NAME: DATE:

MEDICATION DIET & NUTRITION BiPAP MONITOR HYGIENE URINE REC.

MEDICATION LISTS 7AM 1PM 4PM 7PM TIME H20 SUIS TIME FULLBATH TIME TIME OUTPUT
100ML
1
ON
7AM SPONGE
2 CLEAN PEG 7
OFF
10AM CHANGE H20
3
4 CHANGE PEG
1PM FUNC TIME SET
5
o2 NAILS CUT
6 4PM
HAIR CUT
7 Cough
7PM
8 Assist EARS/NOSE
CLEAN
9 10PM
10
ASSESSMENT
11 LIST REMARK
12
PHYSIOTHERAPY
WEIGHT
13 LIST REMARK
SALIVA/MOUTH
14
STANDING/ STOOL
15 SQUATTING
LUNGS
CYCLING 15 MINS
BGT
VITAL SIGNS ROM ON U.E EYES
TIME BP PR TEMP O2
HEAD & NECK URINE
STRETCHED
1 7AM SKIN
THORACIC
2 9AM EXPANSION
3 12PM NOTE:
UPPER TRAPEZIUS
STRETCHING --------------------------------------------------------------------------------------
4 5PM
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5 10PM CHEST
PERCUSSION & --------------------------------------------------------------------------------------
6 3AM VIBRATION --------------------------------------------------------------------------------------
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