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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