ANDREWS UNIVERSITY - SCHOOL OF NURSING NURSING CARE PLAN WORKSHEET PATIENT WORKSHEET # 1 Student: Josip Benko Patient #: n/a

Age: __57____ Room # : __94___ Date: 9-18-2012 Vital signs: ____Every 4 hours_______________________________________

Allergies: _____No Known Allergies___________________________________________________________________________________ Code Status: ___Full___ Fall precaution: Yes ( x ) No ( ) Restraints: Yes ( ) No ( x ) Pain management: Yes ( x ) No ( )

History of present illness: ____Difficulty Breathing_______________________________________________________ Medical diagnosis (es): __Acute Pulmonary Emboli / Acute Respiratory Failure__________________________________________________ Past Medical/Surgical History: PVD, chest pain, HTN, colon polyps, diarrhea, anemia, arthritis, SoB, blood clots, wound abscess, esophageal cancer, pressure ulcers, gastric bleeding, pelvic fracture, stenosis, dyslipidemia, femoral artery aneurysm, chronic pain syndrome, UTI, cirrhosis of the liver, above knee amputation, diagnostic ultrasound of the digestive system x 3, Endoscopic control of gastric or duodenal bleeding x3, upper gastrointestinal endoscopy x8, transfusion of pack cells x2, venous catheterization, positive DVT

Diet: Clear Liquids

Activity: Bed Rest

IVs: Right side upper arm and Left side upper arm

Treatments: Nasal Cannula + 4L of oxygen, Hospice Consult, Telemetry Special procedures for today: Hospice consult SBAR (Situation, Background, Assessment, recommendations): I am the student nurse who was taking care of the patient in room 94. The patient is a 57-year-old white male who was admitted Friday night because he was experiencing difficulty breathing. So far his only complaint is general pain that he reports at a level of 6 on a scale from 0 to 10. He is receiving pain medication. Also, he has a stage two ulcer on the 1

right upper gluteus and needs to be turned repositioned every two hours and off the ulcer. Patient is also very drowsy and may want to sit up, watch so he does not put to much pressure on the ulcer. His vitals are stable, but his on nasal cannula 4L of oxygen. Check the patient and make sure he does not pull on his Foley catheter because earlier he tried to pull on it because it was discomforting for him. The family has been waiting for the doctor since eight this morning, could you also check the status of the doctor and see where he is. Lastly, he is positive for DVT on his right forearm if taking blood pressure it has to be done on the left forearm. DVT PREVENTION: YES ( ) NO ( x ) GASTRIC PROTECTION: YES ( x ) NO ( )

ANDREWS UNIVERSITY - SCHOOL OF NURSING PATIENT WORKSHEET # 2 PATIENT DIAGNOSIS/SITUATION Medical diagnosis/es: Acute Pulmonary emboli TEXTBOOK PICTURE Diagnosis/es definition and pathophysiology: Pulmonary embolism is blockage in one or more arteries in your lungs. In most cases, pulmonary embolism is caused by blood clots that travel to your lungs from another part of your body most commonly, your legs. Pulmonary embolism is a complication of deep vein thrombosis (DVT), which is clotting in the veins farthest from the surface of the body.

Patient signs and symptoms: Difficulty breathing

Book description of typical sign and symptoms: Common signs and symptoms include sudden and unexplained shortness of breath, chest pain and a cough that may bring up blood-tinged sputum

Patients potential/actual disease etiology/cause: Obesity Prolonged immobility Bed Rest

Disease etiology/cause: Peripheral artery disease Cancer Smoking

Diagnostic tests scheduled or performed: Diagnostic ultrasound of the digestive system Upper gastrointestinal endoscopy

Diagnostic test suggested: Cirrhosis of the Liver Gastric Ulcers and esophageal cancer

List of actual patient medication (name and dose):

Medication suggested for the diagnosis:

On medication list page 4 A lot to list in this box

Heparin IV

Actual patient treatments (medical and nursing): Nasal Cannula 4L of Oxygen Photonics Heparin IV

Suggested treatments: Help patient with weight loss Continue providing medicine

Actual nutrition ordered:

Suggested nutrition:

Clear Liquids Diet

Clear Liquids Diet

Patient teaching needs:

Teach patient how to do active ROM Teach patient how to use incentive spirometer and deep breath

MEDICATION LIST
Trade name Generic name Dose ordered Route ordered Time of adminis tration Drug action/indications Nursing implications, considerations, side effects to look for, Pt. education

