BLOOD REQUEST CSR REQUISITION DISCHARGE

FORM FORM SUMMARY

MEDICATION DNR PRE – OP EVAL/

SHEET FORM CP EVAL

LABORATORY DIAGNOSTIC NURSE-PATIENT

SHEET RESULT FORM ASSIGNMENT

ENDORSEMENT NURSE’S
SHEET NOTE

DOCTOR’S ORDER DEATH CERTIFICATE

SHEET FORM

PERITONEAL MONITORING ANTHROPOMETRIC

DIALYSIS SHEET SHEET MONITORING SHEET

DAMA

PHLEBITIS LINEN WEEKLY

MONITORING SHEET CONSUMPTION

X – RAY REQUEST CONSENT FOR

BED TAG
FORM SURGERY

DISCHARGE PLAN BLOOD

DISCHARGE
DIET LIST
TRANSFUSION SHEET
INSTRUCTION
MONITORING CONSENT FOR TEACHING AND
TOOL EQUIPMENT DIAGNOSTIC/ LEARNING
FUNCTIONALITY THERAPEUTIC ACTIVITIES
Furosemide 20mg in 2ml 4
Lidocaine 2% 2mg/ml 2
Hydrocortisone 100mg/2ml 2
PNSS 500ml 1
Water for injection 1
Methyl prednisone 1gm 1
Ephedrine 10mg/ml 2
Magnesium Sulfate 50% 5mg/10ml vial 2

Drawer 2 Venipuncture Tubes and Equipment

ITEM QUANTITY
Disposable syringe – 1ml, 2ml, 5ml, 10ml, 2 each
20ml and 50ml
Disposable needle 18 gauze without filter 5
Disposable needle 23 gauze 5
Tourniquet 1
IV dressing (Tegaderm) 5
IV cannula – 16G, 18G, 20G, 22G, 24G, 2 each
26G
Cotton swabs 10
Plaster (micropore) 1 inch 1
Sterile gauze 2 packets
IV extension 10cm 2
IV set (macroset and microset) 2
Burette set/Soluset 1
3 way stopcock 2
Disposable kidney tray 1
Sterile Gloves size 6, 7, 7.5, 8 2 each
Multilumen catheter 7 F 1

Drawer 3 Airway Management

ITEM QUANTITY
ECG GEL
Electrodes-adult
Electrodes Pediatric
Airways-00,0,1,2,3,4
Nasal and Oral Airways, assorted sizes
Laryngoscope set: Mil 1, 2, Mac 1, 2, 3
Tongue depressor wooden
ET stylet pediatric/adult
ET tube size 2.5, 3, 3.5, 4, 4.5, 5, 5.5, 6, 6.5,
7, 7.5
Battery (C, AA, AAA, D)
Leukoplast 1 inch
Disposable gloves
Laryngeal mask-No: 3, No: 4
Neonatal, Pediatric and Adult oxygen mask
Drawer 4
ITEM QUANTITY
Suction catheter all sizes 2 each
5 Fr, 8 Fr, 10 Fr, 12 Fr, 14 Fr, 16 Fr
Siliconized Umbilical catheter 3.5
CTT set (ER)
Broselow pediatric emergency tape 1
Intra osseous needle pediatric (bone 1
injection gun) 18 gauze
Intra osseous needle, adult (bone injection 1
gun) 15 gauze
Medication additive labels

Drawer 5 IV Fluids
ITEM QUANTITY

1000ml D5W, D5LR, D5NSS, PNSS 1 each

500ml D10W, D5W, D5LR, D5NSS, D5 0.3 1 each
NaCl D5lMB
100ml NSS 1 each