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I. Major Operations

This document contains a record of clinical experiences for a nursing student named Michael Richard Infante Palma from Our Lady of Fatima University. It includes details of major operations, minor operations, actual deliveries, and deliveries assisted by the student. Each entry is signed by the student, clinical coordinator, chief nurses, dean, and supervising faculty member and includes their credentials.

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Leahcim Palma
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
55 views

I. Major Operations

This document contains a record of clinical experiences for a nursing student named Michael Richard Infante Palma from Our Lady of Fatima University. It includes details of major operations, minor operations, actual deliveries, and deliveries assisted by the student. Each entry is signed by the student, clinical coordinator, chief nurses, dean, and supervising faculty member and includes their credentials.

Uploaded by

Leahcim Palma
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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OUR LADY OF FATIMA UNIVERSITY

#1 Esperanza St. Hilltop Mansion Heights, Lagro, Quezon City


Name of Student: PALMA, MICHAEL RICHARD INFANTE__________________________________________________________________________________________________________________________
Name and Address of School: OUR LADY OF FATIMA UNIVERSITY, # 1 ESPERANZA ST. HILLTOP MANSION HEIGTHS, LAGRO, QUEZON CITY________________________________________________
Accreditation Level (if any): PACU-COA LEVEL II
Year Granted: APRIL 10, 2002______________________________________________________________________________
Date School/Program was Recognized: APRIL 25, 2001
Number: 033
__
Year: 2001______________________________________
First Course (if any): NOT APPLICABLE
School Graduated From: NOT APPLICABLE
Year: NOT APPLICABLE_______________________
Year of Admission in the Bachelor of Science in Nursing Program: 2007_______________________________________________________________________________________________________________
Year Graduated (BSN Program): October 2009__________________________________________________________________________________________________________________________________
I. Major Operations

No.

Date of
Operation

Case
No.

Name of
Patient

Diagnosis

Operation
Performed

Type of
Anesthesia

Name of
Surgeon

Name of Hospital

Supervised by Qualified CI

Signature of
Qualified CI

1.

2.

3.

4.

5.
Prepared by:

Noted by:

Concurred by:

Concurred by:

Approved by:

PALMA, MICHAEL RICHARD I.


Signature over printed Name of Student

MARISOL GARCIA-MANIPOL, RN, MAN


Signature over printed name of Clinical
Coordinator
Date Signed: __________
Degree: BSN, MAN
a.) PRC NO: 0296870
Valid Until: September 2012
b.) PNA NO: 013487
Valid Until: October 31, 2010

ARLENE GALANG-GENEROSA, RN, MAN


Signature over printed name of Chief Nurse
Date Signed: _______
Degree: BSN, MAN
a.) PRC NO: 152240
Valid Until: October 19, 2011
b.) PNA NO: 18248
Valid Until: Lifetime

LOUISE MARIE D. FLORES, RN, MAN, DPA


Signature over printed name of Chief Nurse
Date Signed: ___________
Degree: BSN, MAN, DPA
a.) PRC NO: 0086759
Valid Until: March 2012
b.) PNA NO: 10355
Valid Until: Lifetime
c.) ANSAP NO: 0316
Valid Until: Lifetime

NELIA R. CAPULONG, RN, RM, MAN


Signature over printed name of Dean
Date Signed: ____________
Degree: BSN, MAN
a.) PRC NO: 0041904
Valid Until: July 31, 2012
b.) PNA NO: 18698
Valid Until: Lifetime
c.) ADPCN NO: 0627
Valid Until: December 2010

Supervised by:
Dr. JULIET B. COSTALES, RN, MAN
Signature over printed name of Faculty
Date Signed: ____________
Degree: BSN, MAN
a.) PRC NO: 59866
Valid Until: December 20, 2015
b.) PNA NO: 035591
Valid Until: January 4, 2011

