Documentation for Suture and Staple Removal
ADNG 1050 Foundations of Nursing Skills
Scenario:
26-year-old male who has returned to the clinic for suture removal.
🗂️ Documentation
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To complete: Upload this document to your computer & fill it out electronically (directly into the assignment)
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To turn it in: Re-upload it to the correct file/drop box in D2L.
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1. Write a
DARP note including: (Erase below information under each heading and type as if you are writing a nursing note)
D: Data
· Baseline vital signs
· Initial wound assessment
· Reason for suture removal
A: Action
· State that education was given
· What was the procedure you performed
R: Response/Results
· Patient’s tolerance to procedure
· Reassessment of site and/or VS
P: Plan
· Discharge education
· Follow-up only if signs of infection or complications
🧑🏫
2. Patient Education (Write as a Script) Keep short and to the point.
· Describe the skill being performed in simple terms.
· Explain the need for the skill to be done.
· Educate on what they can expect during the skill and after the skill is complete. You will experience pressure during the insertion part. Remember to bear down.
· Provide any other valuable knowledge to patient that is relevant to the skill being done.
🔐 3. National Patient Safety Goal (NPSG) Choose 1 priority NPSG that is relevant to this scenario and tell us why in 1 paragraph.
NPSG Chosen:
Why It Matters:
📝 4. Nursing Diagnosis & Care Plan
✅ 3-Part Nursing Diagnosis:
Instructor example
: Anxiety
related to unfamiliar medical procedures and potential pain
as evidenced by patient asking multiple questions and expressing nervousness before suture removal.
Student nursing diagnosis:
🎯 5. SMART Goal:
Instructor example
: Patient will verbalize understanding of the procedure and report anxiety level of 3 or less (on a 0–10 scale) prior to the start of the suture removal today.
Student SMART goal:
🩹 List:
·
2 Interventions to accomplish this goal
· Rationale for each intervention
· Evaluation for each intervention
1. Intervention:
· Rationale:
· Evaluation:
2. Intervention:
· Rationale:
· Evaluation:
🎥Video Review: IF you have any limited comments (“I would have….” OR “I forgot to…”) Please add below.
