KARDEX

RM/BED PATIENT’S NAME (LAST, FIRST, MIDDLE NAME) AGE M STATUS RELIGION CITIZENSHIP
F
DATE OF BIRTH REGISTRATION # CASE # Philhealth H.M.D Contact Person:

DATE AND TIME OF ADMISSION PROBLEMS/NEED NURSING ACTION & EVALUATION

ATTENDING PHYSICIAN

OPERATION DELIVERY DATE

DIAGNOSIS SPECIAL ENDORSEMENT

WT: ________ HT: ________

DIET
TP _____ BP _____ CR _____ RR _____
ORDER LABORATORY, DIAGNOSTICS PROCEDURES REGULATION INTRAVENOUS MEDICATION & TREATMENT
DATE & CONSULTATIONS FLUID

GLASGOW COMA SCALE SCORE:

Eye Opening
Responses: Verbal Responses: Motor Responses: TOTAL SCORE:
4 = Spontaneous 5 = Oriented 6 = Obeys commands BEST RESPONSE: 15
3 = To verbal stimuli 4 = Confused 5 = Localizes pain COMATOSE CLIENT: 8 or less
2 = To pain 3 = Inappropriate words 4 = Withdraw from pain TOTALLY UNRESPONSIVE: 3
1 = None 2 = Incoherent 3 = Flexion to pain or decorticate
1 = None 2 = Extension to pain or decorticate
1 = None

NURSES’ ASSIGNED
DATE DATE DATE DATE DATE DATE
6AM 2PM 10PM 6AM 2PM 10PM 6AM 2PM 10PM 6AM 2PM 10PM 6AM 2PM 10 PM 6AM 2PM 10PM

STAGES OF PRESSURE SORES

STAGE I – SORES ARE NOT OPEN

WOUND
STAGE II – THE SKIN BREAKS OPEN
SKIN III – THE SORE EXTENDS INTO
TISSUE BENEATH THE SKIN
STAGE IV – SORE IS VERY DEEP
REACHING TO MUSCLES AND BONE

OTHERS
 REMINDERS
1. NO ABBREVIATIONS PLEASE.
2. KINDLY SPELL OUT ALL INSTRUCTIONS ESPECIALLY DOSAGES AND FREQUENCY OF MEDICATIONS.
3. DO NOT USE TRAILING ZERO.

Nurse’s Name Initial Nurse’s Name Initial Nurse’s Name Initial

DATE
Date Medication & Treatment
Ordered

STAT MEDICATION
Date Medication Initial Date Medication Initial

MEDICATION RECORD

LAST NAME FIRST NAME (Suffix e.g. Jr) MIDDLE NAME CASE NO. REGISTRATION NO.