KwikKlips.nursingbro..
Transcription
KwikKlips.nursingbro..
2 EDI 006 TIO N GET THE JUMP ON YOUR CLINICALS WITH THE ULTIMATE NURSING REFERENCE CLIPBOARD • Calculator with calendar and clock including second hand function. • Cardiovascular assessment information including EKG intervals, heart sounds, hemodynamic norms and calculations, pulse scale, edema scale, murmur scale. • Integumentary assessment information including skin breakdown areas, skin integrity scale and descriptors for skin temperature, moisture and color. • Elimination assessment information including urinalysis values and descriptors for urinary and bowel function, sounds, patterns and color. • Neurological assessment information including pain intensity scale, pupil scale, muscle testing scale, deep tendon reflex scale, glasgow coma scale, descriptors for pupil reaction, motor response, behavior and level of consciousness. • Respiration assessment information including common respiratory patterns, breath sound assessment, descriptors for breath quality, rate, sputum and cough. • IV infusion information including IV infusion rate calculation, hourly dosage IV flow chart, multiple hour IV dosage flow chart. • Injection information for needle length, gauge, maximum volume and insertion degree. • Normals for serum electrolytes, arterial blood gases, complete blood count, urinalysis. • Vital sign normals for children through seniors for temperature, pulse, respiration and blood pressure. • Assessment chart for respiratory and metabolic acidosis and alkalosis. • Conversion formulas for volume, weight, temperature and length. • BMI weight management guidelines and formulas. • Dosage calculation formulas for both pills and liquids. • Metric and standard rulers. ORDER FORM WITH CALCULATOR: $21.95 25+ ..................$18.95 per clipboard 50+ ..................$16.95 per clipboard WITHOUT CALCULATOR: $18.95 25+ ..................$15.95 per clipboard 50+ ..................$13.95 per clipboard STORAGE TRAY: $8.00 FREE laminated sheet included with every clipboard outlining common healthcare abbreviations, documentation tips, unsafe abbreviations and patient care planning, a $9.00 value. SHIPPING CHARGES: Please add the following amounts to your order for shipping charges: 1 - 5 ..................$2.50 per clipboard 6 - 24 ................$1.25 per clipboard 25+ ....................$0.75 per clipboard For trays in any quantity, add $0.75 QUESTIONS? Contact us at: Clipboards by Kwik Klip Phone: 800-653-7017 Fax: 954-212-2411 E-mail: clipboards@earthlink.net Website: www.clipboards.org ❑ Check ❑ VISA ❑ MASTERCARD 0 Enclosed is $_________________ C L I P B OA R D P R I C E S : 12 COMPREHENSIVE NURSING CLIPBOARD INCLUDES: 1 11 2 DAILY PATIENT ASSESSMENT INFORMATION 8 7 7 8 13 14 6 MOTOR RESPONSE Flexion & Withdrawl Oriented Localizes Pain 5 Obeys Commands LIQUID D ____ xQ=X H MD order: Digoxin 0.25 mg Drug available: Digoxin 0.125 mg per tablet D=0.25 H=0.125 X=2 tablets MD order: Dilantin 50 mg Drug available: Dilantin 125 mg/5ml D=50 H=125 Q=5 X=2 ml IV INFUSION RATE CALCULATION Total Volume (ml) x IV Drip Factor = Drip Rate (gtts/min) Time (mins) BMI WEIGHT MANAGEMENT Below 18.5 18.5 - 24.9 25.0 - 29.9 Above 30 Underweight Normal Overweight Obese 4 BMI = Weight (kg) / (Height (m) x Height (m)) 20 D = MD order H= Dose on hand Q = Amt of liquid X = Amt of medication to administer 19 Flexion Posture Disoriented 18 Extension Posture Inappropriate 17 Unintelligible Spontaneously 6 PILLS D ____ =X H None None To Pain To Command 4 16 + AMOUNT TO ADMINISTER 15 VERBAL RESPONSE None 3 21 PAIN INTENSITY SCALE CRANIAL NERVES COMMON RESPIRATORY PATTERNS Normal rate and rhythm 3 NORMAL ABNORMAL [Central airways] Bubbling, rumbling sound [Main stem-bronchi] Soft, blowing, medium pitched; inspiration = expiration Hyperpnea Deep respirations at normal rate Vision Oculomotor Eye Movement, Pupil Dilation 4 Trochlear 5 Trigeminal 6 Abducens Eye Movement 7 Facial Taste, facial movement 8 Vestibulocochlear 9 Glossopharyngeal Taste, gag, swallow, saliva secretion 10 Vagus FUNCTION Sensory, motor, autonomic control of viscera Smell Eye Movement Chewing, sensation in face and head Kussmaul’s Fast [> 20 bpm], deep [sigh like], labored respirations without pause Hearing, balance 11 Spinal Accessory Head and shoulder movement 12 Hypoglossal Tongue movement 27 [Anywhere] High pitched musical squeaks Rhonchi [Lung periphery] Soft, swishing, breezy, low pitched; inspiration > expiration Bronchovesicular Slow regular respirations [< 12 bpm] Optic 3 26 Wheezes Vesicular