Republic of the Philippines

CEBU TECHNOLOGICAL UNIVERSITY

Main Campus
in consortium with
CEBU CITY MEDICAL CENTER COLLEGE OF NURSING
Dionisio Jakosalem Street, 6000, Cebu City, Cebu Website: Email:
Phone: +6332 – 316 1987 or 316 5128

NCM 3113
NURSING CARE MANAGEMENT OF CLIENTS WITH PROBLEMS IN
OXYGENATION, FLUID & ELECTROLYTE, INFECTIOUS, INFLAMMATORY
& IMMUNOLOGIC
RESPONSE, CELLULAR ABERRATION, ACUTE AND CHRONIC

PERIOPERATIVE NURSING
Module 1.1 PREOPERATIVE
Nurse Instructor: Rowena L. Madrid, R.N.

1.A Terminology

Overview of the Lesson:

This module deals with the general concepts of perioperative nursing. The
perioperative period is the time period of a patient's surgical procedure. It commonly
includes ward admission, anesthesia, surgery, and recovery. The primary concern of
perioperative care is to provide better conditions for patients before operation,

Desired Learning Outcome:

At the end of this module, the nursing student will be able to:
1. .Assess with the client`s condition/health status through interview,
physical examination, and interpretation of laboratory findings;
2. Identify actual and at-risk nursing diagnosis;
3. Define and understand the perioperative phase.
4. Identify the risk factor of patient who will undergo surgery and provide health
teaching.
5. Relate with the client`s and their family and the health team appropriately

Lesson Content:
I. PERIOPERATIVE NURSING

A. What is surgery?
-any procedure performed on the human body that uses instruments to alter tissue or
organ

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Perioperative Nursing
- Connotes the delivery of patient care.in the preoperative , intraoperative and
post opearative periods of the patients surgical experience through the framework of
nursing process. The nurse assess the patient- collecting, organizing, and prioritizing
patient data; establishing nursing diagnosis; identifies desired patient outcome;
develop and implements a plan of care in terms of outcomes achieved by the patient.

Perioperative Phase
P- reoperative phase- begins when the decision to have surgery is made and ends
when the patient is transferred to the OR table.
I- ntraoperative phase- begins when the patient is transferred to the OR table and
ends when the patient is admitted to the PACU (Post Anesthesia Care Unit)
P-ostoperative phase- begins with the admission of the patient to the PACU and
ends when healing is complete.

Types of Surgery
1. Purpose/reasons
a. Degree of urgency – necessity to preserve the client’s life, body part, or
body function.
b. Degree of risk – involved in surgical procedure is affected by the client’s
age, general health, nutritional status, use of medications, and mental
status.
c. Extent of surgery– Simple and radical

2. Purpose
a. Diagnostic- Allows to confirm or establishes diagnosis.
b. CorrectiveCorrective- Excision or removal of diseased body part.
c. ReconstructiveReconstructive-Restore function or appearance to
traumatized or malfunctioning tissues.
d. AblativeAblative – Removes a diseased body parts
e. PalliativePalliative – Relieves or reduces pain or symptoms of a disease; it
does not cure
f. TransplantTransplant – Replaces malfunctioning structures
g. CosmeticCosmetic- Performed to improve personal appearance.

Categories of Surgical Procedure

A. Urgency
1. Emergency- performed immediately to preserve function or the life of the
client.
2. Elective – is performed when surgical intervention is the preferred
treatment for a condition that is not imminently life threatening or to
improve the client’s life.
3. Urgent – Necessary for client’ health to prevent additional problem from
developing; not necessarily an emergency.
4. Required – has to be performed at some point; can be pre-scheduled.
B. Degree of Risk
1. Major – involves a high degree of risk.
2. Minor – normally involves little risk.

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 3. Age – very young and elder clients are greater surgical risks than children
and adult.
4. General health- surgery is least risky when the client’s general health is
good.
5. Nutritional Status – required for normal tissue repair.

