NIBBLES approach:
  • Neurological Level: include AIS
  • Immobilization: any spinal orthoses, extremity orthoses/splints/wraps? (to prevent contracture, facilitate stability, promote tenodesis, etc.) place nursing communication
  • Bladder: appropriate UMN vs LMN orders
  • Bowel: appropriate UMN vs LMN orders
  • Blood Pressure: consider orthostatic hypotension
  • Bone: vitamin D level, supplementation prn
  • Lungs: include orders for nebulizers, ventilator settings, chest perccusion, post drainage and insufflator use if any needed
  • Embolism / Extremities: DVT Prophylaxis
  • Skin: wound care orders, turning schedule, also Lac-hydrin if dry skin
  • Sexuality: include any sexual dysfunction
  • Pain: neuropathic? nociceptive? visceral?
  • MSK: include any pertinent MSK concerns. Assess for heterotopic ossification