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ICU Nurse Report Sheet

This document appears to be a template for documenting a patient's medical history and course of treatment in a hospital. It includes sections for identifying information, present illness, past medical history, tests, neurological and cardiovascular exams, respiratory status, labs, drains, pain levels, and treatment plan. The template provides fields for clinicians to record key details about a patient's admission and care.

Uploaded by

Puteri Hutami
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We take content rights seriously. If you suspect this is your content, claim it here.
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4K views1 page

ICU Nurse Report Sheet

This document appears to be a template for documenting a patient's medical history and course of treatment in a hospital. It includes sections for identifying information, present illness, past medical history, tests, neurological and cardiovascular exams, respiratory status, labs, drains, pain levels, and treatment plan. The template provides fields for clinicians to record key details about a patient's admission and care.

Uploaded by

Puteri Hutami
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Name Code Isolation Attending

Age Allergies Precautions Consults


Admitted VTE
Room#

Course

Present Illness

PMH: DM / CHF / HTN / CAD / PCI / HLD / PVD / GERD / COPD / Asthma / CKD / ESRD / Smoker / Drug Abuse /
Psych / CVA / Dementia / Hypothyroid / CA /

Tests

Neuro Lines Meds/IVF Site Size Dose Rate

A&O IV
1
GCS Central
RASS HD
CAM Date 2
NIH
Neuro ✓s 3

Cardiovascular EF% Edema In In In In

Rhythm Pacemaker Int/Ext


Out Out Out Out
Rate Pacer A : V Pulses

Dysrhythmias % Paced Net Net Net Net

Respiratory Labs GU
Foley
O2 ___LPM FiO2%____ HD
NC NRB CPAP BiPAP Vent
Setting
GI
ETT Size___ Type
Diet
CT (R/L) Level ____ Desc ____
TF

Skin/Wounds Drains Pain AC AC AC HS

Plan

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