{"text":"CHI Number: 0809555328 Patient Name: AGNES CLELLAND Page 3 of 5 \ne \n\" \u201cDoes the patient smoke?| No \n| \nRefer to smoking cessation clinic\u00a2?: . Referral made to Smoking Cessation Services? No | \nDoes'the patient use recreational drugs?:No ! i \nHow often does patient have 6 or more drinks on'one occasion? o o _ {Never ! \n+ FAST Tool completed? - o o \u2018 , No | \ni 9. AdmussnonDocumentatlon completed by \ni Name:! Gillian Thomson \u00a5 Designation: Registered Nurse - -; Daje:_;!g\u20181w3\/03\/2013 o i \ni \nL | - \n% Nursmg Admlssmn Assessment \ng LBreathmg \n; ) Symptoms or hlstory of' resplratorv problems? \/ C \/3 \n= Dyspnoeicat rest? \u00a2 : \u2018NA :Dyspnoeic:on minimal exertion? o \u2018Yes i \nDyspnoeic on maxnmum exertion? ] NA !Normally receives oxygeh therapy? ) \u201c\"NA \u00a7 \ni 'Detarls- i \n% . Symptoms? - ) : : ' NA iKnown cardiac or circulatory problems? E | Yes ' i \nImmediate Action Taken' \u2018hypenensmn : i \n: %}AHs?hma minimal exertion % \n' Obese BMI 45 1 \n% 2. Communication and Mental Status \n3 *Assessmeht of ability to commumcate\" : : : \n\u2018What language does.the patient English Interpreter Required? ; . \ni speak ] . . ) ! \n. Does the patient have: \" | Speech difficullies: \n; \u00a7[ Learning difficulties (e.g. Down's syndrome): ; \n% iEVesigh\u2019E R - # e \u00bb . e . ] ' \n\u00a7 Normal vision? ] \"NA ) ?Glasses? Yes Distanice? \u00a7NA ?R'e'ading? :Yes \n\" \u201c'prosthesis2 . . NA \u2018Left: NA IRight= INA 1 \n\u2018Contact L\u00e9nses? - : {NA gReglstered Blmd? INA \nE ,{Hearin'g\" : e ! * T T s g \nNormal? \/ \u2018Yes rHearing impaired? tNA . \n'Hearing Aid? [NA Left: INA \u2018Right: [NA \nMental Statu i 3 et \nOrientated? | Yes \u2018Confused? :NA 'Distressed? \u2018NA {Unconscious? iNA \nAggressive \/ Abusive 'NA ' \nB Hydrahon and Nutntlon \n\u2018Nutrition screeniig should b\u00e9.rep\u00e9ated in 7 days on the followmg date. - 20\/03\/201\u20183 - \nNutrition screening required? ' { ;MUST Score: |0 i \n4. Elimination \nContinent (Bla'dcge,r,)': L Yes ;Continent (Bowel); iYes { \nIncontinent (Bladder): -~ \u00b0 INA \u2018Incontinent (Bowel): \":_ L NA \nLong term urinary catheter insi\u2018t;.l?:\u2018 - \u2018NA i i % V : \nContinente assesshent commenced? NA \u2018Specify any containment products in use: i : \n- Bowel regular? . ' INA Constipated? [NA .Diarrhoea \/ loose . {NA ! \ni ) e i ;\u2019StQOIS? 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