OUR LADY OF FATIMA UNIVERSITY


#1 Esperanza St. Hilltop Mansion Heights, Lagro, Quezon City
Name of Student: PALMA, MICHAEL RICHARD INFANTE__________________________________________________________________________________________________________________________
Name and Address of School: OUR LADY OF FATIMA UNIVERSITY, # 1 ESPERANZA ST. HILLTOP MANSION HEIGTHS, LAGRO, QUEZON CITY________________________________________________
Accreditation Level (if any): PACU-COA LEVEL II
Year Granted: APRIL 10, 2002______________________________________________________________________________
Date School/Program was Recognized: APRIL 25, 2001
Number: 033
__
Year: 2001______________________________________
First Course (if any): NOT APPLICABLE
School Graduated From: NOT APPLICABLE
Year: NOT APPLICABLE_______________________
Year of Admission in the Bachelor of Science in Nursing Program: 2007_______________________________________________________________________________________________________________
Year Graduated (BSN Program): October 2009__________________________________________________________________________________________________________________________________
II. Minor Operations
No.

Date of
Operation

Case
No.

Name of
Patient

Diagnosis

Operation Performed

Type of
Anesthesia

Name of
Surgeon

Name of Hospital

Supervised by Qualified CI

Signature of Qualified
CI

1.

2.

3.

4.

5.
Prepared by:

Noted by:

Concurred by:

Concurred by:

Approved by:

PALMA, MICHAEL RICHARD I.


Signature over printed Name of Student

MARISOL GARCIA-MANIPOL, RN, MAN


Signature over printed name of Clinical
Coordinator
Date Signed: __________
Degree: BSN, MAN
a.) PRC NO: 0296870
Valid Until: September 2012
b.) PNA NO: 013487
Valid Until: October 31, 2010

FELICITAS R. NERY, RN, MAN


Signature over printed name of Chief Nurse
Date Signed: ___________
Degree: BSN, MAN
a.) PRC NO: 0095235
Valid Until: January 12, 2011
b.) PNA NO: 7501
Valid Until: Lifetime

LOUISE MARIE D. FLORES, RN, MAN, DPA


Signature over printed name of Chief Nurse
Date Signed: ___________
Degree: BSN, MAN, DPA
a.) PRC NO: 0086759
Valid Until: March 2012
b.) PNA NO: 10355
Valid Until: Lifetime
c.) ANSAP NO: 0316
Valid Until: Lifetime

NELIA R. CAPULONG, RN, RM, MAN


Signature over printed name of Dean
Date Signed: ____________
Degree: BSN, MAN
a.) PRC NO: 0041904
Valid Until: July 31, 2012
b.) PNA NO: 18698
Valid Until: Lifetime
c.) ADPCN NO: 0627
Valid Until: December 2010

Supervised by:
Dr. JULIET B. COSTALES, RN, MAN
Signature over printed name of Faculty
Date Signed: ____________
Degree: BSN, MAN
a.) PRC NO: 59866
Valid Until: December 20, 2015
b.) PNA NO: 035591
Valid Until: January 4, 2011

OUR LADY OF FATIMA UNIVERSITY


#1 Esperanza St. Hilltop Mansion Heights, Lagro, Quezon City

Name of Student: PALMA, MICHAEL RICHARD INFANTE__________________________________________________________________________________________________________________________


Name and Address of School: OUR LADY OF FATIMA UNIVERSITY, # 1 ESPERANZA ST. HILLTOP MANSION HEIGTHS, LAGRO, QUEZON CITY________________________________________________
Accreditation Level (if any): PACU-COA LEVEL II
Year Granted: APRIL 10, 2002______________________________________________________________________________
Date School/Program was Recognized: APRIL 25, 2001
Number: 033
__
Year: 2001______________________________________
First Course (if any): NOT APPLICABLE
School Graduated From: NOT APPLICABLE
Year: NOT APPLICABLE_______________________
Year of Admission in the Bachelor of Science in Nursing Program: 2007_______________________________________________________________________________________________________________
Year Graduated (BSN Program): October 2009__________________________________________________________________________________________________________________________________
III. Actual Deliveries
No.

Case
No.

Diagnosis

Name of
Mother

Age

Date of
Delivery

Time of
Delivery

Gender
of Baby

Name of Hospital

Type of Delivery

Supervised by: Qualified C.I.

