NFDN 1002

PN Online Bed Rotations

Bed #1

(Print, Complete and Bring to Lab Day 1)

Mr. John Smith has just been admitted for CHF. He complains of shortness of breath and angina when he
walks up stairs. Mr. Smith has a Doctors order for Oxygen to maintain (Sp02) levels > 92%. He also has a sinus
infection which has spread into his right eye and right ear. He also has been diagnosed with Glaucoma. Due to
increased mucous production Mr. Smith has been experiencing difficulty clearing the mucous from his
oropharynx. Mr. Smith requires daily catheter care and help connecting a leg bag so he can ambulate easier
when out of bed.

Initial Vital Signs (First meeting patient):

Blood Pressure: 135/90 mmHg; Pulse (radial): 90 bpm strong/regular; Resp Rate: 22 labored/fast (wheezes
noted to the RUL and LUL on auscultation; no accessory muscle use noted on inspection); Temp (oral): 36.6
Celsius; SpO2: 89% on RA; Pain Rated: 0/10 on pain scale.

Focused Assessments: (Student to complete)

Equipment / Skills kits needed: (Student to complete)

Procedures Performed during rotation: (Student to Complete and Arrange by Priority)

Post Vital Signs (after all treatment):

BP: 130/80 mmHg; Pulse (radial): 110 bpm strong/regular; Resp Rate: 18 unlabored/regular (no adventitious
breath sounds heard on auscultation; no accessory muscle use noted on inspection); Temp (oral): 36.9
Celsius; SpO2: 94% on _?__L oxygen via nasal cannula; Pain Rated: 0/10 on pain scale.

V1.21
 NFDN 1002

PN Online Bed Rotations

*Organizational / Time Management Hint: Collect ALL medications required from physician order/MAR pertaining to
your patient, take to bedside at the same time. Know what skill kits are required for each Bed Rotation with Medication
Cards and group them in packages for when you come to lab. Plan ahead! ☺

Bed #1 ORGANIZATION CARE PLAN (you will need to do one of these for each
medication administering)

PRIORITY NURSING DIAGNOSIS:

CLIENT-CENTRED OUTCOME RELATED TO

PRIORITY DIAGNOSIS (Using SMART Criteria; Specific, measurable, attainable, realistic, timely)

NURSING INTERVENTIONS 1. 2. 3.
RELATED TO PRIORITY
DIAGNOSIS
1. Identify one
intervention related to
nursing care.
2. Identify one
intervention related to
medication
administration.
3. Identify one
intervention related to
teaching.
Evaluate effectiveness of
the three nursing
Interventions:
Medication Research
Medication Name (trade
and generic)
Purpose (in laymen’s
terms)
Safe Dose:
(Show Rationale – how do you
know cite source)
Nursing Assessments (related
to medication)

V1.21
 NFDN 1002

PN Online Bed Rotations

PT ID: 4322 NAME: SMITH, John
PHN: 80498 SEX: M
HT: 182 CM DOB: 21OCT1981
WT: 62 KG ROOM: 4-110 – Bed #1
DR. T. DOGOOD
Bed #1
PHYSICIANS ORDERS

ALLERGIES: Codeine
DATE TIME Admission Orders:

Day/Mon 0830 Vital Signs Routine

Apply Oxygen to keep SpO2 over 92%
/Yr
Oropharyngeal Suctioning PRN

Incentive Spirometry/DB&C 10 times every hour while awake

Salbutamol 2 inhalations (100 mcg/spray) via MDI every four

hours with aerochamber while awake
Ipratropium Bromide 500 mcg via nebulizer three times per day
while awake
Anti-embolic stockings every AM daily

Nitroglycerin transdermal patch (Practi-Nitro) 0.4mg/Hour on at

0800 and off at 2000
Gentamicin eye ointment 1 cm strip to both eyes every 12 hours.
Pilocarpine 0.5% solution, two drops to each eye four times daily.
Fluocinolone acetonide 0.01% 2 drops to left ear twice daily X 7
days
Keep indwelling catheter in place – change to leg bag for days

Ins and outs every shift

Collect Urine for Urinalysis and C&S

--------------------------------------------------------------------------Dr. T. Dogood

PT ID: 4322 NAME: SMITH, John

V1.21
 NFDN 1002

PN Online Bed Rotations

PHN: 80498 SEX: M
HT: 182CM DOB: 21OCT1981
WT: 62KG ROOM: 4-110 – Bed #1
DR. T. DOGOOD
SIGNATURE / INITIAL IDENTIFICATION RECORD

NAME (Last, first) Please Print SIGNATURE (with Designation) INITIALs

Band, Roberta R. Band SPN RB

* Form identifies your initials and signature in chart for reference and legal purposes. Filled with
sample.

