Rm

CODE

Allergies

Dx

Name:

Tests/Procedures

Vitals

Drips
K Mg Heparin

time

value

replace

recheck

t p bp rr O2 L:____ pain IV @ ml/hr

Labs/specimens needed

PCA: po/ivp/routine
8

MEDS ivpb
8 9 10 11 12 13 14 15

9 10 11

site: Drains/tubes

12 13 14 15

Neuro A/Ox conf?

Pain

Cardiac/TELE rate/rhythm

Resp lungs:

Labs K Mg BUN creat Na WBC hgb hct plt PT/INR PTT

LD: edema RR Nebs Skin O2

GU brp/bsc foley urinal bp

GI diet: abd bs n/v/c/d

Act

dressing Accu Bfast : Lunch : O SS?

PLAN/ ORDERS/ TO DO:

/specimens ed

ivpb

O chart O chart

****chart****: VS VS Assess Outcomes POC teach I/O Pains clear PCA

****Chart Audits****

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