Heparin

Heparin sodium

1000 units/hr

IV

Contin uous

Action: accelerates formation of antithrombin, deactivates thrombin Indications: full dose continuous IV infusion therapy for deep vein thrombosis

-evaluate risks and benefits -ok to use during pregnancy -check order and vial

Slo-Salt Sodium Chloride 5mL IV push, Injection Q8H

Protonix Pantoprazole 8mL/hr IV Contin uous

Action: replaces sodium and chloride and maintains levels Indications: fluid and electrolyte replacement in hyponatremia caused by electrolyte loss or in severe salt depravation Action: inhibits proton pump activity by binding to hydrogen-potassium adenosine triphosphatasesuppress gastric acid secretion Indications: erosive esophagitis with GERD Action: relaxes bronchial, uterine, and vascular smooth muscle by stimulating beta2 receptors Indications: to prevent or treat bronchospasm in patients with reversible obstructive airway disease Action: Balsam Peru increases blood flow to a wound area, and also helps fight bacteria. Castor oil prevents skin cells from breaking down, which aids in wound healing. Trypsin helps shed damaged skin cells Indications: The combination of balsam Peru, castor oil, and trypsin topical (for the skin) is used to treat bed sores and other skin ulcers. This medication can help promote healing and relieve pain caused by these conditions.

Albuterol Inh Sol Albuterol

2.5mg

Inhalatio n

Q4H

Granulex Balsam Peru/ Castor Oil/ Trypsin

1 appl

Topical

TID

-local tenderness, tissue necrosis at injection site -may increase sodium levels -edema when given too rapidly -may decrease potassium levels -monitor electrolyte levels -anxiety, asthenia, dizziness, headaches, insomnia, migraine, pain, chest pain, UTI, rash, bronchitis, constipation, diarrhea, nausea -symptomatic response to therapy doesnt preclude the presence of gastric malignancy -dont confuse with Prilosec, Prevacid, or Prozac -tremor, nervousness, insomnia, dizziness -may decrease sensitivity of spirometry used for diagnosis of asthma -may be taken by children as young as age 2 -warn patient about risk of paradoxical bronchospasm and to stop drug immediately if it occurs - allergic reaction, burning where the medicine is applied. - Avoid contact with eyes; for external use only; shake well before spraying - Clean wound prior to application and at each redressing; shake well before spraying; hold can upright ~12" from area to be treated - If you miss a dose, use it as soon as you can. If it is almost time for your next dose, use only that dose. Do not use double or extra doses.

MEDICATION LIST
Trade name Generic name Dose ordered Route order ed Time of administration Drug action/indications Nursing implications, considerations, side effects to look for, Pt. education

Spironolactone Aldactone, Novospiroton

Spironolactone

25mg = 1Tab

PO

Daily

Cholecalciferol

Vitamin D3

1Tab

Po

Daily

Action: antagonizes aldosterone in the distal tubules, increasing sodium and water excretion Indications: Use only for those conditions for which it is indicated; edema due to heart failure, hepatic cirrhosis, hypertension, severe heart failure Action: helps absorption of calcium and phosphorus, regulates calcium homeostasis Indications: calcium deficiency

-headaches, drowsiness, lethargy, confusion, ataxia, diarrhea, vomiting, gastric bleeding -monitor electrolyte levels, fluid intake and output, weight, blood pressure -instruct patient to take drug in morning to prevent urinating at night

-calcium deposits in soft tissue , confusion and disorientation, damage to kidneys, headaches -hypersensitivity, hypercalcemia -take only as directed -review diet modifications

Alka-Mints Tums Rolaids Calcium Carbinate

Elemental Calcium

500mg = 1Tab Chew

PO

TID w/ meals

Action: reduces total acid in GI tract, elevates gastric pH to reduce pepsin activity Indications: acid indigestion, calcium supplement

-headaches, diarrhea, weakness, nausea, constipation -record amount and consistency of stools -manage constipation with laxatives -monitor calcium levels -advise patient not to take indiscriminately or to switch antacids without prescribers advice -dizziness, headache, asthenia, insomnia, somnolence, syncope, vertigo -monitor for decreases in blood pressure -symptoms of BPH are similar to prostate cancer, rule out that possibility before starting therapy 6

Flomax Tamsulosin

0.4mg1 Cap

PO

Daily

Action: selectively blocks alpha receptors in the prostate, leading to relaxation of smooth muscles in the bladder neck and prostate, improving urine flow and reducing symptoms of

