PATIENT MONITORING SHEET

PATIENT NAME: AGE: HOSPITAL NO.:

PHYSICIAN: SEX: WARD/ROOM:

DATE/ VITAL SIGNS OTHERS

SHIFT TIME BP CR/PR RR TEMP O2 SAT GCS CBG
 KARDEX
PATIENT NAME: Anton Louie AGE: 59 HOSPITAL NO.: 2020 - 61235
PHYSICIAN: Dr. Jomaya SEX: male WARD/ROOM: medical ward
Date Admitted: 9/11/20 Chief pain and itchiness
Diagnosis: Allergies:

DIAGNOSTICS DATE ORDERED NURSING ACTION

MEDICATIONS DATE ORDERED NURSING ACTION

IV FLUIDS DATE ORDERED NURSING ACTION

SPECIAL ENDORSEMENTS DATE ORDERED NURSING ACTION

TREATMENT DATE ORDERED NURSING ACTION

PROCEDURES DATE ORDERED NURSING ACTION

DIET DATE ORDERED NURSING ACTION

NURSING NEEDS DATE ORDERED NURSING ACTION

 MEDICATION SHEET
PATIENT NAME: AGE: HOSPITAL NO.:
PHYSICIAN: SEX: WARD/ROOM:

DATE/
MEDICATION/DOSAGE/FREQUENCY SHIFT 08/17/20 02/18/20 02/18/20
7AM - 3PM

3PM-11PM

11PM-7AM

7AM - 3PM

3PM-11PM

11PM-7AM

7AM - 3PM

3PM-11PM

11PM-7AM

7AM - 3PM

3PM-11PM

11PM-7AM

7AM - 3PM

3PM-11PM

11PM-7AM
 7AM - 3PM

3PM-11PM

11PM-7AM

7AM - 3PM

3PM-11PM

11PM-7AM

7AM - 3PM

3PM-11PM

11PM-7AM

TRANSCRIBE THE DOCTOR'S ORDERS AND

FILL OUT THE NECESSARY INFO ON THIS
MEDICATION ADMINISTRATION RECORD
 FLUID MONITORING SHEET
PATIENT NAME: AGE: HOSPITAL NO.:
PHYSICIAN: SEX: WARD/ROOM:

TIME INTAKE (ML) OUTPUT (ML)

MORNING SHIFT
7:00 AM Type of fluid Oral NG URINE NG/ASPIRATE DRAINS

3:00 PM TOTAL
TOTAL INTAKE
TOTAL OUTPUT
TIME INTAKE (ML) OUTPUT (ML)
AFTERNOON SHIFT
3:00 PM Type of fluid Oral NG URINE NG/ASPIRATE DRAINS
 11:00 PM TOTAL
TOTAL INTAKE
TOTAL OUTPUT
TIME INTAKE (ML) OUTPUT (ML)
NIGHT SHIFT
11:00 PM Type of fluid Oral NG URINE NG/ASPIRATE DRAINS

7:00 AM TOTAL
TOTAL INTAKE
TOTAL OUTPUT
NOTES SHIFT TOTAL (ML) 24 HOUR BALANCE (ml)
INTAKE FROM TO
MORNING SHIFT OUTPUT DATE DATE
INTAKE TIME TIME
AFTERNOON SHIFT OUTPUT TOTAL INTAKE

INTAKE TOTAL OUTPUT

NIGHT SHIFT OUTPUT DIFFERENCE

T (ML)

STOOL

T (ML)

STOOL
T (ML)

STOOL

LANCE (ml)
TO
 IV/BT SHEET
PATIENT NAME: AGE:
PHYSICIAN: SEX:

DATE/TIME

SHIFT DATE IV FLUID/BLOOD TRANSFUSION RATE START END

MORNING

AFTERNOON

NIGHT
HOSPITAL NO.:
WARD/ROOM:

FLUID RIE
 NURSES' NOTES
PATIENT NAME: AGE:
PHYSICIAN: SEX:

DATE/TIME FOCUS D - ATA A - ACTION R - RESPONSE

HOSPITAL NO.:
WARD/ROOM:

NURSE SIGNATURE
 LORMA COLLEGES CON TEMPLATE
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LEARNING PACKET ASSESSMENT COVER

Student ID Number
Student Name
Yr and Section
Course Code
Course Title
Semester and year
Rotation Clinical Instructor
Assignment number
Assignment Title
Due date of assignment
Date submitted
To be set by the instructor (will not include text in figures
Prescribed word count and images, bibliography/references as well as the front
cover text)
Actual word count

I DECLARE THAT THIS IS MY OWN WORK AND REFLECTS MY OWN LEARNING. I HAVE
ACKNOWLEDGED ALL SOURCES WHERE I HAVE USED OR REFERRED TO SOMEONE
ELSE'S WORK AND/OR IDEAS

I HAVE NOT SUBMITTED THIS WORK, IN WHOLE OR IN PART, FOR CREDIT

IN ANY OTHER COURSE.

