Medsurg Report Sheet 6s726j
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- Words: 252
- Pages: 1
7
Rm:
8
9
10
11
12
1
2
3
4
5
Allergies:
6
7
Code:_______ MEWS:____ Assessment
O2:__________ S/L:__________ Diet:____________ IV:_________________ Infused:A_______B:_______ T:_____ P:_____ R:_____ B/P:________ O2:______ T:_____ P:_____ R:_____ B/P:________ O2:______ T:_____ P:_____ R:_____ B/P:________ O2:______ Accu : 0700_____ 1130_____ 1630____ 2100____ BRP / foley / BSC / urinal
UA / C&S stools x ____
Activity: ↑ad lib / bed rest / ↑in chair / O2 walks / assist
F
Precautions: / fall / seizure / aspiration / neuro
B
PCA Drug:__________ Dose:___mg/___ml; ___ml/hr 0800 ATT:___ INJ:___
1000 ATT:___ INJ:___
1200 ATT:___ INJ:___
1400 ATT:___ INJ:___
1600 ATT:___ INJ:___
1800 ATT:___ INJ:___
Hgb
Total ml INJ:________
7
Rm:
8
WBC
9
10
11
12
Plt
Hct
1
2
Na
Cl
BUN
K+ CO2 Cr
3
Mg Glu
Ca PO4
4
Allergies:
5
PTT
PT
6
INR
7
Code:_______ MEWS:____ Assessment
O2:__________ S/L:__________ Diet:____________ IV:_________________ Infused:A_______B:_______ T:_____ P:_____ R:_____ B/P:________ O2:______ T:_____ P:_____ R:_____ B/P:________ O2:______ T:_____ P:_____ R:_____ B/P:________ O2:______ Accu : 0700____ 1130____ 1630_____ 2100_____ BRP / foley / BSC / urinal
UA / C&S stools x ____
Activity: ↑ad lib / bed rest / ↑in chair / O2 walks / assist
F
Precautions: / fall / seizure / aspiration / neuro
B
PCA Drug:__________ Dose:___mg/___ml; ___ml/hr 0800 ATT:___ INJ:___
1000 ATT:___ INJ:___
1200 ATT:___ INJ:___
1400 ATT:___ INJ:___
1600 ATT:___ INJ:___
1800 ATT:___ INJ:___
Total ml INJ:________
Hgb WBC
Hct
Plt
Na Cl BUN Glu K+ CO2 Cr
Mg Ca PO4
PTT
PT
INR
Rm:
8
9
10
11
12
1
2
3
4
5
Allergies:
6
7
Code:_______ MEWS:____ Assessment
O2:__________ S/L:__________ Diet:____________ IV:_________________ Infused:A_______B:_______ T:_____ P:_____ R:_____ B/P:________ O2:______ T:_____ P:_____ R:_____ B/P:________ O2:______ T:_____ P:_____ R:_____ B/P:________ O2:______ Accu : 0700_____ 1130_____ 1630____ 2100____ BRP / foley / BSC / urinal
UA / C&S stools x ____
Activity: ↑ad lib / bed rest / ↑in chair / O2 walks / assist
F
Precautions: / fall / seizure / aspiration / neuro
B
PCA Drug:__________ Dose:___mg/___ml; ___ml/hr 0800 ATT:___ INJ:___
1000 ATT:___ INJ:___
1200 ATT:___ INJ:___
1400 ATT:___ INJ:___
1600 ATT:___ INJ:___
1800 ATT:___ INJ:___
Hgb
Total ml INJ:________
7
Rm:
8
WBC
9
10
11
12
Plt
Hct
1
2
Na
Cl
BUN
K+ CO2 Cr
3
Mg Glu
Ca PO4
4
Allergies:
5
PTT
PT
6
INR
7
Code:_______ MEWS:____ Assessment
O2:__________ S/L:__________ Diet:____________ IV:_________________ Infused:A_______B:_______ T:_____ P:_____ R:_____ B/P:________ O2:______ T:_____ P:_____ R:_____ B/P:________ O2:______ T:_____ P:_____ R:_____ B/P:________ O2:______ Accu : 0700____ 1130____ 1630_____ 2100_____ BRP / foley / BSC / urinal
UA / C&S stools x ____
Activity: ↑ad lib / bed rest / ↑in chair / O2 walks / assist
F
Precautions: / fall / seizure / aspiration / neuro
B
PCA Drug:__________ Dose:___mg/___ml; ___ml/hr 0800 ATT:___ INJ:___
1000 ATT:___ INJ:___
1200 ATT:___ INJ:___
1400 ATT:___ INJ:___
1600 ATT:___ INJ:___
1800 ATT:___ INJ:___
Total ml INJ:________
Hgb WBC
Hct
Plt
Na Cl BUN Glu K+ CO2 Cr
Mg Ca PO4
PTT
PT
INR
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