 resting, é RR w/activity Interventions: Assess O2 sat, administer O2 during periods of dyspnea, administer humidified RA to liquefy congestive secretions and improve breathing, elevate HOB to improve effectiveness of respirations. Meds: Duoneb (bronchodilator) and Advair (corticosteroid)- égas exchange by opening the airways, assess ABGs

1. Ineffective airway management Data to Support: Trach, thick, copious secretions, difficulty expelling secretions Interventions: Assess O2 sat, RR and ease of breathing, administer O2 during periods of dyspnea, administer humidified RA to liquefy congestive secretions and improve breathing, elevate HOB to improve effectiveness of respirations. Encourage cough and assist with cough as needed. During episodes of partial or complete airway occlusion r/t mucous plug, rapidly push 10mL NS directly in to trach to mobilize secretions and assist with expulsion. Meds: Duoneb (bronchodilator) and Advair (corticosteroid)- égas exchange by opening the airways

5. Risk for aspiration Data to Support: Dx of COPD (excessive fluids) with trach and difficulty expelling mucous, ineffective/depressed cough, heavy pain medication administration, decreased GI mobility and tube feedings, impaired swallowing, previous aspiration on admission Interventions: Assess cough, gag reflex, swallowing ability, auscultate bowel sounds for GI motility, assess lung sounds for crackles/ronchi, suction as needed, elevate HOB, check GT tube residuals

3. Excess fluid volume Data to Support: Dx of COPD, coarse crackles in lungs, generalized edema Interventions: Auscultate lung sounds, Monitor I&O (Consult with physician to consider starting pt on diuretic therapy)

Chief Medical Diagnosis: COPD Priority Assessments: Pt is at risk for respiratory failure, so monitoring lung sounds, RR, ease of breathing, and O2 sat is crucial. Pt also has a trach, cancer, and PVD, so trach patency, pain management and effective tissue perfusion are important for this pt as well.

4. Anxiety r/t pain management Data to Support: Pt frequently requesting pain medication and asking when the next dose of Dilaudid or oxycodone can be administered, pt appears agitated prior to administration of pain meds Interventions: Assess pt’s pain level and administer pain medication on time, write analgesic schedule on pt’s whiteboard to relieve anxiety of when next dose will be administered, reassure pt that his pain meds will be received as quickly as possible to manage pain levels, (Consult with physician to consider adding an anti-anxiety to pt’s medication list)

6. Risk for bleeding Data to Support: Platelet count 32, multiple scattered bruises on lower extremities Interventions: Assess skin for wounds, bruising, prolonged bleeding at puncture sites, monitor PLT count and coagulation studies (no PT/INR in pt labs), monitor VS for decreased BP and increase, use soft toothbrush and electric razor to prevent injury, fall precautions.

Student Name: __Alyssa Cardinal__

Problem Evaluation

Problem # Evaluation of Patient Response

1 (0800)- O2 sat 96% on humidified RA, generalized coarse crackles, RR 19, no

dyspnea. HOB elevated. Infrequent mildly productive cough. (0845)- Dyspnea r/t mucous plug occluding airway. FiO2 increased, O2 sat

dropped to 91%. Removed pt’s inner cannula and flushed trach w/ NaCl x3. Pt coughed and expelled plug. O2 sat increased to 98%. Inner cannula replaced.

(0900)- Meds administered (0930) Crackles in bilateral bases, no dyspnea

2 (0800)- O2 sat 96% on humidified RA, generalized coarse crackles, RR 19, no

dyspnea. HOB elevated. Infrequent mildly productive cough. (0845)- Dyspnea r/t mucous plug occluding airway. FiO2 increased, O2 sat

dropped to 91%. Removed pt’s inner cannula and flushed trach w/ NaCl x3. Pt coughed and expelled plug. O2 sat increased to 98%. Inner cannula replaced.

(0900)- Meds administered (0930) Crackles in bilateral bases, no dyspnea

3 (0800)- Generalized coarse crackles, intake- 120 mL/hr, output- 375mL

(0930) Crackles in bilateral bases (1030)- Intake- 120 mL/hr, output 250mL

4 (0715) Anxious behaviors r/t pain. Pt continuously asks for pain medication

schedule. Pain 7-8/10. (0745) Administered Dilaudid.

(0800) No observable anxious behaviors, pain 5/10. (1010) Anxious behaviors r/t pain. Administered oxycodone.

(1030) No observable anxious behaviors, pain 5/10.