Cephulac Constulose Enulose Lactulose

Lactulose

45mL

PO

Q6H

BPH Indications: BPH, adjunctive treatment of ureteral stones Action: Increases water content and softens the stool. Lowers the pH of the colon, which inhibits the diffusion of ammonia from the colon into the blood, thereby reducing blood ammonia levels. Indications: constipation, to prevent and treat hepatic encephalopathy, including hepatic precoma and coma patients with severe hepatic disease Action: replaces potassium and maintains potassium level Indications: to prevent hypokalemia

-abdominal cramps, belching, diarrhea, nausea, vomiting -monitor sodium levels for hypernatremia -monitor mental status Replace fluid loss -show home care patient how to mix and use drug -instruct patient not to take other laxatives during therapy

Cena-K Klor-Con

Potassium Chloride

20mEq 2Tab

PO

w/brea kfast and dinner

Inderal, Novopranol

Propranolol

20mg 1Tab

PO

TID

Action: reduces cardiac oxygen demand by blocking catecholamineinduced increases heart rate, blood pressure, and force of myocardial contraction Indications: angina pectoris, to decrease risk of death after MI, hypertension

-parenthesia of limbs, listlessness, confusion, weakness, heaviness of limbs, arrhythmias, heart block, cardiac arrest, respiratory paralysis -patients may have an increased risk of GI lesions - commonly used orally with potassium-wasting diuretics to maintain potassium levels -monitor renal function -teach patient how to prepare powders and how to take drug -teach signs of hyperkalemia -fatigue, lethargy, fever, vivid dreams, bradycardia, heart failure, intensification of AV block, bronchospasm, rash -abrupt withdrawal of the drug may cause exacerbation of angina or MI; must gradually reduce drug intake over a few weeks - drug masks common signs and symptoms of shock and hypoglycemia -monitor black patients for expected therapeutic effects 7

-caution patient to continue taking this drug as prescribed, even when feeling well

Metocloprami de

Reglan

10mg = 2mL

IV, Injec tion

AC + Action: bind to dopamine D2 Bedtime receptors where it is a receptor antagonist, and is also a mixed 5-HT3 receptor antagonist/ 5-HT4 receptor agonist. Indications: relieve heartburn and speed the healing of ulcers and sores in the esophagus

- Side Effects include drowsiness, excessive tiredness, weakness, headache, dizziness, diarrhea, nausea, vomiting, breast enlargement or discharge, missed menstrual period, decreased sexual ability, frequent urination, inability to control urination -Teach patient that this medication may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you. -Assess for extrapyramidal symptoms and tardive dyskinesia (more likely in older patients). - Assess for gastrointestinal complaints, such as nausea, vomiting and constipation. - In oral administration, for better absorption allow 30 minutes to one hour before eating. - Rinse mouth frequently to combat dryness.

DIAGNOSTIC TESTS Include all normal and abnormal values that may be significant for the patient. Include Laboratory test, CT scan, MRI, endoscopies, XRs, intervention radiology procedures, or any other significant test for the patient Name of the test and date Magnesium Potassium Platelet Count Sodium Hemoglobin Hematocrit Chloride BUN INR aPPT WBC Count RBC Count Calcium Phosphorous Albumin Creatinine CO2 Glucose Patient result 1.8mg/dL 4.1mEq/L 102 thou/mcL 137 mEq/L 10g/dL 31.9% 103mEq/L 5mg/dL 1.4 37.2 7.98 3.37cells/mm^3 7.7 mg/dL 2.4mg/dL 1.8 g/dL 0.65mg/dL 28 mEq/L 78mg/dL Normal value 1.6-2.6 mg/dL 3.5-5 mEq/L 130-470thou/mcL 135-145 mEq/L 13.2-17.3g/dL 38-51% 97-107mEq/L 6 - 20 mg/dL 1.0- 1.5 21 35 seconds 3.8 11.0 10^3 / mm3 5.2-5.8cells/mm^3 8 11 mg/dL 2.5-4.5mg/dL 3.5 5.0 g/dL 0.6-1.2mg/dL 23-29 mEq/L 65 99 mg/dL Significance for the patient Normal Normal Low: anemia, alcohol toxicity, bleeding gastric ulcers Normal Low: anemia, blood loss, carcinoma, cirrhosis of liver, fluid retention Low: anemia, blood loss, carcinoma, cirrhosis of liver, fluid retention Normal Low: Liver failure, Low protein diet, Malnutrition, Over-hydration Normal High: low levels of platelets, blood loss Normal Low: Chemotherapy, Hemolytic anemia, nutrition deficient, over hydration Normal Low: Alcohol withdrawal, Drugs: Beta-Blockers, Albuterol Low: malabsorption, decreased synthesis by the liver Normal Normal Normal

