Room# Pt Name: M/F: Age: BS: Assessment Skin: Temp: Turgor: Color: Bruises: Rashes: Redness: Wounds: Other: Braden: GI: Diet

: Aspiration: N/V: Abdomen: Bowel Sounds: Last BM: Ostomy: Colo/Ileo: Stoma: Tubes: Date Inserted: Nare: Placement: Gtube: Jtube: PEG: Tube Feed:

WNL

WNL

Lt/Rt

NG/OGT/Dobhoff Lt/Rt √'d

ADL's Bath/Daily Care: Incontinent: Breakfast: Lunch: Activity: Neuro: Lethargic: Agitated: Disoriented: Unresponsive to: Abnormal Speech: Neuro √'s: GU: Last Void: Foley: Other: Respiratory: Respirations: Breath Sounds: LUL: LLL: RUL: RML: RLL: Bases: Retractions/Grunting: Nasal Flaring: NPC/Prod Cough: O2: Safety: Bed Low: Call Light: Alarm: Sitter/Suicide/Fall:

Today's Labs:

Today's Tests:

Time

700

800
WNL Cardiovascular: JVD: Abnormal Pulse: Edema: Calf Tenderness: Tele: Peripheral Pulses: Cath Lab: Angioseal: Stents: Pacemaker: AICD: ROM: Full: Weakness: Contractures: Deficits: Equipment: SCDs/CPM: Bed: Telemetry: Continuous Motion: Continuous Pulse Ox: BSC/Cane/Walker: WNL

900

x

1000
x2/4/6

1100
Lt/Rt Groin A/V/AV/D WNL

1200

WNL

1300
Lt/Rt

1400

1500

NOTES:

Med/VS/Turn/Assess .

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