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Roosevelt College System

Institute of Nursing and Health Education

Sumulong Hi-way Cainta, Rizal

RELATED LEARNING EXPERIENCE ON

LEADERSHIP AND MANAGEMENT

DAILY PATIENT ASSIGNMENT SHEET

DATE: _____________________ AREA: __-_____________________________

Name of Student

Staff NurseName of Patient Room and Bed Number

Name

of PhysicianDiagnosis

Patient Care

Classification

Prepared by: _______________________ Noted by: ________________________

Johnrey Avelino Panganiban

Student Head Nurse Clinical Instructor

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CHECKLIST OF NURSING TASKS

Name of Student Staff Nurse: __________________________ Group & Section: ___________

Duration: _______________________

R- Rendered PR- Partially Rendered NA- Not Applicable NR- Not rendered

Name of patient

V/SOrdered&

rendered

Oral(am)Care/Perenial

Care

Turning

Rom

Exercises

Bronchialcare

Assisting

inFeeding

MeasureI&O

WoundCare

PsychospiritualCare

Healthteaching

Followuplab.Result

Explanationtherapeutic

diagnosticprocedures

NewDoctorsOrderCarried

out

DischargePlanofCare

M

eds.given

R e f e

r r a l s d o n e

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NAME:

SECTION AND GROUP:

HOSPITAL:

DURATION OF EXPOSURE:

DAILY REQUIREMENT CHECKLIST

CRITERIA DAY 1 DAY 2 DAY 3 DAY 4 DAY 5 DAY 6

PART I: Attendance

PART II: Paraphernalia

Functional BP app. With Stethoscope

Calculator

Thermometer

Bandage scissors

Tourniquet

Penlight with batteries

Canister w/ Dry cotton balls (labeled)

Canister w/ Cotton balls soaked in Alcohol

(labeled)

Medicine Tray with Cloth lining

Small Alcohol

Black, Blue, Red, Green Ballpens

Nail Cutter

Micropore

Sterile gloves

Clean gloves

mask

Eraser and Small Ruler

Small Notebook

Pencil

NANDADrughandbook

Total




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IV MONITORING SHEET

DATE: __________________ AREA: _____________________________

NAME OF PATIENT

ROOM & BED

NUMBERNAME OF PATIENT IVF ON

RATE PER MIN

RECEIVED ENDORSED

Prepared by: _______________________

Student staff nurse

Noted by: ________________________ ________________________

Melody Platon Olimpiada Adrian Joseph L. Luansing, RN, RM, MAN


IV LEVEL

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ENDORSEMENT SHEET

Group: Level: Date:

Bed#:

Patients Name:

Age:

Diagnosis:

Physical state:

Emotional State:

VITAL SIGNS

Time:

Temp:

RR:

CR:

BP:

Significant Findings upon Assessment:

Meds due Next Shift:

Treatment Schedule:

Laboratory/ Diagnostics Schedule:

Diet:

Ongoing IV Fluid:IVF to follow:

Other Contraptions:

Intake:

Output:

IV Infused:

IFC:

Oral:

VOM:

NGT:

TOTAL:

Nursing Care Rendered:

Prepared by: _______________________

Student Staff Nurse

Noted by: ________________________ ________________________



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ENDORSEMENT SHEET

Group: Level: Date:

Bed#:

Patients Name:

Age:

Diagnosis:

VITAL SIGNS

TIME BP RR PR T

Significant findings upon assessment:

Diet:

Ongoing IV Fluid:

IVF to follow:

Intake:Output:

Nursing Care Rendered:

Prepared by: _______________________

Student Staff Nurse

Noted by: ________________________ ________________________



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TRADITIONAL

Prepared by: _______________________

Student Staff Nurse

Noted by: ________________________ ________________________



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NURSING CARE PLAN

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Prepared by: ___________________ Noted by: ________________________ ________________________

Student Staff Nurse Melody Platon Olimpiada Adrian Joseph L. Luansing, RN, RM, MAN


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DRUG STUDY

Prepared by: ___________________ Noted by: ________________________ ________________________

Student Staff Nurse Melody Platon Olimpiada Adrian Joseph L. Luansing, RN, RM, MAN


Generic/Trade

Name

Dosage/

FrequencyClassification Indication Contraindication Side Effects

Nursing

Responsibility

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