Whiteboard

Room#:
Day:
Patient Name:
Housekeeper:
Date:
Doctor:
Nurse:
Next Visit:
Nurse Assistant:
Diet:
Oxygen
Fluid Restriction:
lpm
continuous
as needed
Oximetry
continuous
spot check
Intake/Output
Mobility:
Special Precautions:
Cane
Independent
Walker
Assistance of 1
SKIN CARE (SOS)
Seizures
EZ Stand
Assistance of 2
FALL RISK
Hip
No B/P IV on
Hoyer Lift
Other:
Pain Management
is Our Goal!
0-1
2-3
NO PAIN
•COMFORTABLE
Goal
4-5
6-7
8-9
10
MILD PAIN
DISCOMFORTINGMODERATE PAIN
DISTRESSING SEVERE PAIN
INTENSE VERY SEVERE PAIN
UNBEARABLE PAIN
•UNBEARABLE •CRUSHING
•ANNOYING
•TROUBLESOME •GRUELING
•NAGGING
•NAUSEATING •NUMBING
•MISERABLE •GNAWING •DREADFUL •VICIOUS
•AGONIZING
•TOTURING •TEARING
•HORRIBLE •CRAMPING
Goals for today:
Last Pain Medication:
Next Dose Available:
Questions for my Doctor:
Anticipated Discharge Date:
Planning Discharge to:
Planned Transport Method/Time:
Discharge Pending: