Post Operative Nursing Follow Up Sheet

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‫السلطة الوطنية الفلسطينية‬ ID: M.R.

Nc: ………………………………
‫وزارة الصحة‬ Patient Name: ………………………….
...................................... :‫مستشفي‬ Age: ………………………………………….
......................................... :‫القسم‬ Date of a omission: …………………

Post Operative Nursing Follow up Sheet

Diagnosis : ………………………………….. Type of anesthesia : ……………………………


Operation : …………………………………

Hour/ ……AM…….. Hour/__


Time: Hour/__ Hour/__
PM
Items First hr Second hr Third hr Fourth hr
BP
Temp
Pulse
Respiration
Full conciseness
Consciousness Semi
level conciseness
Not conciseness
Drain output/cc
Dressing
Urin output/cc
Urin color
Circulation
Orthopedic
Sensation
surgery
Movement
Analgesia (vaslno)
Name and signature

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