KARDEX

DATE ADMITTED:_________________ AGE: ________ ROOM: __________

ADDRESS: _______________________ OCCUPATION: __________ WARD: __________
SEX: _________ RELIGION: ________ DIET: __________
NX ASSESSMENT INDEPENDENT COLLABORATIVE / DEPENDENT TREATMENT

MEDICATIONS IVF
PHYSICIAN:

DIAGNOSIS:

PROCEDURE DONE:
IVF TF / BT
NAME OF Px:

DATE : I & O MONITORING

TIME VS MONTORING INTAKE OUTPUT
TEMP PR RR REMARKS ORAL IV OTHERS TOTAL URINE WANGES MISC TOTAL

GRAND TOTAL GRAND TOTAL

INTRAVENOUS CHART
DATE/TIME BOTTLE NO. IVF AND DRUG FLOW RATE SIGNATURE/ DATE/TIME SIGNATURE/
STARTED VOLUME INCORPORATED REMARKS CONSUMED REMARKS

NURSE'S NOTES
DAT SHIFT TIME FOCUS
E
DAT SHIFT TIME FOCUS
E

DRUGS COMPUTATIO
STUDY N
Pt's Generic Pharmacokineti Indication Contraindicatio Specific Nx Drug
Medication name/ cs s ns consideratio computatio
s classification n n

BRIEF INTRODUCTION OF THE DISEASE

DEFINITION

ETIOLOGY
RISK FACTORS

PATHOPHYSIOLOGY

CLINICAL
MANIFESTATION

OX / LAB EXAMS

MEDICAL MNGT

SURGICAL MNGT

NURSING MNGT