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Example of PIE Charting: Patient admitted with osteoarthritis with total knee

replacement.

1. Acute Pain
2. Impaired mobility
3. Activity intolerance

0735 Patient resting quietly. Denies pain. CPM to R knee 0-55; machine on.
Dressing to knee
E#1/2 dry and intact. Hemovac to R knee compressed draining small amt red
fluid.----JMcWha

0920 Patient ambulating with PT using walker. Takes frequent rests to catch
breath. C/O
E#3 fatigue. Able to ambulate 30
feet.-----------------------------------------------------------JMcWha

1125 Patient C/O pain to R knee. Level 9; throbbing and wave-like.


Repositioned patient and P/I #1 medicated for pain-see
MAR.--------------------------------------------------------------JMcWha

1215
E#1 Patient reports pain level 2-3. Resting quietly watching
TV-----------------------------JMcWha

1345 Doctor at bedside, dressing and drain removed by physician. Incision well
approximated with staples, no redness; moderate swelling. Redressed
with sterile primapore . Pt tolerated well—JmcWha (note this entry
does not correlate to any of the 3 NANDAs above, so there does not
need to be a PIE entry here..)

1650 Patient C/O pain to R knee –level 10. Repositioned leg and medicated-see
MAR-
P / I #1 JMcWha

1755
E#1 Patient sleeping. CPM 0-60; machine on. Wife at bedside--------------------
JMcWha

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