ANTICIPATED DISCHARGE PLAN (CHECK APPROPRIATE DESCRIPTIONS) Destination: ______ Home __x__ Extended care ______ Rehabilitation Care level: ______ Self __x___ Assisted ______ Family Needs: __x__ Equipment _x___ teaching _____ Relocation

CLINICAL DAY REVIEW Discuss this weeks clinical experience, positive and negative aspects. What new things did you do or learn? Review the cli nical evaluation tool and explain how well you have met the outcomes: This weeks clinical experience was amazing. At first I was hesitant and felt like everything I learned was just a distant memory, but as soon as the PCP came in and began to talk to me off I went and began to do my assessment of the patient. I had the time of my life. One negative aspect was that the patient I had was in serious trouble and because of it; the nurses did not know what to do expect to make him comfortable and continue the doctors orders. I learned that so much can happen to one person and so much of your lifestyle totally depends on your overall health. My patient was a heavy smoker (quit in 2008) but by that time, he has developed esophageal cancer. He was also a heavy drinker and that resulted in cirrhosis of the liver. Now all the fluid accumulates in his abdomen. How was the concept of restoration to the Image Of God portrayed in the clinical settings? Describe the situation, assessment, intervention made, and evaluation. What was your role? The way we restore the patient back to the image of God is by providing a bath and a change of gown. The patient was sitting in some stool and I was unable to lift him or give him a bath (he refused). However, I asked the PCP to help me turn him and we got right to it. He even accepted a bath! It always surprises me how the little things can really make a difference to a patient. It is like in the Bible, when Jesus goes around healing everyone restoring peoples eye sight, family, and developing relationships. It is just the little things that can make a huge difference. I know that giving a patient a bath is not going to save his life, but it shows that he is still super important.

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Discuss the cultural assessment of this patient. Did the patient have special cultural needs? Were there interventions needed related to these needs? The patient is a white male who has a history of alcoholism and smoking. He has two children and currently living with his daughter. He is also Christian and shows interest in losing weight. No specific cultural interventions where required.

NURSING CARE PLAN Nursing diagnosis: Impaired Physical Mobility Related to [etiology]: Imposed restrictions of movement

As evidenced by [defined characteristics]: Limit range of ROM, right above knee amputation, difficulty breathing Relevant data Patient goals and outcomes in priority order. (able to be measured and with appropriate timing) (The patient will) Nursing interventions (related to the nursing diagnosis and patient ability to do it) (The nurse will) Evaluation (Did the patient achieved the pertinent goals and outcomes?) Rationale (why the intervention is needed)

Limit range of ROM, right above knee amputation, difficulty breathing

The patient will actively eat his meal, remain hydrated, and reposition himself by the end of the morning shift

1. The nurse will assess for impediments to mobility 2. The nurse will evaluate the safety of the immediate environment 3. The nurse will turn and position the patient every 2 hours 4. The nurse will encourage liquid intake of 2000 to 3000 mL/day

Patient was able to successfully eat his lunch on his own, remain hydrated, and reposition himself from side to side.

1. Identifying barriers to mobility guides design of an optimal treatment plan. 2. Obstacles, such as Foley catheter and IV lines, can impede ones ability to move safely 3. Position changes optimize circulation to all tissues and relieves pressure 4. Liquids optimize hydration status and prevent hardening of stool 11

Nursing diagnosis: Chronic Pain

Related to [etiology]: Chronic Physical Pain

As evidenced by [defined characteristics]: Patient reports pain, fatigue, depression and reduced interaction with people Relevant data Patient goals and outcomes in priority order. (able to be measured and with appropriate timing) (The patient will) Nursing interventions (related to the nursing diagnosis and patient ability to do it) (The nurse will) Evaluation (Did the patient achieved the pertinent goals and outcomes?) Rationale (why the intervention is needed)

The patient will report pain of 3 to 4 on a 0 to 10 rating scale by the end of shift. Patient report pain, fatigue, depression Reduced interaction with people

1. Assess pain characteristics 2. Acknowledge and convey acceptance of the patients pain experience 3. The nurse will use therapeutic music and guided imagery 4. Refer the patient and family to community support and shelf-help groups for people coping with chronic pain

Patients reported pain level of 4 on a 0 to 10 rating scale by the end of the shift.

