ICU Brain 4 9 13 Aqua - Straight A Nursing

[Pages:1]Room #: Dx:

Code:

SITUATION Safety: Confused Fall Restraints Alarm Suicide Isolation: None Contact Droplet Airborne Neutropenic

Admit Date: ______ From: ______ Reason: _____________________ Tests Done Hospital Course:

BACKGROUND PMH:

MD: Allergies:

Psychosocial:

Decision Maker:

ASSESSMENT

Temperature

Neuro: 4 3 2 1

+ - NOC T-Max _____ Day T-Max _____ RASS _______ CAM

Pain

EVD Cardiac

Hemodynamics

EF: ______ Echo Date: _____________

Rhythm: _________________________

A-Line CVP Monitor Swann

Respiratory

GCS _____________________________

Clear Vent Settings ET Trach Ch T MODE ________ IS

PS ___________

Vt ____________ P/F Ratio: _____

RT ARDS

FiO2 ____________

PEEP ___________

RATE ____________

GI

GU

NG OG PEG LWS ______ Foley BSC BRP Anuric Dialysis

C-Diff: - +

Last BM: _________ NOCS

DAYS

In ______ Out______ In ______ Out ______

In ______ Out ______ In ______ Out ______

In ______ Out ______ In ______ Out ______

Diet

Fluid Balance

Muskuloskeletal

Skin

Drains

Clear Dsng: _________________

Wounds: ______________________

IV Sites PIV:

Central:

SCDs TEDs Boots Special Bed Sling Ambulating

DVT & Stress Ulcer Prophylaxis: Heparin Lovenox SCDs Pepcid Protonix

Immune System Flu: Needs Received PNA: Needs Received MRSA: Admit > 7 Days in ICU

PICC: Other:

Gtts 1) ___________________ @ ________ 2) ___________________ @ ________ 3) ___________________ @ ________ 4) ___________________ @ ________ 5) ___________________ @ ________ 6) ___________________ @ ________

Sepsis: Infection Simple Severe Lactate: __________ CVP: _______ ScVO2: ________ Abx: _____________________ Given @ :_________ Abx: _____________________ Given @: _________ Abx: _____________________ Given @: _________ Abx: _____________________ Given @:_________

Lab Draws Accu-Check:

K Parameters Mg Ph Ca

PRNs Given

7) ___________________ @ ________ Cultures: Blood x2 Urine Sputum

RECOMMENDATION / PT NEEDS

TO-DO LIST

Na: _____ ______ ______ K: _____ ______ ______ Mg: _____ ______ ______ Ca: _____ ______ ______

Ph: _____ ______ ______ Cr: _____ ______ ______

BUN: _____ ______ ______ WBC: _____ ______ ______

Hgb: _____ ______ ______ PLT: _____ ______ ______

PT: _____ ______ ______ INR: _____ ______ ______

Lactate: _____ ______ ______ HCO3: _____ ______ ______

Other:

MISC

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