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SILLIMAN UNIVERSITY COLLEGE OF NURSING

STUDENT NURSE KARDEX SHEET

PROFILE ENDORSED IVF PROFILE ENDORSED IVF


NAME: ________________________________ TYPE: ____________ IDEAL IVF: ________ NAME: ________________________________ TYPE: ____________ IDEAL IVF: ________
BOTTLE #: ________ BOTTLE #: ________
ROOM AND BED NUMBER: ________________ FR: ______________ ACTUAL IVF: ______ ROOM AND BED NUMBER: ________________ FR: ______________ ACTUAL IVF: ______
SITE: ____________ SITE: ____________
AGE:_______ DOCTOR: ___________________ _________________ TOTAL INFUSION: AGE:_______ DOCTOR: ___________________ _________________ TOTAL INFUSION:
TIME CONSUMED: _________________ TIME CONSUMED: _________________
C/C: ___________________________________ _________________ _________________ C/C: ___________________________________ _________________ _________________

VITAL SIGNS IVF MONITORING SHEET VITAL SIGNS IVF MONITORING SHEET
8 AM / 4 PM 12 NN/ 8PM TIME 8 AM / 4 PM 12 NN/ 8PM TIME
T = _______________ T = _______________ 7 3 T = _______________ T = _______________ 7 3
P = _______________ P = _______________ P = _______________ P = _______________
R = _______________ R = _______________ 8 4 R = _______________ R = _______________ 8 4
BP = ______________ BP = ______________ BP = ______________ BP = ______________
9 5 9 5
CAPILLARY REFILL (CRT) CAPILLARY REFILL (CRT) CAPILLARY REFILL (CRT) CAPILLARY REFILL (CRT)
__________________ ___________________ __________________ ___________________
10 6 10 6
PERIPHERAL PULSE: PERIPHERAL PULSE: PERIPHERAL PULSE: PERIPHERAL PULSE:
__________________ __________________ 11 7 __________________ __________________ 11 7

SPECIAL REMINDERS 12 8 SPECIAL REMINDERS 12 8


DIET: ___________________________________ DIET: ___________________________________
_______________________________________ 1 9 _______________________________________ 1 9
_______________________________________ _______________________________________
2 10 2 10
OTHERS: ________________________________ OTHERS: ________________________________
_______________________________________ 3 11 _______________________________________ 3 11
_______________________________________ INPUT AND OUTPUT _______________________________________ INPUT AND OUTPUT
_______________________________________ TOTAL INPUT: TOTAL OUTPUT: _______________________________________ TOTAL INPUT: TOTAL OUTPUT:
_______________________________________ U= _______________________________________ U=
_______________________________________ S= _______________________________________ S=
_______________________________________ _______________________________________
_______________________________________ _______________________________________

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