Nursing "brains" Report Sheet 1
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Pt______ Age____ Rm#_____
Pt______ Age____ Rm#_____
Pt______ Age____ Rm#_____
Pt______ Age____ Rm#_____
RN:____________
RN:____________
RN:____________
RN:____________
Dx:_________________
Dx:_________________
Dx:_________________
Dx:_________________
FSBS:______Coverage:______
FSBS:______Coverage:______
FSBS:______Coverage:______
FSBS:______Coverage:______
T ____ •
____
♥ ____ _____ O2 ____ _____ RR____ _____ B/P_________ _________
Labs KNa-
T ____
Labs
____
♥ ____ _____ O2 ____ _____ RR____ _____ B/P_________ _________
KNa-
T ____
____
♥ ____ _____ O2 ____ _____ RR____ _____ B/P_________ _________
Labs KNa-
T ____
Labs
____
♥ ____ _____ O2 ____ _____ RR____ _____ B/P_________ _________
Pain ____/10 _______
Pain ____/10 _______
Pain ____/10 _______
Pain ____/10 _______
____/10 _______
____/10 _______
____/10 _______
____/10 _______
KNa-
PO IV ___ ___ x 0700 _____________ ___ ___ x 0800 _____________ ___ ___ x 0900 _____________ ___ ___ x 1000 _____________ ___ ___ x 1100 _____________ ___ ___ x 1200 _____________ ___ ___ x 1300 _____________
PO IV ___ ___ x 0700 _____________ ___ ___ x 0800 _____________ ___ ___ x 0900 _____________ ___ ___ x 1000 _____________ ___ ___ x 1100 _____________ ___ ___ x 1200 _____________ ___ ___ x 1300 _____________
PO IV ___ ___ x 0700 _____________ ___ ___ x 0800 _____________ ___ ___ x 0900 _____________ ___ ___ x 1000 _____________ ___ ___ x 1100 _____________ ___ ___ x 1200 _____________ ___ ___ x 1300 _____________
PO IV ___ ___ x 0700 _____________ ___ ___ x 0800 _____________ ___ ___ x 0900 _____________ ___ ___ x 1000 _____________ ___ ___ x 1100 _____________ ___ ___ x 1200 _____________ ___ ___ x 1300 _____________
IV_______________ RATE___________
IV_______________ RATE___________
IV_______________ RATE___________
IV_______________ RATE___________
Notes:
Notes:
Notes:
Notes:
Pt______ Age____ Rm#_____
Pt______ Age____ Rm#_____
Pt______ Age____ Rm#_____
RN:____________
RN:____________
RN:____________
RN:____________
Dx:_________________
Dx:_________________
Dx:_________________
Dx:_________________
FSBS:______Coverage:______
FSBS:______Coverage:______
FSBS:______Coverage:______
FSBS:______Coverage:______
T ____ •
____
♥ ____ _____ O2 ____ _____ RR____ _____ B/P_________ _________
Labs KNa-
T ____
Labs
____
♥ ____ _____ O2 ____ _____ RR____ _____ B/P_________ _________
KNa-
T ____
____
♥ ____ _____ O2 ____ _____ RR____ _____ B/P_________ _________
Labs KNa-
T ____
Labs
____
♥ ____ _____ O2 ____ _____ RR____ _____ B/P_________ _________
Pain ____/10 _______
Pain ____/10 _______
Pain ____/10 _______
Pain ____/10 _______
____/10 _______
____/10 _______
____/10 _______
____/10 _______
KNa-
PO IV ___ ___ x 0700 _____________ ___ ___ x 0800 _____________ ___ ___ x 0900 _____________ ___ ___ x 1000 _____________ ___ ___ x 1100 _____________ ___ ___ x 1200 _____________ ___ ___ x 1300 _____________
PO IV ___ ___ x 0700 _____________ ___ ___ x 0800 _____________ ___ ___ x 0900 _____________ ___ ___ x 1000 _____________ ___ ___ x 1100 _____________ ___ ___ x 1200 _____________ ___ ___ x 1300 _____________
PO IV ___ ___ x 0700 _____________ ___ ___ x 0800 _____________ ___ ___ x 0900 _____________ ___ ___ x 1000 _____________ ___ ___ x 1100 _____________ ___ ___ x 1200 _____________ ___ ___ x 1300 _____________
PO IV ___ ___ x 0700 _____________ ___ ___ x 0800 _____________ ___ ___ x 0900 _____________ ___ ___ x 1000 _____________ ___ ___ x 1100 _____________ ___ ___ x 1200 _____________ ___ ___ x 1300 _____________
IV_______________ RATE___________
IV_______________ RATE___________
IV_______________ RATE___________
IV_______________ RATE___________
Notes:
Notes:
Notes:
Notes:
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