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Name: ________________________________________ DOB: _______________DATE______________ PLEASE CIRCLE EACH MEDICATION YOU HAVE USED FOR PAIN OR HEADACHE MANAGEMENT
Analgesics
Heart/Blood Pressure Meds
Muscle relaxants
Anti-Inflammatories
Antidepressants
Anticonvulsants
Decongestant/
Anit-Nausea/
Antihistamine
Phenothiazines/
Sleeping Pills/
Neuroleptics
Tranquilizers
Antimigraine
Medications
Steroids
Other Medications used for pain control in the past
_______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ LIST ALL MEDICATION ALLERGIES
________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ LIST ALL MEDICATION ADVERSE EFFECTS
1. ______________________________________________________________________________________________ 2. ______________________________________________________________________________________________ 3. ______________________________________________________________________________________________ 4. ______________________________________________________________________________________________ 5. ______________________________________________________________________________________________ PLEASE LIST BELOW ALL MEDICATIONS YOU ARE USING NOW
Frequency you are actually using
1. ______________________________________________________________________________________________ 2. ______________________________________________________________________________________________ 4. ______________________________________________________________________________________________ 5. ______________________________________________________________________________________________ 6. ______________________________________________________________________________________________ 7. ______________________________________________________________________________________________ 8. ______________________________________________________________________________________________ 9. ______________________________________________________________________________________________ 10. _____________________________________________________________________________________________ 11. _____________________________________________________________________________________________ 12. _____________________________________________________________________________________________ 13. _____________________________________________________________________________________________ 14. _____________________________________________________________________________________________ 15. _____________________________________________________________________________________________ 16. _____________________________________________________________________________________________ 17. _____________________________________________________________________________________________ 18. _____________________________________________________________________________________________ 19. _____________________________________________________________________________________________ 20. _____________________________________________________________________________________________

Source: http://painsandiego.files.wordpress.com/2009/04/medications.pdf

Calhen checklist

VAP: Ventilator Acquired Pneumonia Primary Drivers Secondary Drivers Standardize processes and care Institute a standardized protocol or bundle for the care of a reminders bundle reminders and checklists on a flow sheet or EMR checklist Elevate Head of Bed raised between visual cues so it is easy to identify when the bed is in the proper 30-45 degrees position,

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By Chuck Palahniuk The View from Smalltown, USA The problem is I don’t have a television so I have to visit people. I listen to the radio. Plus, there’s always the phone and e-mails. I had to call a lot of folks. The other problem is that this is Oregon, 2000 miles from the attack. My friend Mike shrugs and says, “So? If people want to live in New York they need to accept the risks.

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