3+3+1 ACCOMPLISHED REQUIREMENTS of 3- DAY BASIC INTRAVENOUS THERAPY TRAINING PROGRAM for NURSES

Name of Registered Nurse Name of Hospital offering IV Training Date of IV Training Program Attended CALUMAG, TAIRON JAMES NABOR MARIANO MARCOS MEMORIAL HOSPITAL & MEDICAL CENTER JUNE 24, 25 AND 26, 2011 PRC Number Provider No. Venue 0624054 192 MARIANO MARCOS MEMORIAL HOSPITAL& MEDICAL CENTER (Training Center)

I.

Initiating/ Maintaining Peripheral IV Infusions Signature over Printed name of Certified Trainer/ Preceptor Manuela C. Pe Benito 15 drops per minute

Patient No. 533957

Name of Patient

Age

Date

Time

Kind of Infusion D5 NM

Site

Type of Cannula Venflon Gauge 18 Venflon Gauge 19 Venflon Gauge 18

Dose

Rate 15 drops per minute

License No.

1. Tarona, Marjorie, Cadavona

29

07/14/2011

09:10 AM

Right Basilic Vein

1000 ml

0132986

278571

2. Badanguio, Catherine Bulong

37

07/14/2011

09:45 AM

D5 Water

Left Metacarpal Vein

500 ml 10 drops per minute

Manuela C. Pe Benito

0132986

347192

3. Manaran, Imelda Tallion

43

07/14/2011

11:45 AM

Plain NSS

Right Cephalic Vein

1000 ml

Manuela C. Pe Benito

0132986

II.

Administering Intravenous Drugs

Patient No.

Name of Patient

Age

Date

Time

Drugs Incorporated

Dose

Diagnosis

Signature over Printed name of Certified Trainer/ Preceptor Manuela C. Pe Benito

License No.

611683

1. Bueno, Maren de la Fuente

23

07/14/2011

10:05 AM

Ampicillin

2 grams

G2P1(1001)Pregnancy Uterine 29 4/7 weeks AOG not in labor G2P1(1001)Pregancy Uterine 29 4/7 weeks AOG; cephalic in labor G2P1(1001)Pregancy Uterine 29 4/7 weeks AOG; cephalic in labor

0132986

609739

2. Barroga, Virginia Jose

37

07/14/2011

12:05 PM

Cefuroxime

750 mg

Manuela C. Pe Benito

0132986

609739

3. Barroga, Virginia Jose

37

07/14/2011

12: 10 PM

Diclofenac Na

75 mg

Manuela C. Pe Benito

0132986

III.

Administering and Maintaining Blood and Blood Components

Patient No.

Name of Patient

Age

Date

Time

Volume/ Blood Type/ Components/ Rate

IV Insertion

Type of Cannula

Diagnosis

Signature over Printed name of Certified Trainer/ Preceptor Manuela C. Pe Benito

License No.

607553

1. Galzote, Kathleen Madriaga

19

07/14/2011

09:35 AM

1 unit(450 cc)/O+/Packed Red Blood Cells/20 drops per minute

Right Cephalic Vein

Venflon Gauge 18

G1P1(1001) Day 1 post partum, post partum hemorrhage probably 2 uterine sub involution probably 2 to refaced placental fragment, R/O Endometritis

0132986

Submitted by: Signature over Printed Name

Date Submitted: _____________

Received by:

Approved by: Director of Nursing Service (Signature over Printed Name)