BSN134 Group133

Ward: 2&3

CHECKLIST FOR THE ROUTINE SHIFT ASSESSMENT

1. Mental Status
a. Level of Conciousness/Responsiveness: ___________
b. Alertness/Orientation: ___________
c. PERRLA(Pupils Equal, Round, Reactive to Light Accomodated) : ___________
d. Mood: ___________
e. Behavior: ___________
2. Vital Signs
a. Blood Pressure: ____mmHg
b. Pulse Rate: ______bpm
c. Respiratory Rate: ____cpm
d. Temperature:____oC
e. Pain and Comfort Level
3. Motor Sensory Level
a. Range of Motion: ___________
b. Paralysis: ___________
c. Weakness: ___________
d. Numbness or Tingling: ___________
4. Integumentary System(Skin/Mucous Membranes)
a. Color: ___________
b. Temperature: ___________
c. Turgor: ___________
d. Moisture: ___________
e. Edema: ___________
f. Integrity: ___________
5. Cardiopulmonary
a. Heard Sounds:

b. Apical:
c. Lung Sounds
d. Breathing Pattern: _____cpm
e. Peripheral Pulse: _____
f. Capillary Refill: ______secs

6. Gastrointestinal

a. Bowel Sounds: ___________

 b. Abdominal Palpation: ___________

c. Degree of Abdominal Distention: ____

d. Bowel Elimination Problem

___diarrhea ___constipation ___flatulence ___others

e. Nausea( ) YES, Characteristics: ___________ ( ) No

7. Wound

a. Cleanliness: ___________

b. Swelling/ Redness/ Infection: ___________

c. Drainage: ___________

d. Bandage Dressing: ___________

8. Invasive Tubes

___Intravenous Line ___NGT ___Wound Drainage ___Catheters ___Others