6. Medications – regular use of certain medications can increase surgical

risk.
7. Mental status – disorder that affect cognitive function

Surgical Settings:

 Inpatient Settings- eg. Hospitals

 Out-Patient Settings
-hospital based ambulatory surgical centers
-free standing surgical centers
-Physicians office
-ambulatory care centers

OUT PATIENT SURGERY/AMBULATORY SURGERY

Advantages:
1. Reduces length of hospital stay and cuts costs
2. Reduces stress for the patient
3. Less incidence of hospital acquired infection
4. Less time lost from work by the patient minimal disruption on the patient `s
activities and family life
Disadvantages:
1. Less time to assess the patient and perform preoperative teaching
2. 2. Less time to establish rapport
3. Less opportunity to assess for the late postoperative complication.

Example of Ambulatory Surgery:

Teeth extraction
Circumcision
Vasectomy
Cyst removal
Tubal ligation

A. PRE-OPERATIVE NURSING

 Patients Assessment:
1. Nursing History
Eg. Bleeding disorder, cardiovascular dse., respiratory dse, Liver dse, DM,
Renal dse
2. Past medical/surgical History
3. Allergies
4. Smoking and alcohol habits
5. Occupation
6. Emotional health
7. Significant others support
8. Patients and significant others understanding of surgery

3
 Surgical Risk:
a. obesity
- encoursge wt. reduction
b. Nutritional status
- weigh the patient before surgery
-diet
c. fluid and electrolytes imbalance
- correct any imbalances
d. age
-anticipate lesser dosage of meds.
-anticipate problem from the c. dses
e. Chronic comorbid dses
(eg.cardio vascular dse. DM, Respiratorydse.)
-avoid fluid overload
-assess v/s
-encourage position changes
-monitor blood glucose
f. Alcoholism
-anticipate acute withdrawal symptoms
g. Smoking
- Encourage vitamin intake
-concurrent or prior Pharmacotherapy
-obtain medication history
-stop all medications

-other factors:
- nature of condition
-location of the condition
-magnitude/ urgency of the surgery
-mental attitude of the patient
-caliber of the health care team

 Physical Examination
- Must be brief and complete
- Determine the following
 Nutritional status
-Assess for obesity wt. loss, malnutrition, metabolic
abnormalities, and the effects of medication on nutrition
 Height and weight
 Body mass index (BMI)
 Serum protein level
 Nitrogen balance
 Respiratory Status
-Advise pt. to stop smoking 6 mos prior to surgery
-teach breathing and coughing exercises
-if the patient has respiratory infections postpone the
surgery
 Cardiovascular status
-if the patient is hypertensive, postpone the surgery
-avoid sudden changes in position, prolonged
immobilization, and overloading hypotension, hypoxia,

 Hepatic and renal status

4
 -optimal liver function is essential
-surgery is complicated in patients with;
a. nephritis, acute renal insufficiency, and oliguria
or anuria or acute renal problems
 Endocrine status
-patient with DM are prone to hypoglycemia and
hyperglycemia
-perform Complete Blood Glucose before, during, and
after,. Maintain CBG below 300mg/dl.
-Use of corticosteroids places the patient at riskfor
adrenal insuffiency.
-patients with thyroid disorder are at risk for
thyrotoxicosisor respiratory failure
 Immune status
-determinepresence of allergies
-document any sensitivity to medications and past
adverse reaction to these agents.
-strict asepsis on immunosuppressed surgical patient.

 Laboratory and diagnostic studies

Screening test - depend on the condition of the client and the nature of the surgery. If
test results reveals severe problems the surgery may be cancel until the condition is
stabilized.

