Nursing Report Sheet
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1Date:
Room:
H:
W:
MD:
NP/PA:
#:
Allergies:
Isolation:
Family:
Admit/Surgery:
Hx: DM HTN CKD OSA HLP Smoker Obesity CHF
N EURO
GT T S:
LOC/Pupils:
Movement:
Hep:
CAM:
PAIN:
Temp:
Restraints:
Epi:
Amio:
Activity:
Levo:
Prop:
WBC:
Abx:
D5W:
C V
HR/Rhy:
Pacer:
LA BS
BP:
Goal:
aPTT:
pH:
Pulses:
Plt:
CO2:
Edema:
INR:
pO2:
Lactate:
HCO3:
CVP:
IABP:
PA:
T&C:
Tacro:
Vanc:
Hgb:
K:
Mg:
Phos:
Ical:
Na:
RES P
Int:
Ext:
O2:
IS:
Vent:
ETT:
CT:
ECMO/LVAD:
RPM:
Watts:
Flows:
GI
Tube:
Insulin:
TF/Flush:
Diet:
BM:
AST/ALT:
TBili:
GU
Foley:
CVVHD/fistula:
Creat:
S kin:
TEDS/SCDS/Mepilex
Drains:
Lines
SkSkin
Notes:
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