*If no bowel movement, chart in the progress notes how long without one, assessment and what interventions were done. 
Student First Name            Last Name

Glasgow Coma Scale/Neurological System:
If a patient has an infusion for sedation or received intermittent sedation any route select the score for the RASS (Richmond Agitation-Sedation Scale)




Overtly combative or violent;
immediate danger to staff

Very agitated
Pulls on or removes tube(s) or catheter(s) or has aggressive behavior toward staff

Frequent nonpurposeful movement or patient–ventilator dyssynchrony

Anxious or apprehensive but movements not aggressive or vigorous

Alert and calm
Spontaneously pays attention to caregiver

Not fully alert, but has sustained
(more than 10 seconds) awakening,
with eye contact, to voice

Light sedation
Briefly (less than 10 seconds)
awakens with eye contact to voice

Moderate sedation
Any movement
(but no eye contact) to voice

Deep sedation
No response to voice, but any movement to physical stimulation

No response to voice
or physical stimulation

WARNING: Please print your Assessment data first.

The Restraint Charting page and the Risk Assessment pages open in a different browser, so you will not lose your Assessment data. Just remember to go back to the browser that has your Assessment data.