V1.21
 NFDN 1002

PN Online Bed Rotations

PT ID: 4322 NAME: SMITH, John
PHN: 80498 SEX: M
HT: 182CM DOB: 21OCT1981
Bed #1 CAUTION WT: 62KG ROOM: 4-110 – Bed #1
DR. T. DOGOOD

Allergies and Adverse Reactions

Important Patient Information

Patient Information:
Admission Height: 182cm Weight: 62_kg
(Weight: x Measured Estimated)
Pregnant Lactating Dialysis

List known allergies and adverse reactions below.

Update if new allergies and adverse reactions occur.

No known allergy / adverse reaction. Initial: ________

Unknown (no information available) Initial: ________

Medications: Reaction Initial Data Entry*

__Codeine______________ __Hives_____________ ___RB_____ x
______________________ ____________________ ________
______________________ ____________________ ________
______________________ ____________________ ________

Latex Allergy: Reaction:

Foods: Reaction Initial Data Entry*
_______________________ ____________________ _________
_______________________ ____________________ _________
_______________________ ____________________ _________
_______________________ ____________________ _________
Other Substances: Reaction Initial Data Entry*
________________________ _____________________ _________
________________________ _____________________ _________
Date: ____________________ Date of 1st Revision: ___________________
Date of 2nd Revision: _______________ Date of 3rd Revision: ___________________

* Data entered electronically into required database(s).

Completed form to be forwarded electronically to Pharmacy and to Food Services immediately upon admission, and upon each
revision.
Form to be placed inside front cover of patient’s chart.

V1.21
 NFDN 1002

PN Online Bed Rotations

PT ID: 4322 NAME: SMITH, John
PHN: 80498 SEX: M
HT: 182CM DOB: 21OCT1981
Allergies: Codeine WT: 62KG ROOM: 4-110 – Bed #1
DR. T. DOGOOD

MEDICATION ADMINISTRATION RECORD

Month: ____ Year: _____
Day→
1 2 3 4 5 6 7 8 9 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 3 3
Medication Time↓ 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1

Nitroglycerin 0800
patch (Practi- on
NITRO) 0.4
mg/hour on at site
0800 off at 2000 2000
off
Fluocinolone 0800
acetonide 0.01%
2000
2 drops to left ear
twice daily
Gentamicin eye 0800
ointment 1 cm 2000
strip to both eyes
every 12 hours
Pilocarpine 0800
0.5% solution, 1200
two drops to 1600
each eye four
2000
times daily
Salbutamol 2 0800
inhalations (100
1200
mcg/spray)
every four hours 1600
via MDI with
aerochamber 2000
while awake 2400
Ipratropium
Bromide 500
mcg via
nebulizer three
times per day
while awake

V1.21
 NFDN 1002

PN Online Bed Rotations

MEDICATION ADMINISTRATION RECORD

Month: ____ Year: _____ (for practice- line through date and write in day if not on MAR)

Day→ SCHEDULED MEDICATIONS

Medication Time
↓ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

V1.21
 NFDN 1002

PN Online Bed Rotations

Nitroglycerin patch 0800
(Practi-NITRO) 0.4 ON
mg/hour on at
0800 off at 2000 SITE

2000
OFF

Fluocinolone 0800
acetonide 0.01% 2
drops to left ear 2000
twice daily

Gentamicin eye 0800

ointment 1 cm strip
to both eyes every 2000
12 hours

Pilocarpine 0800
0.5% solution,
two drops to 1200
each eye four
1600
times daily
2000

Day→ Scheduled Medications

Medication
1 2 3 4 5 6 7 8 9 10 11 12 13 1 15 16 17 18 19 20 21 22 23 24 25
Time 4

Salbutamol 2 0800
inhalations (100
mcg/spray) 1200
every four hours
1600
via MDI with
aerochamber 2000

V1.21
 PT ID: 4322 NAME: SMITH, John
PHN: 80498 SEX: M
HT: 182CM DOB: 21OCT1981
ROOM: 4-110 – Bed #1
NFDN 1002
WT: 62KG
DR. T. DOGOOD

PN Online Bed Rotations

while awake

Ipratropium 0800
Bromide 500
mcg via nebulizer 1200
three times per
1600
day while awake
2000

Fluticasone 0800
Propionate 2
sprays each
nostril once daily

PT ID: 4322 NAME: SMITH, John

PHN: 80498 SEX: M
HT: 182CM DOB: 21OCT1981
WT: 62KG ROOM: 4-110 – Bed #1
DR. T. DOGOOD

Nursing Care Record

Date: Time:
DD/Mon/YYYY (24hr)

V1.21
 NFDN 1002

PN Online Bed Rotations

V1.21