Incident Report

You are a nurse for 2-10pm shift at a Medical- Surgical ward, and had to continue duty for another 8 hours as the
night shift nurse had an emergency and cannot come for duty. At 4 am you had hook a follow up  IVF of Normal
Saline 1Liter for  your patient Mrs. Reyes a 57 years old woman with Congestive Heart Failure, to keep vein open. At
6:45am during endorsement, the watcher of another patient came to the nursing station and informed that Mrs.
Reyes is having difficulty of breathing. Upon coming to the room with the morning duty nurse, you have seen that
Mrs. Reyes is having shortness of breath and with distended jugular vein, SPO2- 90-92% HR- 100 beats per minute 
RR- 40 and BP- 180/100mmHG as checked, given oxygen and informed the doctor. Attending doctor ordered to give
diuretics and anti arrythmic drugs and to the send patient to the CCU for further management and observation. You
did your documentation and reported the incident to your supervisor in charge.  Based on the given scenario, make
your incident report accordingly. You can create names and details of the scenario.

REPORTED BY: Gienelle Ferrer DATE OF REPORT: 08/23/2022

TITLE / ROLE: Incident INCIDENT NO.:

INCIDENT INFORMATION

INCIDENT TYPE: Stage 2 Hypertension & DOB w/ Distended jugular vein DATE OF INCIDENT: 08/23/2022
LOCATION: N a z a r e t h G e n e r a l H o s p i t a l

CITY: Dagupan City STATE: Pangasinan ZIP CODE: 2400

SPECIFIC AREA OF LOCATION (if applicable):

Medical- Surgical ward
INCIDENT DESCRIPTION
Mrs. Reyes a 57 years old woman with Congestive Heart Failure, to keep vein open. At 6:45am during endorsement, the watcher of
another patient came to the nursing station and informed that Mrs. Reyes is having difficulty of breathing. Upon coming to the room
with the morning duty nurse, you have seen that Mrs. Reyes is having shortness of breath and with distended jugular vein, SPO2- 90-
92% HR- 100 beats per minute RR- 40 and BP- 180/100mmHG as checked, given oxygen and informed the doctor. Attending doctor
ordered to give diuretics and anti-arrhythmia drugs and to the send patient to the CCU for further management and observation.
NAME / ROLE / CONTACT OF PARTIES INVOLVED

1. Ma. Veronica Ferrer - Cardiologist (MD)

2. Maureen Olivar - Registered nurse (RN)

NAME / ROLE / CONTACT OF WITNESSES

1. Karen Abad, the watcher of another patient

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 Incident Report Template

REPORTED BY: Chritian DATE OF REPORT: 23/12/2018

TITLE / ROLE: Ectrical jolt INCIDENT NO.: 23120018

INCIDENT INFORMATION

INCIDENT TYPE: Electrical jolt DATE OF INCIDENT: 23/12/2018

LOCATION: Subiaco
CITY: Perth STATE: Wa ZIP CODE:

SPECIFIC AREA OF LOCATION (if applicable): Office

INCIDENT DESCRIPTION

was
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.
NAME / ROLE / CONTACT OF PARTIES INVOLVED
8am at the office an It technician was repairing the motherboard of an office person l computer, When he tried attempt
to remove the CPU from the motherboard he suffered an electronical jolt

1. Christian / IT technician

2. resource CourseHero
3.
NAME / ROLE / CONTACT OF WITNESSES

1.
3.
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POLICE REPORT FILED?

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PRECINCT: Subiaco Office
REPORTING OFFICER: Clackson PHONE: 0432586774

FOLLOW-UP AC ION

SUPERVISO
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 NAME: Jack SIGNATURE: Jack DATE: 23/12/2018

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