IF IMAGES HAVE BEEN USED FROM WORKPLACE AND COMMUNITY, I DECLARE THAT I
HAVE OBTAINE PERMISSION FROM AUTHORITIES AND PERSON CONCERNED TO
ACCESS AND USE THESE IMAGES. I WILL USE THESE IMAGES ONLY FOR THE PURPOSE
OF MY ASSESSMENTS AT LORMA COLLEGES. I WILL ALWAYS ENSURE THAT ALL
IDENTIFYING PATIENT DATA IS REMOVED FROM THE IMAGES PRIOR TO SUBMISSION
OF THE ASSESSMENT.
 LORMA COLLEGES CON TEMPLATE
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STUDENT NAME: ROTATION: AREA:

YR LEVEL AND SEC: DATES: CLINICAL INSTRUCTOR:

ARTICLE
You must hyperlink the source of your article/journal in this file.
Lecture discussion on the medical condition is not acceptable. Journal/ Articles must discuss updates, trends, prevention, advancement in the diagnosis,
treatment and management of the disease or health related concerns.

SUMMARY
Provide a 1-2 short paragraphs of what the article/journal is about citing important and salient data.

DISCUSSIONS
Write your opinion regarding the article and relate it to the following aspects:
a) What are the advantages of the said updates, trends, management etc. ?
b) What are the disadvantages of the said updates, trends, management etc.?
c) Is it feasible/adaptable in the local setting? Why? Why not?
d) Relate it to your experience/observation in the area (where applicable)?
e) What resolutions can you provide to manage problems relative to the issue at hand?
f) What are the implications of these updates, trends etc. on the nursing profession?

NURSING THEORY
Cite a specific nursing theory and discuss how this is related to the journal/article that you have chosen.

REFERENCES
Use APA format.
NOTE: All journal analyses are assumed to be original and done by the student.
Anti-plagiarism tools will be used to evaluate authenticity of submitted outputs.
in the diagnosis,
 LORMA COLLEGES CON TEMPLATE
PATIENT HEALTH HISTORY
RELATED LEARNING EXPERIENCE

STUDENT NAME: ROTATION: AREA:

YR LEVEL AND SEC: DATES: CLINICAL INSTRUCTOR:

A. BIOGRAPHIC DATA

B. REASONS FOR SEEKING HEALTH CARE

C. PRESENT HEALTH HISTORY

D. PAST HEALTH HISTORY

E. FAMILY HEALTH HISTORY

F. LIFESTYLE AND PRACTICES

1. DESCRIPTION OF TYPICAL DAY
2. NUTRITION
3. ACTIVITY LEVEL AND EXERCISE
4. SELF-CONCEPT
5. RELATIONSHIP
6. STRESS LEVEL
7. ENVIRONMENT
8. EDUCATION AND WORK
9. VALUES AND BELIEFS
10. SLEEP AND REST

G. DEVELOPMENTAL STAGE
 LORMA COLLEGES CON TEMPLATE
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STUDENT NAME: ROTATION: AREA:

YR LEVEL AND SEC: DATES: CLINICAL INSTRUCTOR:

A. GENERAL ASSESSMENT

B. SKIN, HAIR AND NAILS

C. HEAD AND NECK

D. EYES AND EARS

E. MOUTH, THROAT, NOSE AND SINUSES

F. HEART AND NECK VESSELS

G.ABDOMINAL ASSESSMENT

H. EXTREMITIES

J. GENITALIA

I. NEUROLOGIC
 LORMA COLLEGES CON TEMPLATE
DRUG STUDY
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STUDENT NAME: ROTATION:

YR LEVEL AND SEC: DATES:

DRUG NAME CLASSIFICATION MECHANISM OF ACTION INDICATION CONTRAINDICATION SIDE EFFECTS

AREA:
CLINICAL INSTRUCTOR:

NURSING RESPONSIBILITIES
 LORMA COLLEGES CON TEMPLATE
NURSING CARE PLAN
RELATED LEARNING EXPERIENCE

STUDENT NAME: ROTATION: AREA:

YR LEVEL AND SEC: DATES: CLINICAL INSTRUCTOR:

PROBLEM: DIAGNOSIS:
PRIORITIZATION: DATE:

ASSESSMENT NURSING DIAGNOSIS PLANNING IMPLEMENTATION RATIONALE

Subjective:

Objective:
L INSTRUCTOR:

EVALUATION
 LORMA COLLEGES CON TEMPLATE
LABORATORY DIAGNOSTICS INTERPRETATION
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STUDENT NAME: ROTATION: CLINICAL INSTRUCTOR:

YR LEVEL AND SEC: DATES: AREA:

DATE DIAGNOSTICS DESCRIPTION PURPOSE NORMAL RESULT IMPRESSION

LORMA COLLEGES CON TEMPLATE
SAMPLE CONCEPT MAP
RELATED LEARNING EXPERIENCE