B. POTENTIAL NURSING DIAGNOSIS

◦ Risk for positioning injury

◦ Risk for infection
◦ Risk for altered body temperature
◦ Risk for injury from mechanical/thermal sources
◦ Knowledge deficit
◦ Anxiety
◦ Risk for ineffective airway clearance
◦ Fear related toFear related to
◦ Disturbed sleep pattern
◦ Anticipatory grieving related to
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Psychosocial assessment and care
Causes of Fears of the Pre-operative clients
a. Fear of unknown anxiety
b. Fear of anesthesia
c. Fear of pain
d. Fear of death
e. Fear of disturbance on body image
f. Worries- loss of finances, employment, social and family roles

Manifestation of fear:
-anxious
-bewilderment
-anger
-tendency o exaggerate
-sad, evasive, tearful, clinging
-inability to concentrate
-short attention span
-failure to carry out simple directions
-dazed

Nursing Intervention to minimize Anxiety

 Explore clients feeling
 Allow client`s to speak openly about fear s/concern
 Give accurate information regarding surgery ( brief, direct to the point, and in
simple terms)
 Give empathetic support

 Consider the person`s religious preference and arrange for a visit by a priest /
minister as desired.

C. LEGAL ASPECT OF THE INFORMED CONSENT

INFORMED CONSENT
-is the process in which a health care provider educates a patient about
the risks, benefits, and alternatives of a given procedure or intervention. The patient
must be competent to make a voluntary decision about whether to undergo the
procedure or intervention.J

PURPOSE:
1. To ensure that the client understand the nature of the treatment including
the potential complication and disfigurement.
2. To indicate that the client decision was made without pressure.
3. To protect the client against the unauthorized procedure.
4. To protect the surgeon and hospital against legal action by a client who
claims that an authorized procedure was performed.

Circumstances Requiring Consent

 Any procedure where scalpel, scissors, suture, hemostasis of
electrocoagulation may be used.
 Entrance into the body cavity
 Radiologic procedure, particularly if a contrast material is required.
 General anesthesia, local infiltration and regional block.

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Essential Element of informed consent
The diagnosis and explanation of the condition
A fair explanation of the procedure to be done and used and the
consequences
A description of alternative treatment or procedure
A description of benefits to be expected
The prognosis, if the recommended care, procedure is refused.

Take note:
 If the patient is MINOR, a parent or legal guardian should sign.
 An emancipated minor, or independently earning a living, he or she may sign.
 A minor who is the parent of infant or child who is having the procedure, he or
she may sign for the child
 Illiterate, he or she may sign with an X, after which the patients
writes “patient`s mark”.
 Unconscious , a responsible relative or guardian may sign
 Mentally incapacitated by alcohol or other chemical substance, a responsible
relative or guardian may sign when the urgency of the procedures does not
allow time for the patient to regain mental competence

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Consent to Operation Sample Form

Republic of the Philippines

City of Cebu
CEBU CITY MEDICAL CENTER

CONSENT TO OPERATION

DATE: Hospital No.:

Permission is hereby given to Dr.

Surgeon, and assistants of his/her choice to administer whatever
anaesthetic is deemed advisable and to perform the following
operation/s together with
any procedure that is deemed necessary by the above named Doctor,
and the Hospital Pathologist is/are authorized to use his/her/their
discretion in the proposal of any severed tissues or membrane.

Patient`s Signature

If the patient is a minor or Patient is a minor age, ( ) or is

Unable to sign below instead: Unable to sign, because:

Witness

Witness

For operation involving possible Pregnancy, complete the following:

I joined authorizing the performance/operation of my wife,

the consented surgery which is stated above.

Printed name and signature of Husband

8
 Republic of the Philippines
City of Cebu
CEBU CITY MEDICAL CENTER
N. Bacalso Avenue, Cebu City
DEPARTMENT OF SURGERY

ANESTHESIA INFORMED CONSENT

Date:
Time:

The anesthesia plan of management, alternative plans, possible

complications and post-operative analgesia are explained and understood and has
been accepted by the patient and/or the relatives.

