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Brain Sheet2011

The document contains a template for recording patient information including name, room number, physician, code status, allergies, diagnoses, history, vitals, activity, diet, pain levels, medication administration times, labs, tasks, and shift interventions for 3 patients. Information would be filled in the corresponding fields for each patient.

Uploaded by

nursekatie
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd
59 views

Brain Sheet2011

The document contains a template for recording patient information including name, room number, physician, code status, allergies, diagnoses, history, vitals, activity, diet, pain levels, medication administration times, labs, tasks, and shift interventions for 3 patients. Information would be filled in the corresponding fields for each patient.

Uploaded by

nursekatie
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd
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Name: Name: Name:

RM #: RM #: RM #:
Sex/Age/DOB: Sex/Age/DOB: Sex/Age/DOB:
Physician: Physician: Physician:
CODE STATUS: CODE STATUS: CODE STATUS:
Allergies: Allergies: Allergies:

Dx: Dx: Dx:


Hx: Hx: Hx:
Wt: Ht: Wt: Ht: Wt: Ht:
IV: Vitals IV: Vitals IV: Vitals
O2: O2: O2:
Foley: Foley: Foley:
Activity: Activity: Activity:
Diet: Diet: Diet:
Pain: Accu Checks Pain Accu Checks Pain Accu Checks

0700/1900 0700/1900 0700/1900

0800/2000 0800/2000 0800/2000

0900/2100 0900/2100 0900/2100

1000/2200 1000/2200 1000/2200

1100/2300 1100/2300 1100/2300

1200/0000 1200/0000 1200/0000

1300/0100 1300/0100 1300/0100

1400/0200 1400/0200 1400/0200

1500/0300 1500/0300 1500/0300

1600/0400 1600/0400 1600/0400

1700/0500 1700/0500 1700/0500

1800/0600 1800/0600 1800/0600

Relevant/Abnormal Labs To Do: Relevant/Abnormal Labs To Do: Relevant/Abnormal Labs To Do:

Shift Interventions Shift Interventions Shift Interventions

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