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MIO Sheet

This vital signs and intake/output form contains information about a patient named Jameel who was admitted to the hospital on August 16, 2021. It tracks their blood pressure, temperature, pulse, respiration rate, oxygen saturation, and intake and output measurements over a 24 hour period, including oral intake, IV fluids, urine output, and stool output. The form is signed by the nurse, JJL, after documenting the patient's measurements each hour.

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jnet
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698 views1 page

MIO Sheet

This vital signs and intake/output form contains information about a patient named Jameel who was admitted to the hospital on August 16, 2021. It tracks their blood pressure, temperature, pulse, respiration rate, oxygen saturation, and intake and output measurements over a 24 hour period, including oral intake, IV fluids, urine output, and stool output. The form is signed by the nurse, JJL, after documenting the patient's measurements each hour.

Uploaded by

jnet
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

VITAL SIGNS AND INTAKE/OUTPUT FORM

Name of Patient: Jameel Ward/Room: MW


Address: Bago City
Age: 35 years old Sex: Female
Admission Date: August 16, 2021

INPUT OUTPUT
Date Time BP T P R O2 CVP Signature
Sat. Oral NGT IV Blood Misc. Urine NG Stool Eme Misc.
T sis
12
am
1 am
2am
3 am
4 am
5 am
6 am
7 am
Total
8 am 120/90 38.3 77 17 200 60 300 1x semi JJL
fomed
brown
9 am 60 JJL
10 150 60 JJL
am
11 JJL
am
12 pm 120/80 38.2 78 18 150 200 JJL
1 pm JJL
2 pm 200 250 JJL
3 pm JJL
TOTAL 700 300 750 JJL
4 pm
5 pm
6 pm
7 pm
8 pm
9 pm
10 pm
11 pm
TOTAL
24 HOURS TOTAL

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