Day of Month

Day of Disease
Number of Days in
Hospital
Weight
Respi- Tempe-
Pain Score Pulse
ration rature
10
5
0

42

41

40

39

38
180

37

160 36

35

140

120

50

40

100
30

20
80
10
 60

Urine Nos.
8-4

4-12

12-8
Stool Nos.
8-4

4-12

12-8
HOLY NAME UNIVERSITY
COLLEGE OF HEALTH SCIENCES
DEPARTMENT OF NURSING

VITAL SIGNS RECORD

Bed No. _______
Case No.: _______________ Doctor: __________________________
Year: ___________________ Month: __________ Name: ___________________________