Signature/Printed Name of Patient Doctor`s Signature/Printed Name

If the patient is unable to sign,

due to

Signature /Printed Name of Signature/Printed Name

Patient`s Relative of Nurse on Duty

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D. PREOPERATIVE TEACHING

1. Surgical procedure
2. Preoperative routines
3. Intraoperative routines
4. Postoperative routines
5. Pain relief
6. Postoperative
exercises Access Devices
 Lung exercises
o Deep breathing
o Coughing
o Incentive spirometry
o Diaphragmatic breathing
 Body exercises
o Leg exercises
o turning to sides exercises
o getting out of bed exercises
 spiritual preparations for surgery

E. PHYSICAL PREPARATION

 Nutrition and hydration

o Diet Orders: NPO 6-12hrs priop to OR
o Monitor input and output
 Elimination
o Catheter insertion
o Bowel preparation (enema, use of laxative
 Rest and Sleep
o Hygiene
o Bath
o Remove cosmetic and nailpolish
o Remove all hairpains and clips
o Remove dentures
o Provide an OR gown
 Medication
o Discontinue medication that are advised to be discontinued
o Administer preoperative medication
 Special orders
o Insertion of NGT
o Special skin preparation
o Take care of patients belongings anf remove all body prosthesis
 Reducing Anxiety and fear
o Promote positive coping strategies
 Imaginary
 Distraction
o Provide preoperative teaching
o Provide opportunity for visits from family and friends

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 F. PREPARATION ON THE DAY OF SURGERY
1. All personal belongings are identified and secured.
2. Jewelry is usually removed.
3.Dentures are removed, labeled and placed in a denture cup.
4.Pt. to verbally confirm the surgical procedures and the surgical site. This
verification process is documented in the medical record on the preop.
5. Morning bath and mouth care
6. Provide a clean gown
7. Remove hair pins, braid long hair, and cover hair withcap.
8. Remove dentures, foreign materials, colored nailpolish, hearing aids,
glasses and contact lens.
9. Take baseline vital signs before pre-op meds.
10. Check ID band7. Check for special orders: enema , gastric tube, IV line
11. Have client void before pre-operative medications.
12. Continue to support emotionally
13. Accomplish the Pre-op Checklist

Skin Preparation
Abdominal Prep (female)
 Shave the area of the abdomen from below the breast down
to the upper third of the thigh including the pubic area.
Laterally shave around the body to the bedline on ethier
sides
Abdominal prep (Male)
 Shave the area of the abdomen area from the nipple down to the
upper third of the thighs including pubic area. Laterally shave
around the body to the bedline on either side
Prep for Neck Surgery
 Shave the anterior neck extending to just below
 the intra ocular border and lower lip back to the
 hairline downward to 1-2 above the nipple

Preoperative Checklist includes:

1. Informed consent
2. Surgeon / nurse conference
3. Laboratory tests
4. Skin preparation
5. Bowel preparation
6. Iv fluids
7. Preoperative medications, sedation and antibiotics
8. Removal of dentures, nail polish and jewelries
9. NPO status

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Pre-operative Checklist Form

Republic of the Philippines

City of Cebu
CEBU CITY MEDICAL CENTER

PRE-OPERATIVE CHECKLIST
Patient:
Sex: Age: Room no.:

Proposed Operation: Anesthesia:

Date of Operation: Time/Schedule:

BODY HYGIENE: YES NO

FULL BATH ( ) ( )
SPONGE BATH ( ) ( )
HAIR CLEANED ( ) ( )
NAILS CLEANED ( ) ( )
OTHERS SPECIFY
COVERING:
SURGICAL GOWN ( ) ( )
HEAD CLEANED ( ) ( )
OTHERS SPECIFY:
ACCESSORIES REMOVED:
DENTURES ( ) ( )
EARINGS ( ) ( )
BRACELET ( ) ( )
RING ( ) ( )
NECKLACE ( ) ( )
BELTS ( ) ( )
OTHERS SPECIFY:
PRE-OP PREPARATION:
SHAVED ( ) ( )
SPECIAL (SPECIFY)
CLINICAL CHART:
HISTORY AND P.E. ( ) ( )
CONSENT FOR OPERATION ( ) ( )
BLOOD PRESSURE:

