Iv Therapy Accomplished Requirements
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IV THERAPY ACCOMPLISHED REQUIREMENTS Davao Medical Center Name of Hospital Offering IV Training
Venue: Davao Medical Center Province/Region: Region XI ANSAP Chapter:
J.P. Laurel Avenue, Davao City Address Accomplished Requirements of: Name of Registered Nurse: MALNEGRO. DEBORAH SORILLA Date of IV Training Program Attended: November 7-9, 2008 Registration No. of Institution Offering the IV Training: 006505 Program Name of Patient I.
Age
PRC No.: 0485817 IV Requirements: 6+6+2
Expiry Date:
May 14, 2011
Kind of IV Infusion Given
Date/ Time/ Site of IV Insertion/ Type of Cannula/ Dose/ Rate/Drug Incorporation Present
Initiating Maintaining Peripheral IV Infusions
1. ANDRADE, Grace
18 y.o.
D5LR 1L
Nov. 13, 2008/9:45p.m./Left Metacarpal Vein/G.18/K.V.O.
2. LARISMA, Rudita
37 y.o.
D5W 500cc
Nov. 17, 2008/8:45p.m./Left Metacarpal Vein/G.18/K.V.O.
3. GIROY, Maria Fe
23 y.o.
D5LR 1L
Nov. 17, 2008/9:10p.m./Left Metacarpal Vein/G.18/K.V.O.
4. VERIDIANO, Abegail
25 y.o.
D5LR 1L
Nov. 17, 2008/9:45p.m./Right Cephalic Vein/G.18/K.V.O.
5. SUMAMPONG, Angel
40 y.o.
D5LR 1L
Nov. 17, 2008/10:20p.m./Right Metacarpal Vein/G.18/K.V.O.
6. SANAMA, Madjah
20 y.o.
D5LR 1L
Nov. 17, 2008/10:45p.m./Right Metacarpal Vein/G.18/K.V.O.
18 y.o.
D5LR 1L
Nov. 19, 2008/9:00p.m./Cefazolin 1gm IVTTq8/ t/c Abscess formation, back area;s/p posterior instrumentation with pedicle screws
49 y.o.
D5NSS 1L
Nov. 19, 2008/9:10p.m./ Tramadol 25mg IVTT q8/ DM, Diabetic Foot, Wagner V (L)
29 y.o.
D5LR 1L
Nov. 19, 2008/9:30p.m./ Cefoxitin 1g IVTT q8/ Fracture Closed, Displaced, transverse, D/3 Radius (L); with Fracture closed, displaced, comminuted
31 y.o.
PNSS 1L
Nov. 19, 2008/9:45p.m./ Gentamycin 80mg IVTT q8/ Open fracture; Montaggia, ® with anterior dislocation on ® elbow joint; fracture closed humerus, m/3rd (L)
5. SALIBAY, Porferia
74 y.o.
D5LR 1L
Nov. 19, 2008/10:00p.m./ Cefuroxime 750mg IVTT q8/ Renal cyst ®; Bosniak 2F
6. ALVARADO, Rogelio Jr.
36 y.o.
D5LR 1L
Nov. 19, 2008/10:15p.m./ Ketoprofen 100mg with PNSS in 10cc Slow IVTT q8/ Staghorn Calculi ®; s/p DS
II.
Administering IV Drugs
1. MELENDREZ, Eduardo 2. JULIAN, Wendelina 3. KASIM, Ibrahim 4. MURILLO, Enocelecio
III.
Signature of Witness M.D./ IV Trained Proceptor
Date/ Time/ Drug Incorporated/ Dose/ Diagnosis
Administering & Maintaining Blood & Blood Components Blood Type/ Volume/ Components
Date/ Time/ Site of IV Insertions/ Type of Cannula/ Rate
1. SANTOS, Merlyn
43 y.o.
Type O+/ 450cc/ PRBC
Nov. 20, 2008/5:45./Right Cephalic Vein/G.18/13 gtts/min
2. ROSETE, Susana
63 y.o.