Signature of
Qualified C.I.

1.

2.

3.

4.

5.
Prepared by:

Noted by:

Concurred by:

Concurred by:

Approved by:

PALMA, MICHAEL RICHARD I.


Signature over printed Name of Student

MARISOL GARCIA-MANIPOL, RN, MAN


Signature over printed name of Clinical
Coordinator
Date Signed: __________
Degree: BSN, MAN
a.) PRC NO: 0296870
Valid Until: September 2012
b.) PNA NO: 013487
Valid Until: October 31, 2010

FELICITAS R. NERY, RN, MAN


Signature over printed name of Chief Nurse
Date Signed: ___________
Degree: BSN, MAN
a.) PRC NO: 0095235
Valid Until: January 12, 2011
b.) PNA NO: 7501
Valid Until: Lifetime

LOUISE MARIE D. FLORES, RN, MAN, DPA


Signature over printed name of Chief Nurse
Date Signed: ___________
Degree: BSN, MAN, DPA
a.) PRC NO: 0086759
Valid Until: March 2012
b.) PNA NO: 10355
Valid Until: Lifetime
c.) ANSAP NO: 0316
Valid Until: Lifetime

NELIA R. CAPULONG, RN, RM, MAN


Signature over printed name of Dean
Date Signed: ____________
Degree: BSN, MAN
a.) PRC NO: 0041904
Valid Until: July 31, 2012
b.) PNA NO: 18698
Valid Until: Lifetime
c.) ADPCN NO: 0627
Valid Until: December 2010

Supervised by:
Dr. JULIET B. COSTALES, RN, MAN
Signature over printed name of Faculty
Date Signed: ____________
Degree: BSN, MAN
a.) PRC NO: 59866
Valid Until: December 20, 2015
b.) PNA NO: 035591
Valid Until: January 4, 2011

OUR LADY OF FATIMA UNIVERSITY


#1 Esperanza St. Hilltop Mansion Heights, Lagro, Quezon City
Name of Student: PALMA, MICHAEL RICHARD INFANTE__________________________________________________________________________________________________________________________

Name and Address of School: OUR LADY OF FATIMA UNIVERSITY, # 1 ESPERANZA ST. HILLTOP MANSION HEIGTHS, LAGRO, QUEZON CITY
_______________________________________________________________________________________________________________________________________________________________________
Accreditation Level (if any): PACU-COA LEVEL II
Year Granted: APRIL 10, 2002
_________________________________________________________________
Date School/Program was Recognized: APRIL 25, 2001
Number: 033
__
Year: 2001
_________________________________________________________________
First Course (if any): NOT APPLICABLE
School Graduated From: NOT APPLICABLE
Year: NOT APPLICABLE_______________________
Year of Admission in the Bachelor of Science in Nursing Program: 2007_______________________________________________________________________________________________________________
Year Graduated (BSN Program): October 2009__________________________________________________________________________________________________________________________________
No.

Case
No.

Diagnosis

Name of
Mother

Age

Date of
Delivery

IV. Deliveries Assisted


Time of
Gender
Name of Hospital
Delivery
of Baby

Type of Delivery

Supervised by: Qualified C.I.

Signature of Qualified
C.I.

1.
2.
3.
4.
5.
Prepared by:

Noted by:

Concurred by:

Concurred by:

Approved by:

PALMA, MICHAEL RICHARD I.


