GORDONS ASSESSMENT NUTRITIONAL/ METABOLIC PATTERN Before Please use the code of the patient (Mrs.

Pooh) Frequency of taking the Iberet Indicate the frequency of eating at food chain/carenderia; indicate the food ordered Indicate the frequency of drinking alcoholic beverage, amount (1 L or 500 ml etc), brand of carbonated drink During Clarify: she usually eats am for her meals ELIMINATION PATTERN Before Patient code After Patient code Micturition frequency Defecated or not? Please always indicate the patient code.

PHYSICAL ASSESSMENT AND REVIEW OF SYSTEM Respiratory system O2 saturation Use of accessory muscles On pleural effusion: check if it is ultrasound guided thoracentesis 2D echo: if there is pericardial effusion, please indicate Gastrointestinal system Describe the pain Ascites grade? Stool? BM daily? If no BM, for how many days?

Drug Study For every medication, give the rationale why what it was given to the patient For every medication, give the date (indicate if it is now especially for PRNs, date of discontinuation)

Nalbuphine o Nursing responsibilities: check BP before giving o Give it very slowly Ampicillin o Please clarify the dosage Clonidine HCl o Nursing responsibilities: check bp and pulse before and after administration Telmisartan o Nursing responsibilities: check bp before and after administration Itopride HCl o Nursing responsibilities: tell the patient to take before meals (please follow doctors order) Bisacodyl o 2 tabs for UTZ (indicate the time) o 1 adult supp./ rectum UTZ (indicate the time) o Rationale why given (for UTZ) Furosemide o Monitor I and O Domperidone o Please indicate the date/ time drug used Simethicone o Date/ Time of administration D50W o Date given Potassium chloride o 20 meq to infuse to what IVF? Do not include anesthetic drugs used for endoscopy

Medical/ surgical management Include the anesthetic drugs used before the procedure: write and indicate only in a brief manner

Health education plan Objective 2: is if for the comfort or for the benefit of the patient? Please include: level 2: promotion and prevention; level 3 rehabilitation; level 4 leadership and management (health teachings) Diet o Cholecystitis: diet should be in moderation for carbohydrate and protein o Omit crab, shrimp o Please take into consideration your DM diet o DM type II: meal plan should be low in protein o Include foot care

Discharge plan Omit the use of BID, TIQ etc, instead use 2x or 3x a day Ganaton should be taken before meals Therapy: 6-8 glasses a day? Any limits in fluid? Is it recommended? Patient has edema Albumin instead of diet rich in protein Follow doctors order for diet Mention about foot care Include rest between exercise program Was the patient advised to be back for readmission or anything?