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Final PRC

1) The document describes surgical scrub procedures performed by nursing students at the University of Cebu - Banilad Campus College of Nursing. 2) It provides details of three surgical scrub procedures conducted on different dates at Cebu City Medical Center including patient initials and case number, surgical procedure, attending nurses and supervising instructor. 3) The forms are signed by the clinical coordinator and dean of the College of Nursing to note and approve the surgical scrub experiences of the students.

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235 views7 pages

Final PRC

1) The document describes surgical scrub procedures performed by nursing students at the University of Cebu - Banilad Campus College of Nursing. 2) It provides details of three surgical scrub procedures conducted on different dates at Cebu City Medical Center including patient initials and case number, surgical procedure, attending nurses and supervising instructor. 3) The forms are signed by the clinical coordinator and dean of the College of Nursing to note and approve the surgical scrub experiences of the students.

Uploaded by

Brian
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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UNIVERSITY OF CEBU BANILAD CAMPUS

College of Nursing
Governor Cuenco Avenue, Banilad, Cebu City 6000
(032) 233-8888; (032) 231-8613; www.uc.edu.ph
PACUCOA Level II 3rd Reaccredited Status, June 2007
SURGICAL SCRUB in CEBU CITY MEDICAL CENTER
Prepared by:

O.R. FORM 1A
O.R. SCRUB
FORM

______________________________
LEONIDA N. MUEZ

Date
Performed and
Time Started

PATIENTS
Initials Only
Case Number

SURGICAL PROCEDURE
PERFORMED

O.R. Nurse on Duty


(Complete Name and
Signature)

May 20, 2011


8:27 AM

F.B.G.
432044

Exploratory, Laparotomy Right


Hemicolectomy (Gastro-intestinal
Anastomosis) with Side to Side
Anastomosis Application of Internal
Retraction Suture (Tumor4 Node1
Metastasis0)

Ms. Ofelia B. Songahid


R.N.

Noted by: ____________________________________________


PILUCHI VICTORINA M. VILLEGAS R.N., M.N
Clinical Coordinator
PRC I.D No. ___________ Valid Until ____________
Date document is signed: _______________________
Time: _______________________
Highest Nursing Degree Earned:_________________

Supervised by Clinical
Instructor
(Complete Name and
Signature)
Ms. Maria Flordeliz G.
Padayao, R.N., M.A.N.

Approved by: _______________________________________


DR. HELEN C. ESTRELLA
Dean
PRC I.D. No. ____________ Valid Until _____________
Date document is signed: _________________________
Time: _______________________
Highest Nursing Degree Earned:___________________

UNIVERSITY OF CEBU BANILAD CAMPUS


College of Nursing
Governor Cuenco Avenue, Banilad, Cebu City 6000
(032) 233-8888; (032) 231-8613; www.uc.edu.ph
PACUCOA Level II 3rd Reaccredited Status, June 2007
SURGICAL CIRCULATING in __________________________________________________
Prepared by:

O.R. FORM 1B
O.R. CIRCULATING
FORM

_________________________________

Date Performed
and Time
Started

PATIENTS
Initials Only
Case Number

SURGICAL PROCEDURE
PERFORMED

Noted by: ____________________________________________


PILUCHI VICTORINA M. VILLEGAS, R.N., M.N
Clinical Coordinator
PRC I.D No. ___________ Valid Until ____________
Date document is signed: _______________________
Time: _______________________
Highest Nursing Degree Earned:_________________

O.R. Nurse on Duty


(Complete Name and
Signature)

Supervised by Clinical
Instructor
(Complete Name and
Signature)

Approved by: ____________________________________


DR. HELEN C. ESTRELLA
Dean
PRC I.D. No. ____________ Valid Until _____________
Date document is signed: _________________________
Time: _______________________
Highest Nursing Degree Earned:___________________

UNIVERSITY OF CEBU BANILAD CAMPUS


College of Nursing
Governor Cuenco Avenue, Banilad, Cebu City 6000
(032) 233-8888; (032) 231-8613; www.uc.edu.ph
PACUCOA Level II 3rd Reaccredited Status, June 2007
ACTUAL DELIVERY in _______________________________________________________
Prepared by:

_________________________________

Date
Performed and
Time Started

PATIENTS
Initials Only
Case Number

PROCEDURE
PERFORMED

Noted by: ____________________________________________


PILUCHI VICTORINA M. VILLEGAS, R.N., M.N
Clinical Coordinator
PRC I.D No. ___________ Valid Until ____________
Date document is signed: _______________________
Time: _______________________
Highest Nursing Degree Earned:_________________

D.R. FORM
ACTUAL DELIVERY
FORM
D.R. Nurse on Duty
(Complete Name and
Signature)

Supervised by Clinical
Instructor
(Complete Name and
Signature)

Approved by: _______________________________________


DR. HELEN C. ESTRELLA
Dean
PRC I.D. No. ____________ Valid Until _____________
Date document is signed: _________________________
Time: _______________________
Highest Nursing Degree Earned:___________________

UNIVERSITY OF CEBU BANILAD CAMPUS


College of Nursing
Governor Cuenco Avenue, Banilad, Cebu City 6000
(032) 233-8888; (032) 231-8613; www.uc.edu.ph
PACUCOA Level II 3rd Reaccredited Status, June 2007
IMMEDIATE NEWBORN CORD CARE in ____________________________________________________
Prepared by:

