Nursing Worksheet Form – Fill Out and Use This PDF

The Nursing Worksheet form, specifically known as the ADDRESSOGRAPH WORKLOAD MANAGEMENT SYSTEM FOR ENTER NURSING - GENERAL WORKSHEET, is a comprehensive document designed to track and manage the workload of nursing staff. It includes sections for patient acuity, critical indicators, and various procedures and treatments, aiming to capture the detailed nursing care required by patients. To ensure quality and efficient patient care management, it's vital for nursing professionals to accurately fill out this form. Click the button below to proceed to filling out the form.

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Nursing Worksheet Form PDF Details

In the bustling world of healthcare, where every moment counts, the Nursing Worksheet form emerges as a crucial tool, ensuring that patient care is meticulously managed and nurses' workflows are streamlined. At the heart of this document lies the ADDRESSOGRAPH WORKLOAD MANAGEMENT SYSTEM, designed to tackle the complexities of ENTER NURSING - GENERAL WORKSHEET, covering vital components such as RN initials, patient's last four SSN digits, and a comprehensive ACUITY SECTION. These sections are meticulously detailed with CRITICAL INDICATORS, POINT CODE VALUES, and a myriad of tasks that range from basic care to specialized procedures. This structured approach encompasses everything from monitoring vital signs, managing IV therapy, to providing emotional support, illustrating a holistic view of patient care. The form intricately categorizes patients based on acuity, ensuring that resources are aptly allocated. It culminates in an acuity category system that tailors nursing care to patient needs, signifying its pivotal role in enhancing patient outcomes and nursing efficiency. Through its detailed sections, the Nursing Worksheet form embodies the essence of nursing care planning and workload management, standing as a testament to the meticulous organization required in the fast-paced environ of nursing.

Question	Answer
Form Name	Nursing Worksheet Form
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	form dd2551 workload pdf, printable nursing acuity worksheet, nursing general worksheet, nursing worksheets

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ADDRESSOGRAPH					WORKLOAD MANAGEMENT SYSTEM FOR
					WORKLOAD MANAGEMENT SYSTEM FOR
		ENTER				NURSING - GENERAL WORKSHEET
		DATE, RN
		INITIALS,
		AND LAST				ENTER DATE, RN INITIALS,
		FOUR SSN				ENTER DATE, RN INITIALS,
		FOUR SSN				AND LAST FOUR SSN
						AND LAST FOUR SSN


ACUITY	SECTION I - CRITICAL INDICATORS		POINT		ACUITY	SECTION I - CRITICAL INDICATORS (Continued)		POINT
CODE	SECTION I - CRITICAL INDICATORS		VALUES		CODE	SECTION I - CRITICAL INDICATORS (Continued)	VALUES
CODE			VALUES		CODE		VALUES

	1. VITAL SIGNS (Manual TPR, BP)					3. ACTIVITIES OF DAILY LIVING (Continued)
1	Vital signs qid or less		1		26	Care - age 6 or more - Complete	14

2	Vital signs q4h or x 6		2		27	Care - age 6 or more - Total	32

3	Vital signs q3h or x 8		3		28	Extra linen change and partial bath x 2 per shift	4

4	Vital signs q2h or x 12		4		29	Turning frame (2 staff members) q2h	14

5	Vital signs q1h or x 24		8		30	Peds recreation/observation - age 0 - 12	8
6	Rectal or axillary temp or apical pulse					4. FEEDING
	qid or more		2		31	Spoon feed meals - age 6 or more - x 3	6

7	Femoral, pedal or popliteal pulses or FHT				32	Spoon feed meals - age 5 or less - x 3	10
	qid or more		2		33	Infant/neonate bottle x 1 feeding	2

8	Tilt test q4h or more		2		34	Infant/neonate bottle q4h or x 6	12

9	Post-op, post-partum, post-delivery				35	Infant/neonate bottle q3h or x 8	16
	(newborn VS)		6		36	Tube feed bolus q4h or x 6	5
	2. MONITORING				37	Tube feed bolus q3h or x 8	8
10	Intake and output q8h		2		38	Tube feed bolus q2h or x 12	10

11	Intake and output q2h		8		39	Tube feed - adult/child/neonate -
12	Circulation or fundus checks q2h or x 12		2			(continuous) q bag change	2
13	Neuro checks q4h or x 6		3			5. IV THERAPY
14	Neuro checks q2h or x 12		6		40	Start IV	2

15	CVP or ICP (manual) q2h or x 12		2		41	Change bottle/bag/volutrol bid or less	4

16	Cardiac/apnea/temp/BP monitor				42	Change bottle/bag tid or qid	6
	(not cumulative)		6		43	Change bottle/bag x 5 or more	8

17	Transcutaneous monitor/oximeter		6		44	Heparin lock or Broviac q4h or x 6	4

18	A-line or ICP monitor or Swan Ganz set-up		4		45	IV Medication q8h or x 3	2

19	A-line or ICP monitor reading q2h or x 12		2		46	IV Medication q6h or x 4	3

20	Swan Ganz PAP/PA wedge reading				47	IV Medication q4h or x 6	4
	q4h or x 6		2		48	Blood products per unit	2

21	Swan Ganz PAP/PA wedge reading				49	Infusion controller/pump (each)	2
	q2h or x 12		4			6. TREATMENTS/PROCEDURES/MEDICATIONS
22	Cardiac output tid or x 3		2		50	Insert NG	2
	3. ACTIVITIES OF DAILY LIVING				51	Pre-op prep/enema/Ace wraps/support hose	2
23	Care - age 5 or less (infant/toddler)		6		52	Catheterization - Foley/straight	2

