VIEW COMPLETED NOTE

SN to notify physician this patient was screened for depression using the PHQ-2 scale and meets criteria for further evaluation for depression, SN to assess for changes in neurological status every visit, SN to assess patient’s communication skills every visit, SN to instruct the Patient/Caregiver on seizure precautions, SN to instruct caregiver on orientation techniques to use when patient becomes disoriented, Maintain bedrest, provide a quiet and relaxing environment, restrict visitors and activities. Cluster nursing interventions and provide rest periods between care activities. Limit duration of procedures., Prevent straining at stool, holding breath, physical exertion., Administer supplemental oxygen as indicated., Determine the need for walking aids. Provide braces, walkers, or wheelchairs. Review safety considerations., Orient the patient to the environment as needed if the patient’s short-term memory is intact. The use of calendars, radio, newspapers, television, and so forth are also appropriate., Assist the client in setting up a medication box., Encourage clients to express feelings (anger, sadness, guilt) and come up with alternative ways to handle feelings of anger and frustration., Maintain a low level of stimuli in client’s environment (e.g., loud noises, bright light, low-temperature ventilation)., Redirect violent behavior., Provide frequent rest periods., Weapons and pills are removed by friends, relatives, or the nurse.