5

(0800)- Infrequent, mildly productive cough. Generalized coarse crackles. Adequate swallow. BS active x4.

No gastric residual. HOB 45 degrees. (0930) Crackles in bilateral bases

6 (0800)- PLT count 32, scattered bruises on lower extremities, no current bleeding

from puncture sites. Generalized coarse crackles. BP127/76, HR 116. Fall risk and bleeding precautions implemented.

(0930) Crackles in bilateral bases (1215) BP135/80, HR 104

Medication:  Generic  &  Trade  Name,  Dose,  Route,  Frequency  

Mechanism  of  Action  &  Class   Pt  Specific  Rationale   Nursing  Considerations  (Assessment  implications,  S/Es,  reasons  to  hold  med,  admin  rate,  etc.)  

vancomycin  1250mg  in  250mL  NS,  IVPB  Q12h  

Tricyclic  glycopeptide  antibiotic;  primarily  inhibits  bacterial  cell  wall  synthesis  to  destroy  bacteria  and  treat  infection.  

Pt  has  extremely  elevated  WBC  indicating  infection.  Vanco  will  tx  the  pt's  infection.  

Hypokalemia  (CHECK  K+),  n/v/d,  cardiac  arrest,  hypotension,  C.diff;  Infuse  over  1  hour  

fluticasone  propionate  salmeterol  (Advair),  250mcg/50mcg  oral  inhalation,  1  puff  Q12h  

Adrenal  glucocorticoid,  anti-­‐inflammatory,  corticosteroid;  Glucocorticoids  inhibit  mast  cells,  eosinophils,  basophils,  lymphocytes,  macrophages,  and  neutrophils,  while  also  inhibiting  production  or  secretion  of  cell  mediators  such  as  histamine,  leukotrienes,  cytokines  and  eicosanoids.  

This  pt  has  COPD  and  asthma.  This  drug  will  reduce  inflammation  and  prevent  exacerbations.  

Candidiasis  of  mouth-­‐  rinse  after  use.  Cough,  nosebleeds,  upper  respiratory  infection,  pneumonia-­‐  observe  for  sx  of  infection  and  monitor  WBC.  Teach  pt  that  this  drug  is  not  for  acute  attacks  and  may  take  a  few  weeks  to  see  results.  Plug  trach  during  administration  of  this  med.  

metronidazole  (Flagyl);  500mg  in  100mL  NaCl    IV  Q8h  

Antibiotic;  selectively  produces  cytotoxic  effects  in  anaerobes  by  a  reduction  reaction,  depriving  the  organism  of  required  reduction  equivalents.    

Pt  has  extremely  elevated  WBC  indicating  infection.  Vanco  will  tx  the  pt's  infection.  

Abd  discomfort,  n/d,  peripheral  neuropathy,  ototoicity;  Infuse  over  1  hour  

piperacillin  sodium/tazobactam  sodium  (Zosyn),  3.375g  in  100mL  NS  IVPB  Q8h  

Penicillin  antibiotic;  a  bactericidal  that  inhibits  bacterial  septum  formation  and  cell-­‐wall  synthesis  to  treat  infection  

Pt  has  extremely  elevated  WBC  indicating  infection.  Vanco  will  tx  the  pt's  infection.  

constipation  or  diarrhea,  n/v,  fever,  C.diff,  pancytopenia;  Infuse  over  1  hour  

acetaminophen  (Tylenol)  650  mg  oral  Q4h  PRN  

analgesic/antipyretic-­‐  centrally  acting  COX-­‐2  inhibitor  that  elevates  the  pain  threshold,  thereby  reducing  pain  levels.  Reduces  fever  by  inhibiting  the  formulation  and  release  of  prostaglandins.  

This  pt  has  pain  constant  aching  pain  caused  by  trach  and  cancer.  This  med  will  treat  his  fever.  

4  g/day  max  to  prevent  liver  failure  (hepatotoxicity,  GI  hemmorhage,  or  nephrotoxicity).  Stevens-­‐Johnson  syndrome.  Take  with  full  glass  of  water  

hydralazine  (Apresoline),  10mg  IV  Q4h  PRN  for  SBP  >160  

Peripheral  vasodilator/antihypertensive;  relaxes  vascular  smooth  muscle  by  interfering  with  Ca+  movement  responsible  for  initiating  or  maintaining  the  contractile  state  within  vascular  smooth  muscle.  

Pt  has  HTN.  This  med  acts  quickly  to  reduce  BP.  