Signature over printed Name of Student

MARISOL GARCIA-MANIPOL, RN, MAN


Signature over printed name of Clinical
Coordinator
Date Signed: __________
Degree: BSN, MAN
a.) PRC NO: 0296870
Valid Until: September 2012
b.) PNA NO: 013487
Valid Until: October 31, 2010

LOUISE MARIE D. FLORES, RN, MAN, DPA


Signature over printed name of Chief Nurse
Date Signed: ___________
Degree: BSN, MAN, DPA
a.) PRC NO: 0086759
Valid Until: March 2012
b.) PNA NO: 10355
Valid Until: Lifetime
c.) ANSAP NO: 0316
Valid Until: Lifetime

FELICITAS R. NERY, RN, MAN


Signature over printed name of Chief Nurse
Date Signed: ___________
Degree: BSN, MAN
a.) PRC NO: 0095235
Valid Until: January 12, 2011
b.) PNA NO: 7501
Valid Until: Lifetime

NELIA R. CAPULONG, RN, RM, MAN


Signature over printed name of Dean
Date Signed: ____________
Degree: BSN, MAN
a.) PRC NO: 0041904
Valid Until: July 31, 2012
b.) PNA NO: 18698
Valid Until: Lifetime
c.) ADPCN NO: 0627
Valid Until: December 2010

Supervised by:
Dr. JULIET B. COSTALES, RN, MAN
Signature over printed name of Faculty
Date Signed: ____________
Degree: BSN, MAN
a.) PRC NO: 59866
Valid Until: December 20, 2015
b.) PNA NO: 035591
Valid Until: January 4, 2011

OUR LADY OF FATIMA UNIVERSITY


#1 Esperanza St. Hilltop Mansion Heights, Lagro, Quezon City
Name of Student: PALMA, MICHAEL RICHARD INFANTE__________________________________________________________________________________________________________________________

Name and Address of School: OUR LADY OF FATIMA UNIVERSITY, # 1 ESPERANZA ST. HILLTOP MANSION HEIGTHS, LAGRO, QUEZON CITY________________________________________________
Accreditation Level (if any): PACU-COA LEVEL II
Year Granted: APRIL 10, 2002______________________________________________________________________________
Date School/Program was Recognized: APRIL 25, 2001
Number: 033
__
Year: 2001______________________________________
First Course (if any): NOT APPLICABLE
School Graduated From: NOT APPLICABLE
Year: NOT APPLICABLE_______________________
Year of Admission in the Bachelor of Science in Nursing Program: 2007_______________________________________________________________________________________________________________
Year Graduated (BSN Program): October 2009__________________________________________________________________________________________________________________________________
No.

Case No.

Date Performed

Name of Baby

Gender of Baby

V. Cord Dressing
Name of Mother

Age

Name of Hospital

Supervised by: Qualified C.I.

Signature of Qualified C.I.

1.

2.

3.

4.

5.

Prepared by:

Noted by:

Concurred by:

Concurred by:

Approved by:

PALMA, MICHAEL RICHARD I.


Signature over printed Name of Student

MARISOL GARCIA-MANIPOL, RN, MAN


Signature over printed name of Clinical Coordinator
Date Signed: __________
Degree: BSN, MAN
a.) PRC NO: 0296870
Valid Until: September 2012
b.) PNA NO: 013487
Valid Until: October 31, 2010

LOUISE MARIE D. FLORES, RN, MAN, DPA


Signature over printed name of Chief Nurse
Date Signed: ___________
Degree: BSN, MAN, DPA
a.) PRC NO: 0086759
Valid Until: March 2012
b.) PNA NO: 10355
Valid Until: Lifetime
c.) ANSAP NO: 0316
Valid Until: Lifetime

ARLENE GALANG-GENEROSA, RN, MAN


Signature over printed name of Chief Nurse
Date Signed: _______
Degree: BSN, MAN
a.) PRC NO: 152240
Valid Until: October 19, 2011
b.) PNA NO: 18248
Valid Until: Lifetime

NELIA R. CAPULONG, RN, RM, MAN


Signature over printed name of Dean
Date Signed: ____________
Degree: BSN, MAN
a.) PRC NO: 0041904
Valid Until: July 31, 2012
b.) PNA NO: 18698
Valid Until: Lifetime
c.) ADPCN NO: 0627
Valid Until: December 2010

Supervised by:
Dr. JULIET B. COSTALES, RN, MAN
Signature over printed name of Faculty
Date Signed: ____________
Degree: BSN, MAN
a.) PRC NO: 59866
Valid Until: December 20, 2015
b.) PNA NO: 035591
Valid Until: January 4, 2011

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