NURSE BRAIN SHEET TELEMETRY UNIT SBAR

allergles
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aLlenL name Age
8oom number AdmlL daLe
1 ux 2 ux
C/C
Code sLaLus
Advanced dlrecLlve on
charL?
hyslclan
ALLendlng
ConsulLanLs
gr/#
#
PlsLory
Surgery: Surgeon
AnesLhesla AnesLheslologlsL L8L
lsolaLlon Core Measures
8esLralnLs CPl Ml nA
lall rlsk vacclne- nA llu
Cardlac: 8/P8/erlpheral pulses/Ldema/PearL sounds
CurrenL rhyLhm
ually wL?
uv1 prophylaxls
aln/sedaLlon
aln scale
LocaLlon
Meds Lype and lasL dose
ulmonary: 8reaLh sounds/SecreLlons/ SpC2/uAs/l/
SponLaneous v1 & vL
venL/blpap eLc
seLLlngs
Accu checks A1C
lrequency
LasL 8esulLs
Cl nC/CC1
8S LasL 8M

uleL Cl rophylaxls
Cu loley/vold
CuLpuL
Skln
Wounds/uralnage
SLaples
uralns
LocaLlon
uucub phoLo on admlsslon
lv uaLe lnserLed
llulds CLLs
sych Soclal
Meds endlng orders
na Cl 8un gluc mg 8n uA
k Co Cr Ca hos uulmer
$
Cardlac enz 1 2 3
Coags
ln8
11
nexL lab
PcL
W l

Pgb
CulLures
C1
Cx8
M8l
Lcho
%
uC lan. ls pL lnformed of plan___ 24 hour orders revlewed____ ShlfL goals