Bradypnea Olfactory 2 25 [Trachea] Loud, high pitched & harsh; expiration > inspiration NAME 1 24 DESCRIPTION Bronchial Rapid respirations; Rate rises 4 bpm for every degree > than normal body temp. 23 BREATH SOUNDS 2 Eupnea Tachypnea # 22 Worst Pain Possible LOCATION Cheyne-Stokes [Lateral lung field; client in upright position] Grating, creaking or squeaking sound Fast deep respirations [30-170 secs] with periods of apnea [20-60 secs] [Anywhere; usually during inspiration] Soft crackling, popping, or bubbling sound Apnea Absence of breathing ● 31 This Clipboard serves as a reference guide only and should not be relied on in providing medical care. Kwik Klip Enterprises is not responsible for the use of this information in the provision of medical care. 30 Pleural friction rub Rales Copyright © 2006 Kwik Klip Enterprises, all rights reserved. 2901 Ellsworth Road, Nortonville, KS 66060 Phone 800-653-7017 FAX 954-212-2411 email clipboards@earthlink.net ORDER ONLINE AT www.clipboards.org 29 0 1 Apneustic Prolonged gasping inspiration followed by very short & ineffecient expiration 28 School Attending: ____________________________________________________________________________________________ QUALITY ■ WNL ■ Deep ■ Shallow ■ Labored ■ Unlabored SOUNDS ■ Clear ■ Cough ■ Moist RATE ■ WNL ■ Slow ■ Rapid SPUTUM ■ Clear ■ White ■ Yellow ■ Green ■ Frothy ■ Brown ■ Blood - tinged COUGH QUALITY P Productive N Nonproductive W Weak S Strong 6 reactive to light, accomodation normal MOTOR RESPONSE ■ Obeys commands ■ Localizes pain ■ Withdraws to pain ■ No motor response LEVEL OF CONSCIOUSNESS (LOC) A Alert V Voice Response P Pain Response U Unresponsive BEHAVIOR ■ Agitated ■ Calm ■ Restless ■ Anxious ■ Withdrawn 12 + EYES OPEN 2 1 No Pain ______________________________________________________________________________________________________________ RESPIRATION PUPIL SCALE (mm) 1 2 3 4 5 PUPIL REACTION ± Sluggish + Reactive – Non-Reactive (PERRLA) pupils equal, round, 11 GLASGOW COMA SCALE 5 ______________________________________________________________________________________________________________ BOWEL PATTERNS ■ Regular ■ Constipation ■ Diarrhea ■ Impaction ABDOMEN ■ Firm ■ Soft ■ Rigid ■ Tender ■ Flat ■ Distended NEUROLOGICAL 10 BREAKDOWN AREAS ■ Hip bones, tailbone, ischium ■ Knees, heels, ankles, toes ■ Spine, shoulder blades, elbows ■ Ears, side/back of head BOWEL SOUNDS + Present 0 Absent Hyperactive Hypoactive 9 SKIN INTEGRITY I Reddened II Broken skin, superficial III Crater, involves fat layer IV Crater, involves muscle & bone ELIMINATION URINE COLOR ■ Yellow ■ Amber ■ Milky ■ Tea ■ Straw ■ Pink ■ Red URINARY FUNCTION ■ Frequency ■ Urgency ■ Polyuria ■ Dysuria ■ Hematuria ■ Nocturia ■ Calculi ■ Retention ■ Incontinence 8 Ship to: _______________________________________________________________________________________________________ SKIN COLOR ■ Ashen ■ Ruddy ■ Dusky ■ Mottled ■ Pale ■ Cyanotic ■ Pink ■ Flushed ■ Jaundiced 7 Credit Card #: ____________________________________________________________ Exp. Date ____________________________ INTEGUMENTARY SKIN TEMP. ■ Warm ■ Hot ■ Cool ■ Cold SKIN MOISTURE ■ Clammy ■ Dry ■ Diaphoretic ■ Moist TURGOR ■ Elastic ■ Firm ■ Fragile ■ Edema 6 9 10 CARDIOVASCULAR HEART SOUNDS ■ Distinct ■ Murmur ■ Rub ■ Distant ■ Extra Sounds ■ Muffled ■ Gallop PULSES 0 Absent +1 Weak, Thready +2 Normal +3 Strong +4 Bounding MUMUR SCALE I/VI Barely audible II/VI Audible, low intensity III/VI Immediately audible, mod intensity IV/VI Loud intensity without thrill V/VI Loud intensity with thrill VI/VI Loudest intensity, thrill, audible with stethoscope slightly off chest EDEMA 0 No edema +1 Barely discernible pit; normal foot & leg contours +2 Deeper pit [<5mm]; fairly normal foot & leg contours +3 Deep pit [5-10mm]; foot & leg swelling +4 Even deeper pit [>1cm]; severe foot & leg swelling 5 ______ Storage Tray(s) 4 ______ Nursing Clipboard(s) with standard clip 3 _____ Nursing Clipboard(s) with calculator Phone: _______________________________________ Email: _________________________________________________________ Mail order form to Clipboards by Kwik Klip, 2901 Ellsworth Road, Nortonville KS, 66060, or FAX to 954-212-2411 You may order online, at www.clipboards.org, using a Visa or Mastercard. We also accept checks, money orders, or purchase orders. Please allow ten business days for shipment of your order. An optional storage tray is available, for both the standard clip as well as the calculator clipboards, at $8.00 plus $0.75 shipping for each tray in any quantity.