My Brain Sheet.docx
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PT_______ Rm#______ Age____ Admit Date__________ Dr_______________________ Precautions____________ Activity _________ Code_________ Rhythm_______ Procedures DX allergies
PT_______ Rm#______ Age____ Admit Date____________ Dr______________________ Precautions:____________ Activity___________ Code_________ Rhythm_______ Procedures DX allergies
Background:
Plan:
Background:
Plan:
Neuro 4 3 2 1
Cardiac EF
Resp
GI
Neuro 4 3 2 1
Cardiac EF
Resp
GI
GU
IV Site:
IV Fluids
Skin
GU
IV Site:
IV Fluids
Skin
Drains/Tubes
Vitals
Drains/Tubes
Vitals
Accu Q___/ ACHS _______@_______ _______@ ______ _______@_______
PRNs Given
Accu Q___/ ACHS _______@_______ _______@ ______ _______@_______
PRNs Given
To Do
ABNORMAL LABS WBC______PT_____ K_____ Na+_____ HGB______ INR____ CA____ pH_____ HCT______ BUN____ PH____ CO2____ PLT ______ CRE_____ MG_____ O2_____ Lac_____ HCO3_____
To Do
ABNORMAL LABS WBC______PT_____ K_____ Na+_____ HGB______ INR____ CA____ pH_____ HCT______ BUN____ PH____ CO2____ PLT ______ CRE_____ MG____ O2_____ LAC______ HCO3_____
PT_______ Rm#______ Age____ Admit Date____________ Dr______________________ Precautions:____________ Activity___________ Code_________ Rhythm_______ Procedures DX allergies
Background:
Plan:
Background:
Plan:
Neuro 4 3 2 1
Cardiac EF
Resp
GI
Neuro 4 3 2 1
Cardiac EF
Resp
GI
GU
IV Site:
IV Fluids
Skin
GU
IV Site:
IV Fluids
Skin
Drains/Tubes
Vitals
Drains/Tubes
Vitals
Accu Q___/ ACHS _______@_______ _______@ ______ _______@_______
PRNs Given
Accu Q___/ ACHS _______@_______ _______@ ______ _______@_______
PRNs Given
To Do
ABNORMAL LABS WBC______PT_____ K_____ Na+_____ HGB______ INR____ CA____ pH_____ HCT______ BUN____ PH____ CO2____ PLT ______ CRE_____ MG_____ O2_____ Lac_____ HCO3_____
To Do
ABNORMAL LABS WBC______PT_____ K_____ Na+_____ HGB______ INR____ CA____ pH_____ HCT______ BUN____ PH____ CO2____ PLT ______ CRE_____ MG____ O2_____ LAC______ HCO3_____
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