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Medsurg Report Sheet

This document contains patient information including allergies, diet, vital signs, intravenous treatments, activity levels, and lab results. Precautions and pain management regimens are also noted. Nursing staff will use this record to monitor the patient's condition and care.

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jjuplifter
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© Attribution Non-Commercial (BY-NC)
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8K views

Medsurg Report Sheet

This document contains patient information including allergies, diet, vital signs, intravenous treatments, activity levels, and lab results. Precautions and pain management regimens are also noted. Nursing staff will use this record to monitor the patient's condition and care.

Uploaded by

jjuplifter
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 PDF, TXT or read online on Scribd
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7 8 9 10 11 12 1 2 3 4 5 6 7

Rm: Allergies: Code:_______ MEWS:____


O2:__________ S/L:__________ Diet:____________ Assessment

IV:_________________ Infused:A_______B:_______
T:_____ P:_____ R:_____ B/P:________ O2:______
T:_____ P:_____ R:_____ B/P:________ O2:______
T:_____ P:_____ R:_____ B/P:________ O2:______
Accu : 0700_____ 1130_____ 1630____ 2100____
BRP / foley / BSC / urinal UA / C&S stools x ____
Activity: ↑ad lib / bed rest / ↑in chair / O2 walks / assist
Precautions: contact / fall / seizure / aspiration / neuro  F B
PCA Drug:__________ Dose:___mg/___ml; ___ml/hr
0800 ATT:___ INJ:___ 1000 ATT:___ INJ:___
1200 ATT:___ INJ:___ 1400 ATT:___ INJ:___
1600 ATT:___ INJ:___ 1800 ATT:___ INJ:___ Mg
Hgb Na Cl BUN
Total ml INJ:________ WBC Plt Glu PTT PT INR
Hct K+ CO2 Cr Ca PO4

7 8 9 10 11 12 1 2 3 4 5 6 7

Rm: Allergies: Code:_______ MEWS:____


O2:__________ S/L:__________ Diet:____________ Assessment

IV:_________________ Infused:A_______B:_______
T:_____ P:_____ R:_____ B/P:________ O2:______
T:_____ P:_____ R:_____ B/P:________ O2:______
T:_____ P:_____ R:_____ B/P:________ O2:______
Accu : 0700____ 1130____ 1630_____ 2100_____
BRP / foley / BSC / urinal UA / C&S stools x ____
Activity: ↑ad lib / bed rest / ↑in chair / O2 walks / assist
Precautions: contact / fall / seizure / aspiration / neuro  F B
PCA Drug:__________ Dose:___mg/___ml; ___ml/hr
0800 ATT:___ INJ:___ 1000 ATT:___ INJ:___
1200 ATT:___ INJ:___ 1400 ATT:___ INJ:___
1600 ATT:___ INJ:___ 1800 ATT:___ INJ:___ Hgb Mg
Na Cl BUN PTT
WBC Plt Glu Ca PO4 PT INR
Total ml INJ:________ Hct K+ CO2 Cr

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