MCN Form 011

Lyceum of the Philippines University

College of Nursing

TPR SHEET

Name Age
Diagnosis Hospital No.
Ward/RM

Date

Number of Days
RR CR T
12

12

12

12

12

12

12

12

12

12
4

8
180
41.0
170
40.0
160
39.0
150
38.0
140
37.0
130

36.0
120

35.0
110

100
70
90
60
80
50
70
40
60
30
50
20
40
10

BLOOD
PRESSURE
6-2

Urine 2-10
times
10-6

6-2

Stool 2-10
No.
10-6