3+3=1 ACCOMPLISHED REQUIREMENTS of 3-DAY INTRAVENOUS THERAPY TRAINING PROGRAM FOR NURSES Name of Registered Nurse: ROCELYN Y.

ELTAGON, RN Name of Hospital offering IV Training: Mindanao Sanitarium Hospital Date of IV Program Attended: January 23-25, 2012 I.
Patient No.

PRC Number: 0623829 Provider No: 142 Venue: Conference Room, Mindanao Sanitarium Hospital

Initiating/Maintaining Peripheral IV Infusions

Name of Patient Age Date Time Kind of Infusion Site Type of Cannula Dose Rate Signature of Certified Trainer/Preceptor/M.D.,RN License No.

Sarilana, Sinay R. 204231 Manoza, Ronib P. 150748 Gineno, Fatima Leah Astrea R. 204278 II. Administering Intravenous Drugs
Name of Patient

74y.o 49y.o 2mos

January 26, 2012 January 26, 2012 January 26, 2012

09:48am 11:35am 02:20pm

PNSS D5NSS D5IMB

Left arm, Cephalic Vein Left arm, Metacarpal Vein Left Foot, Metatarsal Vein

Gauge 18 Gauge 22 Gauge 24

1000cc 1000cc 1000cc

15gtts/min 10gtts/min 10gtts/min

Genevieve F. Lapura, RN Genevieve F. Lapura, RN Genevieve F. Lapura, RN

001848 001848 001848

Patient No.

Age

Date

Time

Drugs Incorporated

Dose

Diagnosis

Signature of Certified Trainer/Preceptor/M.D.,RN

License No.

Castillon, Robejayl P. 204219 204214 204058 Lariosa, Natividad III. Ladores, Jon Elvin

18y.o 8 days

January 26,2011 January 27, 2012

12:00nn 02:00pm

Hyosine N-Butyl Bromide (Buscopan) PNSS 50cc+Vancomycin 500mg D5NM 1L+KCl

4mg 34mg

Pregnancy Uterine Full Term Sepsis Neonaturum

Genevieve F. Lapura, RN Genevieve F. Lapura, RN

001848 001848

65y.o

January 27, 2012

12:00nn

15mcg

Metabolic Encepalopathy

Genevieve F. Lapura, RN

001848

Administering and Maintaining Blood and Blood Components

Name of Patient Age Date Time Volume/Blood Type/Component /Rate IV Insertion Type of Cannula Diagnosis Signature of Certified Trainer/Preceptor/M.D.,RN License No.

Patient No.

T3474904

Maguindanao, Mamintal L.

42y.o

January 26, 2012

05:00pm

350cc/O+/PRBC /30gtts/min

Right Metacarpal Vein

Gauge 18

End Stage Renal Disease

Genevieve F. Lapura, RN

001848

Submitted by: ROCELYN Y. ELTAGON, RN Signature over Printed Name

Date submitted: January 27, 2012

Received by: ________________________

Approved by: SHIRLEY M. BACUS, MAN, MPH, RN Director of Nursing Service (Signature over Printed Name)

3+3=1 ACCOMPLISHED REQUIREMENTS of 3-DAY INTRAVENOUS THERAPY TRAINING PROGRAM FOR NURSES Name of Registered Nurse: RICHIEL MAE Y. ELTAGON, RN Name of Hospital offering IV Training: Mindanao Sanitarium Hospital Date of IV Program Attended: January 23-25, 2012 I.
Patient No.

PRC Number: 720369 Provider No: 142 Venue: Conference Room, Mindanao Sanitarium Hospital

Initiating/Maintaining Peripheral IV Infusions

Name of Patient Age Date Time Kind of Infusion Site Type of Cannula Dose Rate Signature of Certified Trainer/Preceptor/M.D.,RN License No.

204234 193384 204265

Babao, Lota B. Dayok, Jianna Marie R. Panganting , Ansary G.

39y.o 5y.o 42y.o

January 26, 2012 January 26, 2012 January 27, 2012

11:00`am 01:00pm 08:45am

PNSS D50.3NaCl PNSS

Right arm, Metacarpal Vein Right arm, Cephalic Vein Right Arm, Cephalic Vein

Gauge 22 Gauge 24 Gauge 18

1000cc 500cc 1000cc

10gtts/min 70cc/hr 20gtts/min

Genevieve F. Lapura, RN Genevieve F. Lapura, RN Genevieve F. Lapura, RN

001848 001848 001848

II.

Administering Intravenous Drugs

Name of Patient Age Date Time Drugs Incorporated Dose Diagnosis Signature of Certified Trainer/Preceptor/M.D.,RN License No.

Patient No.

168101 204265 154758 III.

Caete, Lamberto S. Ramos, Camilo A. Cabtalan, Lorenzo

92y.o 84y.o 90y.o

January 26,2011 January 27, 2012 January 27, 2012

12:00nn 08:42am 02:00nn

Ceftazidime D5NSS 1L+ D50W PNSS 20cc+Ticarcillin Clavulanic Acid (Triclav)

1 gram 50cc 3.2gms

Urinary Bladder Cancer Diabetes Mellitus Severe Pneumonia

Genevieve F. Lapura, RN Genevieve F. Lapura, RN Genevieve F. Lapura, RN

001848 001848 001848

Administering and Maintaining Blood and Blood Components

Name of Patient Age Date Time Volume/Blood Type/Component /Rate IV Insertion Type of Cannula Diagnosis Signature of Certified Trainer/Preceptor/M.D.,RN License No.

Patient No.

T3474904

Maguindanao, Mamintal L.

42y.o

January 26, 2012

03:00pm

350cc/O+/PRBC /30gtts/min

Right Metacarpal Vein

Gauge 18

End Stage Renal Disease

Genevieve F. Lapura, RN

001848

Submitted by: RICHIEL MAE Y. ELTAGON, RN Signature over Printed Name

Date submitted: January 27, 2012

Received by: ________________________

Approved by: SHIRLEY M. BACUS, MAN, MPH, RN Director of Nursing Service (Signature over Printed Name)