|Student | |Course |NURS 211L |Date |5/27/2011 |
|Instructor | | | | | |
|Patient Initial | _____J.G________ ___Age 59 Female_____ |Height/Weight |65 IN/207.27 KG |
|Unit |TELEMETRY |Room# |206 |
Code Status __DNR______ …show more content…
|Temp (C/F Site) |Pulse (Site) |Respiration |Pulse Ox (O2 Sat) |Blood Pressure |Pain Scale 1-10 |
|98 F/Temporal |102 beats/min (Radial) | 24 | 100% | 141/77 | 0/10 …show more content…
Her O2 saturation improved after neck was repositioned and the O2 |Urine Culture and Sensitivity |
|Via mask 15L/min was delivered. The admission vital signs were: Temp 98.0 F, BP 141/77, Pulse |Foley Catheter |
|102, Respiratory Rate 24, Pain 0/10, and SpO2 100 and she was confused and lethargic on admit. A |*Per family member no past surgical history |
|20 catheter IV was placed on left antecubital and on admission was converted to a saline lock. | |
|The doctor ordered a CBC, ABG, UA-microscopic clean catch, CXR to rule out pneumonia, and an ECG.|