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7 Cards in this Set
- Front
- Back
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Abdominal Assessment
4 P's Soda Pop |
Pee
Pain Privacy Position (supine with knees bent) Suction off Observe abd for contour and distention Don gloves Auscultate x 4 quads for 1 min/6 bs Palpate x 4 quads tenderness, ridgidity Off gloves, On suction unless girth is ordered Per order, do girth at umbilicus |
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Neurological Assessment
LOGIC |
Level of consciousness (PPT) Lights off
Observe PERRL Get visual, auditory,tactile stim. NOT TOUCH TEST Inspect fontanel <1 yr old child Calculate motor responses. Plantar/Dorsiflexion. Hand grasps. Noxious stimuli if on kardex. |
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Peripheral Vascular Assessment
B PERIPH |
Bilateral comparison for all
Pulses most distal Examine skin color Refill capillary <3 sec Inspect temp Patient touching test-tactile stim with eyes closed Has movement-on command or independently |
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Skin Assessment
2 CITEM |
2 vulnerable skin areas (includes one assigned from kardex)
Color changes Integrity (lesions, rash) Temperature Edema Moisture (perspiration, incontinence) |
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Vulnerable Skin Areas
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Heels
Sacral/Coccyx Occiput Trochanter Skin folds Peri anal |
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Respiratory Assessment
PALS |
Position patient Fowlers
Auscultate (side to side) abnormal or normal Look (rate, rhythm, pattern, accessory muscle use.) Sats, 02 if ordered on kardex |
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Vulnerable Skin Areas
He Took Patty & Olivia Shopping Sunday |
Heels
Trochanter Peri anal Occiput Sacral/coccyx Skin folds |
