Shift: _______________________ Cebu Doctors’ University Hospital Date: ____________________

Charge Nurse:________________ Osmeña Boulevard, Cebu City Total Census: _____________

Student Nurse:_______________
SUMMARY OF NURSING CARE PLAN

Rm. No. Name of Patient With IV Fluids / Blood Transfusion Input-Output / Urine Testing Laboratory For OR/MOR
IV # ___, __________ @ __________ Full Diet – U/A –
IV # ___, __________ @ __________
IV # ___, __________ @ __________ Diabetic Diet – S/E –
IV # ___, __________ @ __________
IV # ___, __________ @ __________ Soft Diet – CBC –
IV # ___, __________ @ __________
IV # ___, __________ @ __________ NPO – CBS –
IV # ___, __________ @ __________ DAT –
IV # ___, __________ @ __________ No Colored Foods – Exec Panel –
IV # ___, __________ @ __________
IV # ___, __________ @ __________ Breastfeeding – Renal Panel – Special Endorsements
IV # ___, __________ @ __________ MHBR –
Blenderized Feeding –
IV # ___, __________ @ __________
IV # ___, __________ @ __________ Suction Prec. –
Small Frequent Feedings –
IV # ___, __________ @ __________
IV # ___, __________ @ __________ Treatments Seizure Prec. –
Limit PO Fluids –
IV # ___, __________ @ __________
IV # ___, __________ @ __________ TSB –
qH –
IV # ___, __________ @ __________
IV # ___, __________ @ __________ Bedside Commode –
q2H –
IV # ___, __________ @ __________
IV # ___, __________ @ __________ Cardiopulmonary / X-Ray CFCAS, CFCAV –
IV # ___, __________ @ __________
Dressing Set –
IV # ___, __________ @ __________
IV # ___, __________ @ __________
WOD –
IV # ___, __________ @ __________
IV # ___, __________ @ __________
O2 Inhalation –
IV # ___, __________ @ __________
IV # ___, __________ @ __________
IV # ___, __________ @ __________
IV # ___, __________ @ __________