Brain Sheet - New Shift Report
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1BRAIN SHEET – NEW SHIFT REPORT
Room:____________
____________
DATE:
Patient______________________Age___Sex____ Admitted: _____HD:________LOS:_______
Diagnosis:__________________________Procedure___________________________________
Comorbid ConditionsHx:_____________ Code Status:______Allergies____________________
______________________________________________________________________________
SIGNIFICANT HOSPITAL HISTORY
BODY SYSTEMS
Neuro:
Neuro
:
PLAN:
VARIANCE
Orientation:
Pupils:
Psych/Soc
Extremity Strength
Temp:
Activity
Weight:
Fall Precaution:
Restraints
CV:
Cardiovascular:
PLAN:
VARIANCE
Rhythm:
HR:
BP:
“A” Line
Swan Ganz:
PA
PAWP
CVP:
CO
Pacer Wires:
K+:
CPK:
CBC:
Hct:
PT
Mg+:
MB’s:
Trop:
HGB
PTT
Ca:
Edema (small= +1 moderate=+2 Pitting= +3)
Pulses (R) (L) (absent=0 weak=1 strong=2)
PICC/Central line/ IJ:
Hep Lock:
DRIPS:
cc/hr
PUL:
Respiratory
Extub:
RR:
O
PLAN:
VARIANCE
2
BS:
Mask:
Coughing
Sputum
Triflow
Chest Tubes:
Bipap:
ABG:
Mode:
Cuff Pressure
FiO
2
TV rate
GI
Abd Contour
GI:
PLAN:
VARIANCE
BS
Flatus:
NG
pH:
Diet:
BM
Feeding
Appetite:
Chemstrip:
GU
Foley:
Cath Care:
SG
GU:
PLAN:
VARIANCE
PD
I&O’s
Urine Output:
Hemo
Skin/dressing/incisions:
Specimens:
Test, Labs
Braden Scale:
Procedures, hx, preps
Other:
Other:
Discharge Plan:
Teaching/Learning:
Consults:
Variance to Discharge Plan: Barrier
Resolution:
Special Needs:
Consults:
Ca
PTT
CPK
CKMB%
Mg
PT
CKMB
TROP
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