Pediatric Worksheet Student: Date: Nurse: Priority Assessments: Age: Diet: Activity: Allergies: Dx: PMH

:
 expiration tags  3mL extra in volutrol IV Assessment:  right solution ________  empty @ __________  drip chamber  fluid  right rate ___________  top clamp closed  white peak  site condition _______  volutrol open

Wt:

Client (first, l.): MR # Room #

Med Order

Time

Notes

Teaching:

Treatments / Procedures / RT / Notes

Play: 0630—0700:  meds; 0700—0800:  I.V.; chart vs; 0800—0900:  I.V.; 0900—1000:  I.V.; 1000—1100:  I.V.; 1100—1200:  I.V.; chart vs; 1200—1300:  I.V.; final charting;
Call H.O. if T > ______, SpO2 < ______%, HR > ______ or < ______, RR > ______ or < ______, SBP > ______ or < ______, DBP > ______ or < ______, UOP < __________ .

Labs:
Hc t

Input:

Vitals
Temp HR RR BrSnd

08:00

12:00

W BC Hg b

C RB
Glucose Platelets Hgb Hct WBC

Output:

Sp O2 O2 BowSnd BP

Na+ K+

ClCO2

BUN Creat

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