Administer  each  10mg  over  1  minute.  Hepatotoxicity,  agranulocytosis,  n/v/d,  loss  of  appetite,  chest  pain,  palpitations,  tachyarrhythmias.  

Hydrocodone/  acetaminophen  (Norco-­‐10)  10mg/325mg  1  tab  oral  Q4h  PRN  

Opioid  agonist  analgesic;  Acts  on  the  CNS  to  fill  opioid  receptors  causing  pain  relief  

This  pt  has  pain  ranging  between  7  and  9.  This  med  will  reduce  his  pain  to  enhance  comfort  and  reduce  anxiety  r/t  pain.  

n/v,  dizziness,  Stevens-­‐Johnson  syndrome,  agranulocytosis  (check  WBC),  thrombocytopenia  (check  plt  count),  hepatotoxicity,  respiratory  depression  (check  RR  before  and  after  administration).  Do  not  exceed  more  than  4000mg  acetaminophen  daily.  Teach  pt  to  report  s/s  of  resp  depression.  Do  not  ambulate  after  administration  of  this  med  due  to  dizziness.  

hydromorphone  (Dilaudid),  2mg  IV  Q3h  PRN  

Opioid  agonist  analgesic;  Acts  on  the  CNS  to  fill  opioid  (mu)  receptors  causing  pain  relief  

This  pt  has  pain  ranging  between  7  and  9.  This  med  will  reduce  his  pain  to  enhance  comfort  and  reduce  anxiety  r/t  pain.  

Constipation,  n/v,  hypotension,  resp.  depression,  apnea,  avoid  activities  requiring  mental  alertness.  Administer  over  2  minutes.  

ipratropium/albuterol  (Duoneb),  0.5  mg/  2.5  mg/  3  mL,  oral  inhalation  Q6h  RT  

Beta  2  adrenergic  agonist/  bronchodilator/  sympathomimetic/  anticholinergic.  Albuterol  is  a  sympathomimetic/beta  2  agonist  that  activates  these  receptors  to  relax  the  smooth  muscles  of  the  airway.  Ipratropium  is  an  anticholinergic  that  produces  a  local  effect  (opposed  to  systemic)  that  causes  bronchodilation.  

This  pt  has  COPD  with  a  recent  exacerbation.  It  is  therefore  important  to  maintain  a  relaxed,  dilated  airway  to  enhance  oxygenation  and  prevent  another  exacerbation.  This  is  a  short  acting  med  in  comparison  to  the  Symbicort.  

This  med  can  cause  GI  disturbances,  upper  resp.  infections,  arrhythmias,  bronchospasm,  blurred  vision  and  dizziness.  Remain  in  bed  after  administration  of  this  med  to  prevent  falls.  

sucralfate  (Carafate),  1g/10mL,  1  g  Q10-­‐30min  before  meals  and  at  bed  

Antiulcer;  forms  an  ulcer-­‐adherent  complex  with  proteinaceous  exudate,  such  as  albumin  and  fibrinogen,  at  the  ulcer  site,  protecting  it  against  further  acid  attack.  Also  forms  a  barrier  on  the  stomach  to  protect  from  further  damage.  

This  pt  is  receiving  many  medications  that  cause  GI  irritation.  This  med  will  prevent  acid  erosion/irritation  of  the  stomach  lining  to  prevent  GI  ulcers.  

Constipation,  albumin  toxicity  in  pts  with  renal  failure  

ondansetron  (Zofran),  2mg/mL,  4mg  IV  Q6h  PRN  

Antiemetic,  Serotonin  receptor  antagonist;  Prevents  nausea  by  blocking  5-­‐HT3  receptors  peripherally  on  vagal  nerve  terminals  and  centrally  in  the  chemoreceptor  trigger  zone.  

This  pt  is  in  constant  pain  and  has  anxiety  r/t  his  pain.  This  often  leads  to  nausea.  This  med  will  reduce  the  pt's  nausea,  making  him  more  comfortable.  

Constipation,  diarrhea,  increased  liver  enzymes,  headache,  fatigue,  malaise,  prolonged  QT  interval  

oxycodone  (Roxicodone),  10mg  oral  tab  Q6h  PRN  

Opioid  agonist  analgesic;  Acts  on  the  CNS  to  fill  opioid  (mu)  receptors  causing  pain  relief  

This  pt  has  pain  ranging  between  7  and  9.  This  med  will  reduce  his  pain  to  enhance  comfort  and  reduce  anxiety  r/t  pain.  