24	Care - age 6 or more - Self/Minimal		2		53	Tube care (exclude Trach) x 2	2

25	Care - age 6 or more - Assisted		6		54	Dressing - simple 5 - 7 mins x 2	2

	SUBTOTAL A POINT VALUE					SUBTOTAL B POINT VALUE
DD FORM 2551, FEB 92 (EG)				Replaces DD Form 2551 TEST, NOV 89, which may be used.					Page 1 of 2 Pages
						Designed using Perform Pro, WHS/DIOR, Jul 94

	WORKLOAD MANAGEMENT SYSTEM FOR
	NURSING - GENERAL WORKSHEET
	ENTER DATE, RN INITIALS,
	AND LAST FOUR SSN
ACUITY	SECTION I - CRITICAL INDICATORS (Continued)	POINT
CODE	SECTION I - CRITICAL INDICATORS (Continued)	VALUES
CODE		VALUES
	6. TREATMENTS/PROCEDURES/MEDICATIONS
	(Continued)
55	Dressing - complex 30 mins x 1	4
56	Lab tests performed/collected on the unit x 3	2
57	Do EKG	2
58	Venipuncture, arterial puncture x 2	2
59	Medications - exclude IV - 3-11 trips or q3h - q8h	2
60	Medications - exclude IV - 12 trips or more or q2h	4
61	Irrigations or instillations x 4 or less	2
62	Restraints, 2 point, 4 point, Posey	2
63	Assist OOB chair/gurney and return, x 3	2
64	Assist to ambulate and return, x 1	2
65	Infant circumcision or phototherapy	2
66	Isolation mask, gown and gloves x 8	2
67	Chest tube insertion or lumbar puncture (assist)	4
68	Thoracentesis or paracentesis (assist)	4
69	Range of motion exercises x 3	4
70	New admission - assessment and orientation	12
71	Transfer - in-house (receiving unit only)	4
72	Accompany patient off unit 15 minutes	2
73	Accompany patient off unit 30 minutes	4
74	Accompany patient off unit 45 minutes	6
75	Other activities requiring 15 minutes	2
76	Other activities requiring 30 minutes	4
77	Other activities requiring 45 minutes	6

78	Each hour requiring continuous staff
	attendance	8
	7. RESPIRATORY THERAPY
79	Oxygen therapy or oxyhood	2

80	Incentive spirometer or C&DB q4h or x 6	2

81	IPPB or Maximist bid or x 2	2

82	IPPB or Maximist q6h or x 4	4

83	IPPB or Maximist q4h or x 6	6

84	Croup tent or mist tent	8

	SUBTOTAL C POINT VALUE

DD FORM 2551, FEB 92

	ENTER DATE, RN INITIALS,
	AND LAST FOUR SSN
ACUITY	SECTION I - CRITICAL INDICATORS (Continued)	POINT
CODE	SECTION I - CRITICAL INDICATORS (Continued)	VALUES
CODE		VALUES
	7. RESPIRATORY THERAPY (Continued)

85		Chest pulmonary therapy bid or x 2						2
86		Chest pulmonary therapy q6h or x 4						4

87		Chest pulmonary therapy q4h or x 6						6

88		Suctioning q4h or x 6						2

89		Suctioning q2h or x 12						4

90		Ventilator						10

91		Tracheostomy care x 3						4
	8. TEACHING
92		Teaching - group - per hour						2

93		Teaching - individual - per 30 minutes						4
	9. EMOTIONAL SUPPORT
94		Patient/family support (per 30 minutes)						4

95		Lifestyle modification (per 30 minutes)						4

96		Sensory deprivation - blind, deaf, retarded, etc.						6

97		Maximum points for emotional support						10
	10. CONTINUOUS
98		Patient requiring 1:1 coverage all shifts						96

99		Patient requiring greater than 1:1 coverage
		all shifts						146
					SUBTOTAL D POINT VALUE

					SUBTOTAL A POINT VALUE

					SUBTOTAL B POINT VALUE

					SUBTOTAL C POINT VALUE

						TOTAL POINT VALUE

				PATIENT ACUITY CATEGORY
			SECTION II - ADDITIONAL DATA

1. ACUITY TABLE						2. TYPE OF PATIENT (X as applicable)

CATEGORY			POINTS				a. MED/		e. ANTEPARTUM/
0			O				SURG		POSTPARTUM
	I		1 - 12				b. ICU		f. PEDIATRIC
	II		13 - 31				b. ICU		f. PEDIATRIC
	II		13 - 31
	III		32 - 63				c. NURSERY		g. PSYCHIATRIC
	IV		64 - 95				c. NURSERY		g. PSYCHIATRIC
	IV		64 - 95
	V		96 - 145
	V		96 - 145				d. NEONATAL ICU
	VI		146 - 262				d. NEONATAL ICU

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