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DR Allergies Precautions Charge Nurse PCA RoomPatient DOB M F Diagnosis Procedure Date O2 Neuro I.S. BR Chair AMB Diet TF NGT GT Foley IO Dressing IV 1. 2. 3. 4. PCA Blood Glucose q Hr Rslt Uts _____ ______ ___ _____ ______ ___ _____ ______ ___ _____ ______ ___ _____ ______ ___ _____ ______ ___ VS q B/P T P R O2 0800 ___/___ ____ ____ ____ ___ 1000 ___/___ ____ ____ ____ ___ 1200 ___/___ ____ ____ ____ ___ 1400 ___/___ ____ ____ ____ ___ 1600 ___/___ ____ ____ ____ ___ Goal Hx Notes A C T I V I T Y 0800 VS 0900 ADL/Feeding1000 1100 ADL1200 VS 1300 ADL/Feeding Parameters Labs 1400 I/O1500 ADL1600 VS1700 ADL18001900 Pathophysiology Statement Nursing Diagnosis 1 Nursing Diagnosis 2 Evaluation of Plan of Care Student WORK PACKET Date ____________________ DR Allergies Precautions Charge Nurse PCA RoomPatient DOB M F Diagnosis Procedure Date O2 Neuro I.S. BR Chair AMB Diet TF NGT GT Foley IO Dressing IV 1. 2. 3. 4. PCA CBG q Hr Rslt Uts _____ ______ ___ _____ ______ ___ _____ ______ ___ _____ ______ ___ _____ ______ ___ _____ ______ ___ VS q B/P T P R O2 0800 ___/___ ____ ____ ____ ___ 1000 ___/___ ____ ____ ____ ___ 1200 ___/___ ____ ____ ____ ___ 1400 ___/___ ____ ____ ____ ___ 1600 ___/___ ____ ____ ____ ___ Goal Hx Notes A C T I V I T Y 2000 VS 2100 ADL/Feeding2200 2300 ADL0000 VS 0100 ADL/Feeding Parameters Labs 0200 I/O0300 ADL0400 VS0500 ADL06000700 Pathophysiology Statement Nursing Diagnosis 1 Nursing Diagnosis 2 Evaluation of Plan of Care iNB-Uh HnMzxOc)

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