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Patient Worksheet - NICU 3-Patient

Patient Worksheet - NICU 3-Patient

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Published by Jerry
Worksheet used during my NICU preceptorship to manage the care of 3 neonates for one shift. The back side (if printed in duplex mode) is for taking report on all the beds.
Worksheet used during my NICU preceptorship to manage the care of 3 neonates for one shift. The back side (if printed in duplex mode) is for taking report on all the beds.

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Published by: Jerry on Jun 30, 2009
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05/11/2014

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text

original

Air

Air

Water

Water

Food

Food

Elim

Elim

Activity / Safety

Activity / Safety

Social / Devel

Social / Devel

@

O2

P

R

T

BP

@

O2

P

R

T

Social / Devel @ O2

Activity / Safety

: BVM / O2 / Sxn / IV

: BVM / O2 / Sxn / IV

Elim

strict / diaper-

strict / diaper-

Food strict / diaper- : BVM / O2 / Sxn / IV

Water

IV: none / piv / picc // L / R // ac / saph

IV: none / piv / picc // L / R // ac / saph

Air IV: none / piv / picc // L / R // ac / saph

BP

P

R

T

BP

@ u/s u/s u/s u/s u/s
@

Out

In

Girth

@ u/s u/s u/s u/s u/s
@

Out

In

Girth

@ u/s u/s u/s u/s u/s
@

Out

In

Girth

         

         

         

Notes

Notes

Notes

Next Feed

Next Meds

Next Labs

Next Feed

Next Meds

Next Labs

Next Feed

Next Meds

Next Labs

Name: Allergies:

♂ / ♀ DOL/DOB:
Gest Age:

Name: Allergies:

♂ / ♀ DOL/DOB:
Gest Age:

Name: Allergies:

♂ / ♀ DOL/DOB:
Gest Age:

Air: Water:

Dx:

Name:

♂/♀
Labs: Gest Age: DOL/DOB: Dr: Dx: Name:

1

Food: Elim: Safety/Social/Devel: Air: Water:

♂/♀
Labs: Gest Age: DOL/DOB: Dr: Dx: Name:

2

Food: Elim: Safety/Social/Devel: Air: Water:

♂/♀
Labs: Gest Age: DOL/DOB: Dr: Dx: Name:

3

Food: Elim: Safety/Social/Devel: Air: Water:

♂/♀
Labs: Gest Age: DOL/DOB: Dr: Dx: Name:

4

Food: Elim: Safety/Social/Devel: Air: Water:

♂/♀
Labs: Gest Age: DOL/DOB: Dr: Dx: Name:

5

Food: Elim: Safety/Social/Devel: Air: Water:

♂/♀
Labs: Gest Age: DOL/DOB: Dr: Dx: Name:

6

Food: Elim: Safety/Social/Devel: Air: Water:

♂/♀
Labs: Gest Age: DOL/DOB: Dr: Dx: Name:

7

Food: Elim: Safety/Social/Devel: Air: Water:

♂/♀
Labs: Gest Age: DOL/DOB: Dr: Dx: Name:

8

Food: Elim: Safety/Social/Devel: Air: Water:

♂/♀
Labs: Gest Age: DOL/DOB: Dr: Dx: Name:

9

Food: Elim: Safety/Social/Devel: Air: Water:

♂/♀
Labs: Gest Age: DOL/DOB: Dr:

10

Food: Elim: Safety/Social/Devel:

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