PRE-MEDICATION: TIME GIVEN:_

BLOOD AVAILABLE: UNIT:
CROSSMATCHED:

PREPARATIONS:
BLADDER EMTIED ( ) ( )
CATHETER ( ) ( )
Gastric TUBE ( ) ( )

CHECKED BY:
Supervisor
DATE/TIME:

Nurse on Duty

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Pre-op. medications
1. Prior to administering – check permits prior to administering
2. Purpose: Allay anxiety
Decrease pharyngeal secretions
Decrease gastric secretion.
Decrease side effects of anesthesia.
Induce amnesia

Examples of Medication use in OR:

a. Sedatives/hypnotics- Nembutal
b. Tranquilizers-Ativan, versed, valium
c. Opiate analgesics- Demerol, morphine
d. Anticholinergics-Atropine sulfate,atarax
e. H2o blockers.- Tagamet, Zantac
f. Antiemetic- Reglan, Phenergan

Transporting to the Operating Room

1. Provision of a comfortable stretcher
2. Provision of sufficient blankets
3. Provision of safety measures
4. Proper identification of surgical patient
5. Proper greeting of patient
6. Provision of a quiet environment

Duties and Responsibilities of an Operating Room Nurse

Before Operation
 Scrub Nurse (Instrument and Suture nurse)
1. Gather the following sterile things ready for use
a. sterile linen packs for the case
b. instrument set suited for the case
c. possible additional instrument to be used for the case
2. Inspect the container with concentrated disinfectants solution of all sharps
are already soaked.
3. Adjunct myo stand with tray
4. Cover OR table with a clean cover OR sheet

5. Test electrical necessities, Bp apparatus, IV paraphernalia( IV stand, IV

tubings, torniquet, cottonballs with alcohol, plaster, scissors, armband) either screen
or anesthetics, screw the patient head cover, kelly pad, footstool and etc.
 When patient is already in, start opening the sterile packs and
instrument pack, utilizing the wrappers as the lining for the preparation
table.
13
  Roll the tip first before opening the pack and keep all your things in
your packed
 Prepare your own gown and sterile gloves
 Prepare all needed supplies and sterile accessories like syringes, surgeons
gloves, sharps, OS, visceral pack, suture, rubber tubing, suction tip and
etc.
 Scrub when everything is already complete. Proceed to the scrub area
for scrubbing of your hands and arms
Circulating Nurse
1. Helps the instrument nurse in preparing all the things needed for the care
2. Complete and prepare skin prep. Tray
3. Received patient from the Surgical ward
a. take note for the arrival time
a. ask the patient name and family name
b. read the label of the IVF
c. ask when was the last intake of food/ water
d. inspect if jewelries/dentures are still present
e. Check the chart for signed consent
f. Received especial endorsement like blood of patient`s blood type
screen and cross matched, pending laboratory and due medications.
4. Assist the surgeon and anesthesiologist in positioning the patient and during
introduction of anesthesia.
5. Do the final skin prep.
6. Empty all pails before the start of the operation
7. Prepare papers
a. surgical records
b. charge slips 2 copies
c. OR perform log book ( OR nurse only)
d. sponge instrument log book
Note:
a. This must be rechecked and counter signed by the OR nurse before and after
final count
b. Stay around at all times for the immediate needs of the surgical team. Make
your anticipatory skills.
Students Suture Nurse/Scrub Nurse

14
1. Inquire from the OR nurse what case is to be scheduled first.