1. The most reliable source of information about the chronic pain experience is the patients self-report. 2. Conveying acceptance promotes a more cooperative nursepatient relationship. 3. These centrally acting techniques for pain management work through reducing muscle tension and stress. 4. Adding to the patients network of social support can reduce the burden of suffering associated with chronic pain 12

Nursing diagnosis: Impaired skin integrity

Related to [etiology]: Mechanical factors (friction, shear, pressure)

As evidenced by [defined characteristics]: Pressure ulcer stage 2 on right upper inner glutinous Maximus, dry skin, bruises Relevant data Patient goals and outcomes in priority order. (able to be measured and with appropriate timing) (The patient will) Nursing interventions (related to the nursing diagnosis and patient ability to do it) (The nurse will) Evaluation (Did the patient achieved the pertinent goals and outcomes?) Rationale (why the intervention is needed)

Pressure ulcer stage 2 on right upper inner glutinous Maximus, dry skin, bruises

The patient will experience pressure reduction on ulcer site and skin will remain intact by the end of the shift.

1.

The nurse will assess risk factors for ulcer 2. The nurse will assess history of radiation therapy 3. The nurse will provide an air matters for patient 4. The nurse will provide local wound care for stage II ulcer

Patient has achieved goals, but sometimes would put pressure on ulcer when nursing student leaves the room. Recommendations: Further patient teaching about the importance of reducing pressure on ulcer.

1. Even patients who already have a pressure ulcer continue to be at risk for further injury. 2. Irradiated skin becomes thin and friable, may have less blood supply and is at higher risk for breakdown 3. Air matters help reduce pressure that in put on the ulcer. 4. The goal is to prevent further damage and shearing away of the epidermis.

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Nursing diagnosis: Hopelessness As evidenced by [defined characteristics]: Passivity, apathy, and verbalize that life has no meaning Relevant data Patient goals and outcomes in priority order. (able to be measured and with appropriate timing) (The patient will) Nursing interventions (related to the nursing diagnosis and patient ability to do it) (The nurse will)

Related to [etiology]: Chronic Illness

Evaluation (Did the patient achieved the pertinent goals and outcomes?)

Rationale (why the intervention is needed)

Passivity, apathy, and verbalize that life has no meaning

1.Patient will express positive expectations about the future by the end of the shift.

1. The nurse will assess the role that illness plays in the patients hopelessness 2. He nurse will establish a working relationship with the patient through continuity of care 3. The nurse will provide the physical care that the patient is unable to provide for himself in a respectful way. 4. The nurse will provide opportunity for the patient to control their surrounding environment

1.Outcome: The patient has not yet achieved the desired outcomes, but has shown increased energy in decisionmaking; wanting food, and water, wanting to sit up, and asked for pain medication. Suggestions: Increase the duration in when to achieve the goal to 4 days.

1. Level of physical functioning prognosis and treatment can contribute to hopelessness. 2. An ongoing relationship establishes trust, reducing the feeling of isolation 3. Helps reduce guilt and other negative feelings the person may experience when unable to care or self 4. Hopeless patients may feel they have no control. Yet when given opportunity to make choices, their perception of hopelessness may be decreased 14

CARE PLAN GRADE ASSESSMENT 0= Rarely

1. Consults appropriate sources (Nursing books, nursing Dx books, medical dictionary). Patient worksheet # 2 complete? Medication list complete? 2. Seeks and identifies appropriate sources (H & P, Physicians orders, Progress notes, diagnostic test results, vital signs, patient assessment data, worksheet # 1 complete) 3. Data sufficiently and exclusively supports Nursing Diagnosis (relevant data supports nursing Dx) 4. Distinguishes between normal and abnormal findings (patient laboratory and diagnostic test results (Lab, CXR CT scan, etc.) including the normal values) 5. Accurately identifies and labels abnormalities (diagnostic test specific significance for the patient, and related to the patient diagnosis, medications and treatments) 6. Identifies and addresses cultural needs (Specifically writes about patient cultural status and needs, see appropriate description)

