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SILLIMAN UNIVERSITY COLLEGE OF NURSING

TEAM LEADER’S MONITORING SHEET


DEMOGRAPHIC INFORMATION
INTRAVENOUS FLUID SHEET MEDICATIONS

NAME: TYPE REMARKS MEDICATION TIME ACTION


ADDRESS LEVE
AGE: L
ROOM & BED NUMBER: TIME
SEX: 7
DATE & TIME OF ADMISSION:
4
DOCTOR(S)-IN-CHARGE:
CHIEF COMPLAINTS: 5
RELIGION: 6
NATIONALITY:
7
HISTORY OF PRESENT ILLNESS: 8
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9
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MEDICAL DIAGNOSIS: VITAL SIGNS


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TIME 4 PM 8 PM

ASSESSMENT AREA RESULTS REMARKS RESULTS REMARKS

TEMP

PULSE RATE

RESPIRATION

BLOOD PRESSURE

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DIET AND THERAPY: _______________________________________
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SPECIAL REMINDERS: __________________________________


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