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Date ____________________________

Shift ____________________________
Charge Nurse ____________________
Student nurse: ___________________
Bed/Room No.

Name of Patient/s

Total Census __________


SUMMARY NURSING CARE PLAN
Complaint/s

With IV Fluids / Blood Transfusion


IV #___, _______, IV #___, _______ @ ___ gtt/min; PB ______________
IV #___, _______, IV #___, _______ @ ___ gtt/min; PB ______________
IV #___, _______, IV #___, _______ @ ___ gtt/min; PB ______________
IV #___, _______, IV #___, _______ @ ___ gtt/min; PB ______________
IV #___, _______, IV #___, _______ @ ___ gtt/min; PB ______________
IV #___, _______, IV #___, _______ @ ___ gtt/min; PB ______________
IV #___, _______, IV #___, _______ @ ___ gtt/min; PB ______________
IV #___, _______, IV #___, _______ @ ___ gtt/min; PB ______________
IV #___, _______, IV #___, _______ @ ___ gtt/min; PB ______________
IV #___, _______, IV #___, _______ @ ___ gtt/min; PB ______________
IV #___, _______, IV #___, _______ @ ___ gtt/min; PB ______________
IV #___, _______, IV #___, _______ @ ___ gtt/min; PB ______________
IV #___, _______, IV #___, _______ @ ___ gtt/min; PB ______________
IV #___, _______, IV #___, _______ @ ___ gtt/min; PB ______________
IV #___, _______, IV #___, _______ @ ___ gtt/min; PB ______________
IV #___, _______, IV #___, _______ @ ___ gtt/min; PB ______________
IV #___, _______, IV #___, _______ @ ___ gtt/min; PB ______________
IV #___, _______, IV #___, _______ @ ___ gtt/min; PB ______________
IV #___, _______, IV #___, _______ @ ___ gtt/min; PB ______________
IV #___, _______, IV #___, _______ @ ___ gtt/min; PB ______________
IV #___, _______, IV #___, _______ @ ___ gtt/min; PB ______________
IV #___, _______, IV #___, _______ @ ___ gtt/min; PB ______________
IV #___, _______, IV #___, _______ @ ___ gtt/min; PB ______________
IV #___, _______, IV #___, _______ @ ___ gtt/min; PB ______________
IV #___, _______, IV #___, _______ @ ___ gtt/min; PB ______________
IV #___, _______, IV #___, _______ @ ___ gtt/min; PB ______________
IV #___, _______, IV #___, _______ @ ___ gtt/min; PB ______________
IV #___, _______, IV #___, _______ @ ___ gtt/min; PB ______________
IV #___, _______, IV #___, _______ @ ___ gtt/min; PB ______________
IV #___, _______, IV #___, _______ @ ___ gtt/min; PB ______________
IV #___, _______, IV #___, _______ @ ___ gtt/min; PB ______________
IV #___, _______, IV #___, _______ @ ___ gtt/min; PB ______________
IV #___, _______, IV #___, _______ @ ___ gtt/min; PB ______________
IV #___, _______, IV #___, _______ @ ___ gtt/min; PB ______________
IV #___, _______, IV #___, _______ @ ___ gtt/min; PB ______________
IV #___, _______, IV #___, _______ @ ___ gtt/min; PB ______________
IV #___, _______, IV #___, _______ @ ___ gtt/min; PB ______________
IV #___, _______, IV #___, _______ @ ___ gtt/min; PB ______________
Intake-Output / Urine Testing

CBC

Laboratory
CBS

For OR/ MOR


U/A

OTHERS
Full

Hypo

U/S

Cardiopulmonary / X-Ray
X-RAY
ECHO
CHEMO

CT

OTHERS

Special Diets
DM
Soft

Blender

NPO

OTHERS

Treatments
RAD
OTHERS

Special Endorsements

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