Patient Complex Brain Sheet - Nursing On Point
Name
Rm
Age/sex____
Adm______Dr_____
CC:
Hx:
Activ__________
Other__________
Prevnt:
Falls/SCD/IS/walk/turn
Allergy______________________
IVF___________
at
_______
Site_______
type___________
O2_____
Isolation______________
Meds
13
08
14
09
15
10
16
11
17
12
18
Name
__
Rm_____
Age/sex____
Adm______Dr_____
CC:
Hx:
Activ__________
Other__________
Prevnt:
Falls/SCD/IS/walk/turn
Allergy______________________
IVF___________
at
_______
Site_______
type___________
O2_____
Isolation______________
Meds
13
08
14
09
15
10
16
11
17
12
18
PRNs
given
__________________
____________________________
Specimens
sent
______________
Phys
exam___________________
Last
BM
____________________
Drsgs/wounds_________________
Tubes
________
I O
VS
Labs
Charting:
RS/AI/SS/VAD/IO/CC/Acuity/Pain
AM
labs
ordered?
PRNs
given
__________________
____________________________
Specimens
sent
______________
Phys
exam___________________
Last
BM
____________________
Drsgs/wounds_________________
Tubes
________
VS
I O
Labs
HGB
WBC
HCT
Plat
Charting:
RS/AI/SS/VAD/IO/CC/Acuity/Pain
AM
labs
ordered?
Name
__
Rm_____
Age/sex____
Adm______Dr_____
CC:
Hx:
Activ__________
Other__________
Prevnt:
Falls/SCD/IS/walk/turn
Allergy______________________
IVF___________
at
_______
Site_______
type___________
O2_____
Isolation______________
Meds
13
08
14
09
15
10
16
11
17
12
18
Name
__
Rm_____
Age/sex____
Adm______Dr_____
CC:
Hx:
Activ__________
Other__________
Prevnt:
Falls/SCD/IS/walk/turn
Allergy______________________
IVF___________
at
_______
Site_______
type___________
O2_____
Isolation______________
Meds
13
08
14
09
15
10
16
11
17
12
18
PRNs
given
__________________
____________________________
Specimens
sent
______________
Phys
exam___________________
Last
BM
____________________
Drsgs/wounds_________________
Tubes
________
I O
VS
Labs
HGB
WBC
HCT
Plat
Charting:
RS/AI/SS/VAD/IO/CC/Acuity/Pain
AM
labs
ordered?
PRNs
given
__________________
____________________________
Specimens
sent
______________
Phys
exam___________________
Last
BM
____________________
Drsgs/wounds_________________
Tubes
________
VS
I O
Labs
HGB
WBC
HCT
Plat
Charting:
RS/AI/SS/VAD/IO/CC/Acuity/Pain
AM
labs
ordered?
................
................
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