PDF file - American Nephrology Nurses Association
PDF file - American Nephrology Nurses Association
PDF file - American Nephrology Nurses Association
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N8. Immune N/A<br />
Amyloidosis<br />
HIV/AIDS<br />
Scleroderma<br />
Other<br />
Systemic lupus erythematosus (SLE)<br />
Explanations:<br />
N9. Mental Health N/A<br />
Does the patient report any past or current mental health issues, concerns, or mood<br />
disturbances (feelings of depression or anxiety)?<br />
Yes No<br />
Dementia<br />
Anxiety disorder<br />
Depression<br />
Alcohol or substance abuse<br />
Post-traumatic stress syndrome<br />
Other<br />
Alzheimer’s<br />
Bipolar disorder<br />
Schizophrenia<br />
Explanations:<br />
N10. Cancer N/A<br />
Breast<br />
Gynecologic<br />
Lung<br />
Prostate<br />
Multiple myeloma<br />
Bone<br />
Other<br />
Explanations:<br />
Colon<br />
Hematologic<br />
Melanoma<br />
Renal<br />
Skin<br />
Squamous cell<br />
Basal cell<br />
Other:<br />
Comprehensive Interdisciplinary Patient Assessment / ANNA & NKF Version: 11/18/08 7
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