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IV THERAPY ACCOMPLISHED REQUIREMENTS FORMAT
Butuan Doctors\u2019 Hospital_
Venue: Butuan Doctors\u2019 College, NEW AVR
Name of Hospital Offering Training
Province/Region: Butuan City
ANSAP Chapter: Butuan Chapter
J.C. Aquino Street Butuan City
Address
Accomplished Requirements of:
Name of Registered Nurse: Rickson P. Rambuyon
Date of IV Training Program Attended: November 13 \u2013 15, 2008
PRC No:
Expiry
Date:
IV Requirements: 6+6+2
Registration No. of Institution Offering the IV Training Program:
Name of Patient
Age
Kind of Infusion Given
Date/time/Site of IV Insertions/Types of
Cannula/Dose/Rate/Drug Incorporation Present
Signature of Witness M.D./IV
Trained Preceptor
I. Initiating Maintaining Peripheral IV Infusion
1. Tiempo, Domingo
69
D5 NM 1Liter
Nov. 17, 2008/12:00pm/Left Cephalic Vein/Gage-22/
30gtts/min
Emmanuel Mantilla, RN
2. Rodemio, Felix
53
PLR 1liter
Nov. 18, 2008/1:20pm/Left Cephalic vein/Gage-
22/10cc/hr
Emmanuel Mantilla, RN
3. Aquino, Rolando
69
PNSS 1liter
Nov. 20, 2008/8:30am/Left Cephalic venin/Gage-
22/100cc/hr
Riadne Fesalboni, RN
4. Torralba, Zephanniah
Seith
3
D5 0.3NaCl 500 cc
Nov. 20, 2008/11:20am/Left Metacarpal vein/Gage-
24/60cc/hr
Riadne Fesalboni, RN
5. Montero, Justine
1yr5m
os
D5 0.3NaCl 500 cc
Nov. 20, 2008/3:20pm/Left Metacarpal vein/Gage-
24/90cc/hr
Riadne Fesalboni, RN
6. Telen, Josefina
70
D5 NM 1liter
Nov. 27, 2008/2:4mpm/Left Metacarpal vein/Gage-
22/20gtts/min
Riadne Fesalboni, RN
II. Administering IV Drugs
Drug Incorporation/Dose
Date/Time/Diagnosis
1. Carandang, Daryl
24
Tramadol 50mg
Nov. 26, 2008/9:40am/Vehicular Accident V/A
Joan Siaboc, RN
2. Tan, Andres
76
Pantoloc 4omg
Nov. 27, 2008/6am/Epigastric Pain, (+) Amoebiasis
Joan Siaboc, RN
3. Llaros, Crizelle
4
Cefuroxime (kefox) 500mg
Nov. 27, 2008/10am/Pneumonia
Joan Siaboc, RN
4. Balatero, Florinda
41
Ranitidine 50mg
Nov.27, 2008/10am/Acute Gastritis
Joan Siaboc, RN
5. Cubilo, Rolinda
59
Solucortef 100mg
Nov.27, 2008/12pm/Cough+Dyspnea
Joan Siaboc, RN
6. Gerona, Susan
46
Hyoscine Butylbromide \u00bd
ampule
Nov. 27, 2008/10am/Acute Gastroenteritis with mild
dehydration
Joan Siaboc, RN
III. Administering and Maintaining Blood Components

Blood
Type/Volume/Component
s

Date/Time/Site of Insertions/Type of Cannula/Rate
1. Gudelosao, Alex
43
A+/250cc/PRBC
Dec. 3, 2008/11am/AV Fistula/Gage-16/30gtts/min
Riadne Fesalboni, RN
2. Denurog, Princess Dianne
2
A+/50cc/Platelet
Dec. 20, 2008/9pm/Left Metacarpal Vein/G-18/Fast Drip
Joan Siaboc, RN
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