__________________________________

Date
Performed and
Time Started

PATIENTS
Initials Only
Case Number

IMMEDIATE NEWBORN
CORD CARE
PERFORMED

Noted by: ____________________________________________


PILUCHI VICTORINA M. VILLEGAS, R.N., M.N
Clinical Coordinator
PRC I.D No. ___________ Valid Until ____________
Date document is signed: _______________________
Time: _______________________
Highest Nursing Degree Earned:_________________

ICNB FORM
IMMEDIATE CARE OF
THE NEWBORN FORM

D.R. Nurse on Duty


(Complete Name and
Signature)

Supervised by Clinical
Instructor
(Complete Name and
Signature)

Approved by: _______________________________________


DR. HELEN C. ESTRELLA
Dean
PRC I.D. No. ____________ Valid Until _____________
Date document is signed: _________________________
Time: _______________________
Highest Nursing Degree Earned:___________________

UNIVERSITY OF CEBU BANILAD CAMPUS


College of Nursing
Governor Cuenco Avenue, Banilad, Cebu City 6000
(032) 233-8888; (032) 231-8613; www.uc.edu.ph
PACUCOA Level II 3rd Reaccredited Status, June 2007
SURGICAL SCRUB in CEBU CITY MEDICAL CENTER
Prepared by:

O.R. FORM 1A
O.R. SCRUB
FORM

______________________________
RANI MAE P. VALENZONA

Date
Performed and
Time Started

PATIENTS
Initials Only
Case Number

SURGICAL PROCEDURE
PERFORMED

O.R. Nurse on Duty


(Complete Name and
Signature)

March 13, 2012


10:00 AM

E.S.S
506020

Open Reduction Internal Fixation


(Log Screw Fixation) Medial
Malleolus Left; Open Reduction
Internal Fixation Plate and Screw
Fibula Left

Mr. Romil Galahad M.


Blancas, R.N

Noted by: ____________________________________________


PILUCHI VICTORINA M. VILLEGAS R.N., M.N
Clinical Coordinator
PRC I.D No. ___________ Valid Until ____________
Date document is signed: _______________________
Time: _______________________
Highest Nursing Degree Earned:_________________

Supervised by Clinical
Instructor
(Complete Name and
Signature)
Ms. Maria Flordeliz G.
Padayao, R.N., M.A.N

Approved by: _______________________________________


DR. HELEN C. ESTRELLA
Dean
PRC I.D. No. ____________ Valid Until _____________
Date document is signed: _________________________
Time: _______________________
Highest Nursing Degree Earned:___________________

UNIVERSITY OF CEBU BANILAD CAMPUS


College of Nursing
Governor Cuenco Avenue, Banilad, Cebu City 6000
(032) 233-8888; (032) 231-8613; www.uc.edu.ph
PACUCOA Level II 3rd Reaccredited Status, June 2007
SURGICAL SCRUB in CEBU CITY MEDICAL CENTER

Prepared by:

O.R. FORM 1A
O.R. SCRUB
FORM

______________________________
RANI MAE P. VALENZONA

Date
Performed and
Time Started

PATIENTS
Initials Only
Case Number

SURGICAL PROCEDURE
PERFORMED

O.R. Nurse on Duty


(Complete Name and
Signature)

March 12, 2012


10:07 AM

J.L.P.E
507081

Abdomino-Endo Rectal Pull


Through Take Down of Colostomy

Mr. Jason Noel A.


Manigos, R.N

Noted by: ____________________________________________


PILUCHI VICTORINA M. VILLEGAS R.N., M.N
Clinical Coordinator
PRC I.D No. ___________ Valid Until ____________
Date document is signed: _______________________
Time: _______________________
Highest Nursing Degree Earned:_________________

Supervised by Clinical
Instructor
(Complete Name and
Signature)
Ms. Maria Flordeliz G.
Padayao, R.N., M.A.N

Approved by: _______________________________________


DR. HELEN C. ESTRELLA
Dean
PRC I.D. No. ____________ Valid Until _____________
Date document is signed: _________________________
Time: _______________________
Highest Nursing Degree Earned:___________________

UNIVERSITY OF CEBU BANILAD CAMPUS


College of Nursing
Governor Cuenco Avenue, Banilad, Cebu City 6000
(032) 233-8888; (032) 231-8613; www.uc.edu.ph
PACUCOA Level II 3rd Reaccredited Status, June 2007
SURGICAL SCRUB in ____________________________________________________________
Prepared by:

O.R. FORM 1A
O.R. SCRUB
FORM

______________________________

Date
Performed and
Time Started

PATIENTS
Initials Only
Case Number

SURGICAL PROCEDURE
PERFORMED

Noted by: ____________________________________________


PILUCHI VICTORINA M. VILLEGAS R.N., M.N
Clinical Coordinator
PRC I.D No. ___________ Valid Until ____________
Date document is signed: _______________________
Time: _______________________
Highest Nursing Degree Earned:_________________

O.R. Nurse on Duty


(Complete Name and
Signature)

Supervised by Clinical
Instructor
(Complete Name and
Signature)

Approved by: _______________________________________


DR. HELEN C. ESTRELLA
Dean
PRC I.D. No. ____________ Valid Until _____________
Date document is signed: _________________________
Time: _______________________
Highest Nursing Degree Earned:__________________

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