You are on page 1of 1

Shift : _________________________ Cebu Doctors’ University Hospital Date : __________________

Charge Nurse : __________ _______ Osmeña Boulevard, Cebu City Total Census : ___________
Student Nurse : _________________
SUMMARY OF NURSING CARE PLAN

Rm. No. Name of Patient With IV Fluids / Blood Transfusion Input-Output / Urine Testing Laboratory For OR / MOR
IV # ____, ________ @ __________ Full diet- U/A –
IV # ____, ________ @ __________
IV # ____, ________ @ __________ Diabetic Diet – S/E –
IV # ____, ________ @ __________
IV # ____, ________ @ __________ Soft diet – CBC –
IV # ____, ________ @ __________
IV # ____, ________ @ __________ NPO – CBS –
IV # ____, ________ @ __________ DAT –
IV # ____, ________ @ __________ No colored foods – Exec. Panel –
IV # ____, ________ @ __________
IV # ____, ________ @ __________ Breastfeeding – Renal Panel –
IV # ____, ________ @ __________ Special Endorsements
IV # ____, ________ @ __________ Blenderized feeding –
IV # ____, ________ @ __________ MHBR –
IV # ____, ________ @ __________ Small frequent feedings –
IV # ____, ________ @ __________ Suction secretions-
IV # ____, ________ @ __________ Limit P.O. fluids- Treatments Seizure precautions –
IV # ____, ________ @ __________
IV # ____, ________ @ __________ qH –
IV # ____, ________ @ __________ TSB –
IV # ____, ________ @ __________ q2H –
IV # ____, ________ @ __________ Bedside Commode –
IV # ____, ________ @ __________
Cardiopulmonary / X-ray CFCAS, CFCAV –
IV # ____, ________ @ __________
IV # ____, ________ @ __________
IV # ____, ________ @ __________ Dressing Set –
IV # ____, ________ @ __________
IV # ____, ________ @ __________ WOD –
IV # ____, ________ @ __________
IV # ____, ________ @ __________ O2 Inhalation –
IV # ____, ________ @ __________
IV # ____, ________ @ __________
IV # ____, ________ @ __________