15
2. Proceed to the Surgical ward and notify the Nurse in charge if the patient is
ready for OR
3. Check the following:
a. consent form properly filled up
b. pre- op checklist, including the area of skin prep.
c. patients ID tag
Surgical Nurse:
1. Observe pre-op medications and chart (observe the 5R`s)
2. Observe the following strictly after administering pre-op meds
 Stay with the patient at all times
 Never allow the patient to stand or walk
 Accompany the patient on his to Operating Room with the following:
o Patients chart and laboratory results
o X-Ray Plate
o IV infusion set, IV fluids, available blood of patients blood type screen
and cross matched
Important:
1. Endorsement start from the clinical case where the patient information located,
2. Read the doctors order where the schedule for the said procedure indicated,
3. Checked the signed consent with anesthesia consent and pre op checklist,
4. Endorse if there is pending laboratory
5. Make sure that patient blood in the blood bank was screen and crossmatched.

Learning Activities:

1. In an A4 size bond paper, draw your view about Operating Room.

2. Given the Situation, use the informed consent form, anesthesia consent form and
preoperative checklist form for patient scheduled for surgery.
3. Base on the given scenario below, use the OPERATING ROOM ASSESSMENT
TOOL and do your assessment.
4. With the given scenario please use the following; TPR sheet, Medication Sheet
with medication tickets, Nurses progress note (focus charting), IVF sheet, I & O
sheet
5. Rubrics use; Written output
6. Deadline of submission should be on September 18, 2021 at 3pm. Please be
guided accordingly. Thank you.

16
SCENARO:

A case of 20 years old, female, complaint of right lower quadrant pain. Mefenamic
acid was taken but pain did not subside. Pain scale 10/10 thus seek consultation and
advise admission. Assessment done in Emergency Room suspect of Appendicitis
possible rupture, plan for appendectomy. V/s taken T: 37.8 degree Centigrade, PR:
98b/min, RR: 30breath/min, Bp: 110/80mmhg, Oxygen Saturation of 96%. . WT- 126
lbs. Labs: CBC, Blood typing, HbA1c, ECG and Xray taken at ER.
Labs taken at Emeregency room: CBC, U/A, Stool exam, ECG and X-ray.

Pls. see attached file below.

17
 Republic of the Philippines
City of Cebu
CEBU CITY MEDICAL CENTER
A PHIC ACCREDITED HEALTH CARE PROVIDER
N. Bacalso Avenue corner Panganiban St. Cebu City, Philippines 6000

DOCTOR`S ORDER

Name of Patient:: Jocelyn Mae Salvador Area & bed no. FSW2 Case no.
068802

Date Time Progress Doctor`s Order

Notes

9- 1pm -complaint of -please admit to Female Surgical Ward2

14- right lower -Schedule for Appendectomy tomorrow September
2021 quadrant pain 15, 2021 at 10 am.
-scale of pain: -pls. secure consent
10/10 -IVfF; D5 LR 1L at 30ggts/min @800cc level.
.- V/s taken Labs:
T: 37.8 CBC X-ray APL
degree Blood typing ECG
Centigrade, Urinalysis HbA1c
PR: 98b/min, Stool
RR:
30breath/min, Meds:
Bp: 1. Cefuroxime 750mg IVTT q8hors ANST
110/80mmhg, 2. Raniditine 50mg IVTT q8hours
Oxygen 3. Metronidazole drip 500mg q8h
Saturation of -please secure 2units of PRBC of patients’ blood
96%. type
-Diet: Npo temporarily
-v/s q4h
-I & O q shift
-refer accordingly

Dr. Romeo Lanawan

License no.345561

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Reference:

Nagle, G. M. (2006). Perioperative nursing. Nursing Clinics, 41(2), xi-xv.

Smeltzer, S.C., et al. (2008). Brunner and Suddarth’s Textbook of Medical Surgical
Nursing (11th Ed.) Philadelphia: Lippincott Williams and Wilkins.

Beicher, RobertJ.(2014). History and Evolution of Active Learning Spaces. New

Directions for Teaching and Learning.

Rauta, S., Salanterä, S., Nivalainen, J., & Junttila, K. (2013). Validation of the core
elements of perioperative nursing. Journal of Clinical Nursing, 22(9-10), 1391-1399.