1= Sometimes

2= Most of the time

3= Consistently

Total points

NURSING DIAGNOSIS 0= Rarely

1.Analyzes thoughtfully and accurately (Sufficient, accurate and specific data to support nursing diagnosis) 2. Recognizes and obtains needed knowledge (collects all the data necessary to support the nursing diagnosis) 3. Identifies and prioritizes appropriate Nursing diagnosis for the patient (Nursing diagnosis measures patient priority status) 4. Constructs nursing diagnosis correctly (nursing diagnosis, Related To, As evidenced By)

1= Sometimes

2= Most of the time

3= Consistently

Total points

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PLANNING 0= Rarely
1.Considers and selects appropriate culturally appropriate options, reflecting good judgment 2. Prioritizes intentionally (Priority level written in order?) 3. Collaborates with appropriate sources (Health care team members) Sets realistic, measurable goals (measurable and timed, patient should be able to accomplish the goals and outcomes)

1= Sometimes

2= Most of the time

3= Consistently

Total points

IMPLEMENTATION 0= Rarely
1.Kows what should be done and intervenes appropriately (Specific interventions written in care plan, and student work directly related to the patient on the nursing unit) 2. Initiates actions in a timely manner (Student starts interventions and patient care as soon as the patients needs any planned or new interventions, it will be observed during direct patient care) 3. Provides appropriate health teaching (teaching done related to the patient specific situation to the patient directly and written in the care plan) 4. Uses professional/suitable vocabulary (The student uses the specific professional vocabulary when interacting with the Instructor, other students, unit nurses and other health care team, and when writing the care plan) 5. Shares appropriate information with appropriate persons (shares information with respiratory therapist, Laboratory personnel, charge nurse, floor nurse, Instructor) 6. Documents accurately, legibly, and uses appropriate abbreviations 7. Documents promptly (immediately after assessment, and/or vital signs) 8. Works with dexterity (student knows what needs to be done and intervenes appropriately in an independent manner) 9. Demonstrates thoroughness and neatness (patient and patients room in perfect clean appearance)

1= Sometimes

2= Most of the time

3= Consistently

Total points

16

EVALUATION 0= Rarely
1.Notes and evaluates outcomes appropriately (Writes specific evaluations relates to the goal/outcomes) 2. Measures patient status correctly (assessment data supports nursing diagnosis, patient able to reach the goals and is able to accomplish and follow the described interventions) 3. Thoughtfully reflects on experience (see clinical day review, student describes what she/he did learn with that specific client, positive and negative outcomes)

1= Sometimes

2= Most of the time

3= Consistently

Total points

Christian service grade: __________________ (Total possible points: 6) Professional behavior: ___________________ (Total possible points: 8) Safety: ________________________________ (Total possible points: 10) Care plan: _____________________________ (Total points possible: 78) Total points for the clinical day and care plan: ___________ (total possible points: 102) The clinical grade is calculated by adding the weekly evaluation scores. A grade of 90% is necessary to pass the clinical experience. (Ex. If the student one week has a percentage of 88%, it is below passing ranges, but that scores will be added to the rest of the weeks, and student needs to have a 90% at the end of the clinical experience to pass the clinical and the class)

COMMENTS: __________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________ Instructor signature: ____________________________________ Date: _________________________ 17

ANDREWS UNIVERSITY NURSING STUDENT EVALUATION FOR ROTATION CLINICAL EXPERIENCE Semester of Experience: _____________________ Date: ____________________________________ Hospital: _______________________ ________ __ Unit: ____________________________________ Student name: -_______________________________________________________________________ Instructions: Please indicate your response by writing YES or NO according to student accomplishment

Christian Services
YES (1 point) 1.Demonstrates appropriate self control and self discipline 2. Places welfare of others ahead of own personal interest 3. Is helpful to others- going beyond the minimum that is required 4. Demonstrates respect for others 5. Conveys enthusiasm, warmth, concern 6. Recognizes and responds to spiritual needs appropriately NO (0 points) Not applicable Total points

Professional Behavior
1.Arrives on time, appropriately prepared and present throughout clinical 2. Conducts self in confident, dependable, professional manner 3. Follows established standards of care (policies, procedures) 4. Recognizes and responds to ethical issues appropriately 5. Demonstrates personal initiative 6. Attends and contributes positively in clinical experience and conference/s 7. Maintains client confidentiality 8. Maintains personal appearance according to the policies of the School of Nursing and affiliated agencies

RN Signature: _______________________________

Instructor Signature: ___________________________________ Date: __________

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