Type O+/ 450cc/ PRBC
Nov. 17, 2008/8:45p.m./Left Cephalic Vein/G.18/12 gtts/min
This is to certify that I had successfully performed the above requirements, as countersigned by my witnesses. Received by: ___________________________________________________________________ ANSAP IV Therapy Certification Card No.__________________________________________________
Submitted by: __________________________________________________________ Signature over Printed Name of RN Approved by: __________________________________________________________
Director, Nursing Service Issued by: _____________________________________ Date: ___________________________
Venue: Davao Medical Center Province/Region: Region XI ANSAP Chapter:
J.P. Laurel Avenue, Davao City Address Accomplished Requirements of: Name of Registered Nurse: MALNEGRO. DEBORAH SORILLA Date of IV Training Program Attended: November 7-9, 2008 Registration No. of Institution Offering the IV Training: 006505 Program Name of Patient I.
Age
PRC No.: 0485817 IV Requirements: 6+6+2
Expiry Date:
May 14, 2011
Kind of IV Infusion Given
Date/ Time/ Site of IV Insertion/ Type of Cannula/ Dose/ Rate/Drug Incorporation Present
Initiating Maintaining Peripheral IV Infusions
1. ANDRADE, Grace
18 y.o.
D5LR 1L
Nov. 13, 2008/9:45p.m./Left Metacarpal Vein/G.18/K.V.O.
2. LARISMA, Rudita
37 y.o.
D5W 500cc
Nov. 17, 2008/8:45p.m./Left Metacarpal Vein/G.18/K.V.O.
3. GIROY, Maria Fe
23 y.o.
D5LR 1L
Nov. 17, 2008/9:10p.m./Left Metacarpal Vein/G.18/K.V.O.
4. VERIDIANO, Abegail
25 y.o.
D5LR 1L
Nov. 17, 2008/9:45p.m./Right Cephalic Vein/G.18/K.V.O.
5. SUMAMPONG, Angel
40 y.o.
D5LR 1L
Nov. 17, 2008/10:20p.m./Right Metacarpal Vein/G.18/K.V.O.
6. SANAMA, Madjah
20 y.o.
D5LR 1L
Nov. 17, 2008/10:45p.m./Right Metacarpal Vein/G.18/K.V.O.
18 y.o.
D5LR 1L
Nov. 19, 2008/9:00p.m./Cefazolin 1gm IVTTq8/ t/c Abscess formation, back area;s/p posterior instrumentation with pedicle screws
49 y.o.
D5NSS 1L
Nov. 19, 2008/9:10p.m./ Tramadol 25mg IVTT q8/ DM, Diabetic Foot, Wagner V (L)
29 y.o.
D5LR 1L
Nov. 19, 2008/9:30p.m./ Cefoxitin 1g IVTT q8/ Fracture Closed, Displaced, transverse, D/3 Radius (L); with Fracture closed, displaced, comminuted
31 y.o.
PNSS 1L
Nov. 19, 2008/9:45p.m./ Gentamycin 80mg IVTT q8/ Open fracture; Montaggia, ® with anterior dislocation on ® elbow joint; fracture closed humerus, m/3rd (L)
5. SALIBAY, Porferia
74 y.o.
D5LR 1L
Nov. 19, 2008/10:00p.m./ Cefuroxime 750mg IVTT q8/ Renal cyst ®; Bosniak 2F
6. ALVARADO, Rogelio Jr.
36 y.o.
D5LR 1L
Nov. 19, 2008/10:15p.m./ Ketoprofen 100mg with PNSS in 10cc Slow IVTT q8/ Staghorn Calculi ®; s/p DS
II.
Administering IV Drugs
1. MELENDREZ, Eduardo 2. JULIAN, Wendelina 3. KASIM, Ibrahim 4. MURILLO, Enocelecio
III.
Signature of Witness M.D./ IV Trained Proceptor
Date/ Time/ Drug Incorporated/ Dose/ Diagnosis
Administering & Maintaining Blood & Blood Components Blood Type/ Volume/ Components
Date/ Time/ Site of IV Insertions/ Type of Cannula/ Rate
1. SANTOS, Merlyn
43 y.o.
Type O+/ 450cc/ PRBC
Nov. 20, 2008/5:45./Right Cephalic Vein/G.18/13 gtts/min
2. ROSETE, Susana
63 y.o.
Type O+/ 450cc/ PRBC
Nov. 17, 2008/8:45p.m./Left Cephalic Vein/G.18/12 gtts/min
This is to certify that I had successfully performed the above requirements, as countersigned by my witnesses. Received by: ___________________________________________________________________ ANSAP IV Therapy Certification Card No.__________________________________________________
Submitted by: __________________________________________________________ Signature over Printed Name of RN Approved by: __________________________________________________________
Director, Nursing Service Issued by: _____________________________________ Date: ___________________________
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