Ferguson, M. K. (1999). Preoperative assessment of pulmonary risk. Chest, 115(5),

58S-63S.

Lindwall, L., & Von Post, I. (2008). Habits in perioperative nursing culture. Nursing
ethics, 15(5), 670-681.

19
 Republic of the Philippines
City of Cebu
CEBU CITY MEDICAL CENTER
A PHIC ACCREDITED HEALTH CARE PROVIDER
N. Bacalso Avenue corner Panganiban St. Cebu City, Philippines 6000

NURSES PROGRESS NOTES

Name of Patient: Area & Bed No.: Case

No.:

DATE TIME FOCUS D-ata A-ction R-esponse

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 Republic of the Philippines
City of Cebu
CEBU CITY MEDICAL CENTER
A PHIC ACCREDITED HEALTH CARE PROVIDER
N. Bacalso Avenue corner Panganiban St. Cebu City, Philippines 6000

TPR SHEET
Name of Patient: Area & Bed No.: Case
No.:
DATE
PR TEM AM PM AM PM AM PM AM PM
RR P 12 4 8 12 4 8 12 4 8 12 4 8
oC
12 4 8 12 4 8 12 4 8 12 4 8
200 43

180 42

170 41

160 40

150 39

140 38

130 37

120 36

110 35

100 34

90 33

80 32

70 31

21
60 30

50

40

30

20

10

0 URINE STOOL URINE STOOL URINE STOOL URINE STOOL

6-2
2-10
10-6
BLOOD BLLOD PRESSURE BLOOD PRESSURE BLOOD PRESSURE
PRESSURE
6-2
2-10
10-6
WEIGHT: HEIGHT: HC: AG: MUAC:

Republic of the Philippines

City of Cebu
CEBU CITY MEDICAL CENTER
A PHIC ACCREDITED HEALTH CARE PROVIDER
N. Bacalso Avenue corner Panganiban St. Cebu City, Philippines 6000

MEDICATION SHEET
Name of Patient: Area & Bed No.: Case
No.:
Allergies:
Medication

22
 NURSE`S NAME AND SIGNATURE
NURSE`S 6-2 NURSE`S 2-10 NURSE`S 10-6
SIGNATURE SIGNATURE SIGNATURE

Republic of the Philippines

City of Cebu
CEBU CITY MEDICAL CENTER
A PHIC ACCREDITED HEALTH CARE PROVIDER
N. Bacalso Avenue corner Panganiban St. Cebu City, Philippines 6000

INTRAVENOUS FLUID/ BLOOD TRANSFUSION SHEET

Name of Patient: Area & Bed No.: Case
No.:

NURSE`S
DATE TIME BOTTLE TYPE INFUSION/BLOOD RATE REMARKS NAME AND
NO. OF COMPONENT SIGNATURE
FLUID

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 Republic of the Philippines
City of Cebu
CEBU CITY MEDICAL CENTER
A PHIC ACCREDITED HEALTH CARE PROVIDER
N. Bacalso Avenue corner Panganiban St. Cebu City, Philippines 6000

FLUID INTAKE AND OUTPUT

Name of Patient: Area & Bed No.: Case
No.:

INTAKE OUTPUT
DAT TIM PARENTER ORA OTHER TOTA URIN DRAINAG TOTA STOO
E E AL L S L E E L L

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 Republic of the Philippines
City of Cebu
CEBU CITY MEDICAL CENTER
A PHIC ACCREDITED HEALTH CARE PROVIDER
N. Bacalso Avenue corner Panganiban St. Cebu City, Philippines 6000

VITAL SIGNS MONITORING SHEET

Name of Patient: Area & Bed No.: Case
No.:

Level of
DATE TIME Temp PR RR BP SPO2 Conciousness
(oC) (bpm) (cpm) (mmhg) (%) (GCS)

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26