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Discharge Outcomes

Day 3

Day 4

Day 5

Day 6

Day 7

Date

Verbalizes pain at acceptable level Uses PGA appropriately w/o basal + takes po pain medication around the clock

verbalizes patn at acceptable level; on PO pm pain medication

Pain at acceptable level with PO medication prn

Pain at acceptable level with PO medication pm

Pain 8t acceptable level with PO medication pm

Pain al acceptable level with PO medication prn

Lofitois, minimal-moderate assistance Dancies 2 times, moderate assistance Stands 8-10 minutes for brace mold

Gets intout of bed, moderate assistance Sits in chair (or meals 1-2 times Walks In room, moderale-maximal

Gets in/out of bod. minimal assistance Sits In chair 2-3 times

Walks to hall, moderate assistance 3x

Wearing brace as ordered

Reports need for adjustment of brace

Gets In/out ol bed

Sits in chair 2-3 times

Walks in hall minimal assistance times 3

Gets in/out of bed Independently Sits In chair 2-3 times Walks, Independently 3 times Reports brace correctly fitting

lodep-ndent in/out of bod

Walking on level and up/

doMtstiifS of reached goal

PafenWam-y demonstrate crVotf brace tethrioue

CSM status ai baselire

CSM status at baseline

CSM status al baseline

CSM status at baseline

CSM status at baseline

CSM status at baseline

C. T. 6 DB

Uses ICS q 2’ volume_______

O2 sat >94% on room air

Respiratory system WNL

Uses ICS Independently volume____

Respiratory system WNL

Uses ICS independently volume____

Respiratory system WNL

Uses ICS independently volume____

Respiratory system WNL

Respiratory system WNL

Respiratory system WNL

WNL skin warm, dry and Intact. Normal color and turgor PURV_

WNL skin warm, dry and Intact. Normal color and turgor.

WNL: skin warm, dry and intact. Normal color and turgor

WNL: skin warm, dry and Intact. Normal color and turgor.

PURV_____

WNL: skin warm, dry and Intact. Normal color and turgor.

Skin cleaa, de/, and tniacl; wound well-approximated without rednes&'swe'Lng

Receives and verbalizes understanding of information booklet

Participates In care

Anxiety reduction strategies

Able to group requests

Exhibits decreased anxiety

Verbalizes understanding of Information

Participates in care

Abie to use anxiety reduction strategies

Verbalizes understanding of information

Participates In care

Able to make decisions

Participates in care

Discusses plans lor going home

Makes decisions

Participates In care

Verbalizes ability to manage at home Makes decisions

Verbalizes ability to manage at home and/or with continuing care arrangements

Voiding without difficulty Bcwel sounds present Abdomen non-tender Passing flatus 01 has a bowel movement

Voiding without difficulty Bowel sounds present Abdomen non-tender Passing Hates. or na? a bowel movement

Voiding

Bowel sounds present

Abdomen ngn-tender

Passing flatus, or has a bowel movement

Voiding

Bowel sounds present

Abdomen non-tender

Passing flatus, and has a bowel movement

Voiding

Bowel sounds present

Abdomen non-tender

Passing flatus, or has a bowel movement

Voiding

Had BM during hospitalization

Systems WNL

Systems WNL

Systems WNL

Systems WNL

Systems WNL

Systems WNL

Washes areas m reach Feeds sell

Washes areas In reach

Feeds sett

Bathes sell with minimal assistance

Battves and toilets self with minimal assistance

Independent in self care or reaches goal

Indepemterii in sc ! ca:e or reaches goal

65 or older......................1

Mental status limitations........5

History ot fails.....................5

Mobility limitations.............4

Elimination problems...............2

Medications .....................1

Total Score.....................’

65 or Older... .................1

Mental states limitations .5

History of falls ...............5

Mobility limitations........ ...4

Elimination probterns...........2

Medications.....................1

Toial Scene.............. *

65 or older........................1

Mental status limitations ..5

History of falls..................5

Mobility limitations..............4

Elimination problems..............2

Medications.......................1

Total Score.......................*

65 or older —......................1

Menial status limitations..........5

History of tails..................5

Mobility limitations..............4

Elimination problems..............2

Medications.......................1

Total Score....................... *

65 or older.......................1

Mental status limitations.........5

History of (alls..................5

Mobility limitations..............4

Elimination problems..............2

Medications.......................1

Total Score.......................  *

No falls