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3+3+2 ACCOMPLISHED REQUIREMENTS OF

3-DAY BASIC INTRAVENOUS THERAPY TRAINING PROGRAM FOR NURSES

Name of Registered Nurse: MARIA JOHANNA R. CRAVE PRC Number:


0606446 / Exp Date: 04/12/2013
Name of Hospital offering IV Training: DAVAO MEDICAL CENTER Provider
No.: 093-006505
Date of IV Training Program Attended: August 6 – 8, 2010 Venue: DAVAO
MEDICAL CENTER

I. INITIATING / MAINTAINING PERIPHERAL IV INFUSIONS


Patie Name of Age Date Time Kind of Site Type of Dose Rate Signature over Printed Name of I.V. License
nt patient Infusion Cannula Certified No.
No Trainer/Preceptor/MD/RN
.
1. Sumoroy, 32 y.o 8-9-10 9:00 am D5LR Left Metacarpal Gauge 1 Liter 30 Rodel F. Barcoma, RN 09-027435
Zenaida C. Vein 18 gtts/min Lic. No. 0464995
2. Dagoro, Divina 26 y.o 8-9-10 10:25 D5LR Left Metacarpal Gauge 1 Liter 30 Rodel F. Barcoma, RN 09-027435
L. am Vein 18 gtts/min Lic. No. 0464995
3. Verola, 22 y.o 8-9-10 11:05 D5LR Right Cephalic Gauge 1 Liter 30 Rodel F. Barcoma, RN 09-027435
Estrelita M. am Vein 18 gtts/min Lic. No. 0464995

II.ADMINISTERING INTRAVENOUS DRUGS


Patie Name of Age Date Time Kind of Site Type of Dose Rate Signature over Printed Name of I.V. License
nt patient Infusion Cannula Certified No.
No Trainer/Preceptor/MD/RN
.
1. Sacay, Rey R. 757 8-9-10 1:55 pm PLR 1L Right Gauge Ranitidine 30 Jan Doris Olaivar, RN 08-021271
y.o. Metacarpal 18 50 mg gtts/min Lic. No. 0485775
Vein
2. Limpin, Rey G. 52 y.o 8-9-10 2:15 pm PNSS 1L Right Gauge Clindamyci 30 Jan Doris Olaivar, RN 08-021271
Metacarpal 20 n gtts/min Lic. No. 0485775
Vein 30 mg
3. Cata, Nancy D. 47 y.o 8-9-10 2:30 pm PLR 1L Right Gauge Ketorolac 30 Jan Doris Olaivar, RN 08-021271
Cephalic Vein 20 30 mg gtts/min Lic. No. 0485775

III. ADMINISTERING / MAINTAINING BLOOD AND BLOOD COMPONENTS


Patie Name of Age Date Time Kind of Site Type of Dose Rate Signature over Printed Name of I.V. License
nt patient Infusion Cannula Certified No.
No Trainer/Preceptor/MD/RN
.
1. Landas, 2 y.o 8-11-10 12:10 Packed Right Gauge 150 cc 10 – 15 Chris Adrian A. Perin, RN 08-006429
Jonathan Jr. A. am RBC Metacarpal Vein 20 gtts/min Lic. No. 0393720
“B+”
2. Completo, 57 y.o 8-11-10 9:35 am Packed Right Cephalic Gauge 300 cc 30 Dianne Monica P. Abellar, RN 08-012449
Asteria T. RBC Vein 20 gtts/min Lic. No. 0475405
“O+”

Submitted by: CRAVE, Maria Johanna R. Date Submitted: Received by:


Approved by: VILMA L. COMODA , R.N., M.A.N.
(Signature over Printed Name)
Director of Nursing Services/Chief Nurse

(Signature over Printed Name)