Past Med/Surg Hx: Date: Admit Date: MD: RN: Age: Allergies: STICKER Code Status: Isolation Type: PATIENT Why: Admission Hx: 24 Hour Events: HX Other Neuro: Sedation/Analgesia/Paralytics: Orientation: Cam ICU: EVD/Bolt □ Motor Movement: CIWA Score: ICP Range: GCS: Spinal Precautions: E: 1 2 3 4 Full T&Ls Cleared NEURO V: 1 2 3 4 5 M: 1 2 3 4 5 6 Rhythm: Ectopy: HR Range: Edema: BP Range: Pulses: Map: CVP: CI: Titration Goals: PA: SvO2 CARDIAC IV Drips/Rates: Lung Sounds: ETT/Trach Size: ETT Depth: RR: SpO2: O2 Type: IS Volumes: Vent: Extubated @ Chest X-ray Ordered: Yes No RESP Most Recent ABG: pH / PaCO2 / PaO2 /HCO3 Lactate: 24 Hour Total Ins ______ Total Outs ______ Net _______ Ins Outs IVs/Meds Urine Foley: Tube Feeds GI Labs PO Intake Drains Blood Products 1. PRBCs 2. RENAL FFP 3. Platelets Chest Tubes Cryo 1. CRRT Goals: Albumin 2.
PATIENT STICKER Past Med/Surg Hx: Date: Admit Date: MD: RN: Age: Allergies: Code Status: Isolation Type: Why: HX Admission Hx: 24 Hour Events: NEURO Sedation/Analgesia/Paralytics: Orientation: Cam ICU: Motor Movement: CIWA Score: GCS: E: 1 2 3 4 V: 1 2 3 4 5 M: 1 2 3 4 5 6 Other Neuro: EVD/Bolt □ ICP Range: Spinal Precautions: Full T&Ls Cleared CARDIAC Rhythm: HR Range: BP Range: Map: CVP: CI: PA: SvO2 IV Drips/Rates: Ectopy: Edema: Pulses: Titration Goals: RESP Lung Sounds: RR: SpO2: O2 Type: Vent: Most Recent ABG: pH / PaCO2 / PaO2 /HCO3 Lactate: ETT/Trach Size: ETT Depth: IS Volumes: Extubated @ Chest X-ray Ordered: Yes No RENAL 24 Hour Total Ins ______ Total Outs ______ Net _______ Foley: Labs CRRT Goals: Ins Outs IVs/Meds Urine Tube Feeds GI PO Intake Drains Blood Products 1. PRBCs 2. FFP 3. Platelets Chest Tubes Cryo 1. Albumin 2.
uofuhealth-sicu-nurse-rounds-sheet.docx