Constipation,  n/v,  hypotension,  resp.  depression,  apnea,  avoid  activities  requiring  mental  alertness.  

temazapam  (Restoril),  15mg  oral  cap  at  bed  PRN  insomnia  

Benzodiazepine/Hypnotic;  Enhances  the  effects  of  GABA  to  produce  a  calming  effect  on  the  body.  

This  pt  has  anxiety  r/t  pain,  which  often  causes  insomnia.  With  an  unstable,  unfamiliar  hospital  environment,  it  is  easy  to  become  anxious.  This  med  helps  ease  anxiety  to  make  sleep  easier.  

Hypotension,  somnolence,  lethargy,  avoid  activities  requiring  mental  alertness,  teach  pt  to  report  abnormal  thoughts/behaviors.  This  drug  is  not  taken  on  a  regular  basis,  used  as  needed  for  insomnia.  

LABS Normal Range

RESULT 1

RESULT 2

RESULT 3 Reason for abnormal lab values r/t diagnosis & nursing implications

(Fill in Hospital Norms)

CBC (2/24) 2155

(2/25) 0406

(2/27) 0421

WBC   4.0-11.0 23.1 H 27.0 H 26.5 H Infection likely r/t aspiration on admission

RBC   3.9-5.4 3.62 L 3.62 L 2.75 L Cancer  causes  decreased  RBC  production  

Hemoglobin 11.7-15.5 12.5 L 12.4 L 9.3 L Cancer causes decreased RBC production

Hematocrit 35-47% 34.2 L 34.8 L 26.6 L Cancer causes decreased RBC production

MCV   80-100 95 96 97

MCH   27-33 34.5 H 34.3 H 33.8 H Poorly oxygenated blood

MCHC   31-36 36.5 H 35.6 H 35

RDW   <16.4% 15.3 15.3 15.6

PLT COUNT 150-400 35 LL 32 LL 38 LL!

This pt is not on any blood thinners or other medications that reduce plt count. The reason for thrombocytopenia is unknown- This pt does have a bacterial infection which can cause destruction of platelets. This pt could also has

PVD which can lead to clotting and therefore a large abundance of platelets in one area, reducing the total systemic platelet count.

WBC DIFF NEUTROPHIL % 49-74% 78% H 71 H Infection

BANDS % 11 H% 19 H Infection LYMPHOCYTE% 26-46% 1 L 1 L Infection

MONOCYTE % 49-74% 6% 4

CHEMISTRY

Sodium 136-145 120 L 121 L 130 L This pt has had diarrhea prior to admission which causes hyponatremia. However, he has been on continuous IV NS since admission. Treatment team should consider increasing rate of IV NS to normalize sodium levels.

Potassium 3.5-5.1 3.4 L 4 3.7

Chloride 98-107 83 L 82 L 95 L CO2(bicarb)venous 21-32 31 29 27

Glucose 70-99 93 107 H 128 H High stress levels on the body, including the heart, cause an increased glucose level. The pt is also on a corticosteroid for COPD, which can cause hyperglycemia.

HbA1C

Calcium 8.2-10.2 7.4 L 8.2 7.5 L Low calcium levels are likely r/t malnourishment, as kidney function tests came back normal. Because this pt

hasn't had a BM in 3 days and has abd distention, there is a possibility he has an ileus, leading to poor nutritional absorption and therefore hypocalcemia.

phosphorus 2.5-4.9 2.9 7.5 L Poor oxygenation leads to impaired cellular energy (ATP), which has a direct effect on phosphorous levels

Magnesium 1.8-2.4 1.8

BUN 6.0-25

Creatinine 0.6-1.10 0.77 0.78

HDL 0-100

LDL 0-200

Cholesterol 0-150

Triglycerides

LIVER PANEL 6.4-8.2

Total protein

Albumin 0-1.1

Bilirubin Total 26-137

Alk phosphatase 0-37

AST 0-60

ALT 73-393

Lipase

Amylase

Ammonia

Lactate

Serum Ketones CARDIAC PANEL

CPK

CPK-MB

Troponin I 0-0.5 2.02

Myoglobin

BNP 0-300 3415 High BNP=CHF!! Although this pt does not have a dx of CHF, he does show many symptoms including fluid overload (edema), HTN, and tachycardia.

