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Wuhan Union Hospital of China
First nursing evaluation sheet of in-patient Level of education: □illiterate□primary school□ middle school
□senior middle or technical secondary school□junior college□undergraduate and above
Admiion form: □walking□Supported walking□wheelchair□Flat car □stretcher□others
Fundamental state aement
Consciousne: □clear□sleepine□confusion□lethargy□coma
Body position: □active position□paive position□forced position(□orthopneicposition
□semi-fowler's □lateral position□prone position□others)
Skin and mucous membrane: □normal□preure ulcer□scald□trauma□Diet: □general diet□semifluid□fluid□fasting□NG tube□therapeutical diet
Cacation:□normal□day;Auxiliary:□no□)
□□incontinence □fistulation(ADL:□yes □no)□Urination:□normal□incontinence□urinary retention□dysuria
□retentioncatheteriztion□others
Allergic history: Medicine: □no□unknown□yesFood:□no□unknown□ □ Smoking:□no□yes
Drinking:□no□occasionally□frequently□everyday
ADL:□completely□partially□incompetently
Barthel index:score Tumble risk evaluation: □Tumble history□Activity abnormal□Auxiliary-set
□Sleeping disorders□Vision abnormal
Pain evaluation: □no□)
Degree of pain:□0 analgesia □1~3 slightly pain □4~6 a little pain □7~9 very pain □10sharply pain
（score）
Preure ulcer risk(Norton score):scoreOthers:Introduction of admiion: □admiion knowledge□environment and facilities□related doctor and nurse□diet □security management system□ tumble prevention knowledge□relevant knowledge of disease
Time:1st
