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    Livelife Homecare: Nurse's Daily Psychiatric Assessment Checklist

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    James Trick Ocampo Valera
    This document appears to be a daily psychiatric assessment checklist used by nurses to monitor patients' mental status and behaviors. It includes fields to track a patient's consciousness, mobility, hygiene, interactions, speech, eye contact, affect, behaviors, hallucinations, delusions, appetite, interventions and more over multiple shifts. Nurses can use this form to document assessments and changes in a patient's condition each day.

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    Livelife Homecare: Nurse's Daily Psychiatric Assessment Checklist

    Uploaded by

    James Trick Ocampo Valera
    247 views2 pages
    This document appears to be a daily psychiatric assessment checklist used by nurses to monitor patients' mental status and behaviors. It includes fields to track a patient's consciousness, mobility, hygiene, interactions, speech, eye contact, affect, behaviors, hallucinations, delusions, appetite, interventions and more over multiple shifts. Nurses can use this form to document assessments and changes in a patient's condition each day.

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    mse

    Original Title

    Nurse's Daily Psychiatric Asssesment

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    This document appears to be a daily psychiatric assessment checklist used by nurses to monitor patients' mental status and behaviors. It includes fields to track a patient's consciousness, mobility, hygiene, interactions, speech, eye contact, affect, behaviors, hallucinations, delusions, appetite, interventions and more over multiple shifts. Nurses can use this form to document assessments and changes in a patient's condition each day.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    247 views2 pages

    Livelife Homecare: Nurse's Daily Psychiatric Assessment Checklist

    Uploaded by

    James Trick Ocampo Valera
    This document appears to be a daily psychiatric assessment checklist used by nurses to monitor patients' mental status and behaviors. It includes fields to track a patient's consciousness, mobility, hygiene, interactions, speech, eye contact, affect, behaviors, hallucinations, delusions, appetite, interventions and more over multiple shifts. Nurses can use this form to document assessments and changes in a patient's condition each day.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    LIVELIFE HOMECARE

    # B6 L19-21 Sto. Rosario Drive Phase1C Pacita1 Sto.Rosario Drive, San Pedro City, Laguna
    Visit us at www.livelifehomecare.com
    Tel Nos. (02) 80894-50 / (02) 99446-68 / (0908) 8848769

    Nurses Daily Psychiatric Assessment Checklist


    Patients Name: ______________________________________ Ward No.: __________________

    DATE: __/__/__ NOD: _________________________Shift: DATE: __/__/__ NOD: ________________________Shift:


    AM AM
    Nursing Diagnosis: Nursing Diagnosis:
    ___________________________________ ___________________________________
    A. Conscious Lethargic Unconcious A. Conscious Lethargic Unconcious
    B. Ambulatory Semi-Ambulatory Non-Ambulatory B. Ambulatory Semi-Ambulatory Non-Ambulatory
    C. Fairly Kempt Unkempt C. Fairly Kempt Unkempt
    D. During Instructions: Able to follow Unable to D. During Instructions: Able to follow Unable to
    follow follow
    E. During Interactions: Responsive Limited E. During Interactions: Responsive Limited
    Guarded None Guarded None
    F. Speech: Hypoproductive Hyperproductive F. Speech: Hypoproductive Hyperproductive
    Normoproductive Normoproductive
    G. Eye Contact: Good Poor G. Eye Contact: Good Poor
    H. Affect: Euthymic Restricted Flat Blunt Labile H. Affect: Euthymic Restricted Flat Blunt Labile
    Inappropriate Inappropriate
    I. Behavior: Tranquil Restless Irritable Anxious I. Behavior: Tranquil Restless Irritable Anxious
    Preoccupied Preoccupied
    Others: Others:
    ___________________________________ __________________________________
    J. Hallucinations: Auditory Visual None J. Hallucinations: Auditory Visual None
    Others: Others:
    ___________________________________ __________________________________
    K. Delusions: Specify: ____________________________ K. Delusions: Specify: ____________________________
    None None
    L. Appetite: Good Fair Poor L. Appetite: Good Fair Poor
    M. Nursing Interventions: M. Nursing Interventions:
    ___ Vital Signs Taken: ___ Vital Signs Taken:
    ________________________________ ________________________________
    ___ ADLs Done with Supervision ___ ADLs Done with Supervision
    ___ Medication Given ___ Medication Given
    ___ Safety Prioritized ___ Safety Prioritized
    ___ Increase Fluid Intake ___ Increase Fluid Intake
    ___ Monitored Suicidal and Homicidal Precaution ___ Monitored Suicidal and Homicidal Precaution
    ___ Psychoeducation and Health Teaching ___ Psychoeducation and Health Teaching Provided
    Provided ___ Monitored Patients Condition and Behavior
    ___ Monitored Patients Condition and Behavior N. With Somatic Complains None
    N. With Somatic Complains None Remarks:
    Remarks: __________________________________________
    __________________________________________ __________________________________________________
    __________________________________________________ NOD: _____________________________________ Shift:
    NOD: ______________________________________ Shift: PM
    PM Nursing Diagnosis:
    Nursing Diagnosis: ___________________________________
    ___________________________________ A. Conscious Lethargic Unconcious
    A. Conscious Lethargic Unconcious B. Ambulatory Semi-Ambulatory Non-Ambulatory
    B. Ambulatory Semi-Ambulatory Non-Ambulatory C. Fairly Kempt Unkempt
    C. Fairly Kempt Unkempt D. During Instructions: Able to follow Unable to
    D. During Instructions: Able to follow Unable to follow
    follow E. During Interactions: Responsive Limited
    E. During Interactions: Responsive Limited Guarded None
    Guarded None F. Speech: Hypoproductive Hyperproductive
    F. Speech: Hypoproductive Hyperproductive Normoproductive
    Normoproductive G. Eye Contact: Good Poor
    G. Eye Contact: Good Poor H. Affect: Euthymic Restricted Flat Blunt Labile
    H. Affect: Euthymic Restricted Flat Blunt Labile Inappropriate
    Inappropriate I. Behavior: Tranquil Restless Irritable Anxious
    I. Behavior: Tranquil Restless Irritable Anxious Preoccupied
    Preoccupied Others:
    Others: __________________________________
    ___________________________________ J. Hallucinations: Auditory Visual None
    J. Hallucinations: Auditory Visual None Others:
    Others: __________________________________
    ___________________________________ K. Delusions: Specify: ____________________________
    K. Delusions: Specify: ____________________________ None
    None L. Appetite: Good Fair Poor
    L. Appetite: Good Fair Poor M. Sleeping Pattern:
    M. Sleeping Pattern: 8pm 9pm 10pm 11pm 12am 1am 2am 3am
    8pm 9pm 10pm 11pm 12am 1am 2am 3am 4am 5am
    4am 5am Remarks:
    Remarks: __________________________________________
    __________________________________________ __________________________________________________
    __________________________________________________

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