COAGULATTION

PT

INR ratio

PTT

Fibrin level

Bleeding time

D-Dimer 0-250 715

Testing D-Dimer is important when there is a suspicion of deep venous thrombosis (DVT), pulmonary embolism (PE) or disseminated intravascular coagulation (DIC). This pt has thrombocytopenia, which could indicate a clot. He also has PVD and a recent COPD exacerbation, which can lead to clots. An elevated d-dimer suggests he may

have a clot.

UA collection type

Urine color Urine appearance

Specific gravity

Urine Ph

Urine glucose

Urine bilirubin

Urine blood

Urine Ketones

Urine Nitrites

Urine Protein Urine Leukocytes

URINE MICRO

WBC HPF

RBC HPF

Nitrate HPF

Epithelial

Bacteria

Mucous URINE CULTURE

CSF

• WBC 0-5.0

• RBC 0-2.0

• Glucose negative negative

• Protein negative negative

• Culture negative negative

Blood Cultures

Stool Cultures

Nasal Cultures ABG(FIO2 + device)

pH 7.35-7.45 7.545 H alkalosis

PO2 80-100 63L hypoxemia

PCO2 35-45 34L respiratory alkalosis- r/t hyperventilation (COPD exacerbation)

Bicarbonate 24-26 28.7 H alkalosis Oxygen Saturation 95-100 93 hypoxia

Anion gap 10-20.0 9.4 L A low anion gap in this patient is caused by the COPD exacerbation and elevated HCO3-, resulting in metabolic alkalosis. I would have liked to have seen an ABG for this patient.

Lactate 0.4-­‐2.0   1.2              

Student Clinical Self-Appraisal Weekly (turn in with Care Plan/Map)

Student: Alyssa Cardinal Course: N4810 Instructor: Sherri Brown Instructions: Please evaluate your performance during clinical today using the following concepts: Client Advocate Professional Demeanor Flexible Critical Thinking Communication/rapport Coordinator of Care Self-Initiated Technical skills Team Player Professional Accountability Organized Educator Leadership Well-prepared Ability to Prioritize Nursing Process Comprehensive Assessment Knowledgeable Areas of Strength Today (Date) Critical thinking: This pt’s case was very complex and I feel I did well thinking outside of the lines to determine some of his clinical manifestations. Technical skills: I felt so much more comfortable using the monitors and starting IV meds today. Communication/rapport: I formed an excellent rapport with my pt and nurse this week. This facilitated my learning experience and made the day go by so much faster and easier.

Areas Needing Growth-Include plan of improvement Organized: My organization this week was far better, but I could definitely use improvement in this area. Knowledgeable: As I’m still learning the pathophysiology behind advanced heart and lung disorders and their associated lab values and treatments, I need more time learning and retaining these topics. Comprehensive Assessment: Although I felt my assessments were better this week, they still need the most improvement.

Instructor Comments: Case Map problem #3- I loved your entire case map great job the only thing I have issue with is your fluid overload. You need to support it more. I/0 ratio etc. Because the trach secreations could be causing the airway changes. So you need to support it more, you could have increase BP, more input then output. And other objective data. I love having you in clinical you are a smart young lady who will be a great nurse. Make sure your entire care plan matches throughout.

Student Name: Alyssa Cardinal Date: 2/12/15 Clinical Instructor: Sherri Brown Instructions: Attach a copy of this form to the back of each of you Clinical Plan of Care/Maps for grading purposes. Grading Rubric:

1. Patient Data includes: 20 points possible ____20_ a. Health history b. All blanks and/or issues are addressed

2. Each medication includes: 20 points possible __18___ a. Name b. Rationale c. Side effects d. Nursing implications-specific to this patient

3. Lab Diagnostics 10 points possible ____8_ a. Test b. Results c. Implications & Teaching

4. Problem Identification includes 20 points possible __20___ a. Correctly lists individualized needs b. Correctly identifies problems c. Problems are prioritized and numbered, each problem in priority of importance d. Map includes at least five physiological problems, discharge planning and patient education e. Each problem includes:

i. Nursing diagnosis ii. Data to support iii. Medication iv. Nursing treatment (interventions)

5. Planned interventions includes 10 points possible ___10__

a. Interventions appropriate b. Correctly prioritizes interventions c. Assessments performed d. Communication e. Patient teaching f. Discharge planning

6. Evaluation of Interventions includes 10 points possible ___10__ a. Evaluates physical interventions b. Evaluates teaching

7. a. Priority Assessments are appropriate to diagnoses 10 points possible __10__

b. Clinical Paperwork is complete Total Points _________96____/100 = ____%