Patient Worksheet - Pediatrics 1-patient

Pediatric Worksheet Student:

Age:

Priority Assessments:

Wt:

Client (first, l.):

Date:

Diet:

MR #

Nurse:

Activity:

Room #

Med Order

Time

Notes

Allergies: Dx: PMH:  expiration tags  3mL extra in volutrol IV Assessment:  right solution ________  empty @ __________  drip chamber  fluid  right rate ___________  top clamp closed  white peak  site condition _______  volutrol open

Teaching: Play:

Treatments / Procedures / RT / Notes

0630—0700:  meds; 0700—0800:  I.V.; chart vs; 0800—0900:  I.V.; 0900—1000:  I.V.; 1000—1100:  I.V.; 1100—1200:  I.V.; chart vs; 1200—1300:  I.V.; final charting; Call H.O. if T > ______, SpO2 < ______%, HR > ______ or < ______, RR > ______ or < ______, SBP > ______ or < ______, DBP > ______ or < ______, UOP < __________ .

Input:

Labs:

Vitals

Hc t

Temp

W BC Hg b

C RB

HR RR BrSnd Platelets

Glucose Na+ K+

Cl-

BUN

Hgb

CO2

Creat

Hct WBC

Output:

Sp O2 O2 BowSnd BP

08:00

12:00