PEDIATRICS

Rm:
Initials:
Allergies:
Med DX:

Age:

MD:
AM Report:

Wt.:

RN:

Nx Dx:
Hx:
VS:
0800 T:
HR:
RR:
BP:
1200 T:
HR:
RR:
BP:
1600 T:
HR:
RR:
BP:
Cardiac:
Rhythm: NSR/ ST/ SB --- Apical Pulse:
Cap Refill: < 3 sec / > 3 sec
S1/ S2/ S3/ Murmur/ Click

O2:
O2:
O2:

P:
P:
P:

GI/Fluids/Nutrition:
Diet:
__________ Tube ______ Fr ______ cm@nare____
Active/ Hypo/ Hyper Non distended Soft/ Firm
IVs
CVL#1___________IVF_______________@_______ml/hr
PIV#1___________IVF_______________@________ml/hr
PIV#2___________IVF_______________@________ml/hr
24 hr fluid calc:
Maintenance ____________________ ml/hr
1 times maintenance _______________ ml/hr
Pulm:
RT tx: C/ Fcrackles/ Ccrackles/ H/ D bilat R L
Time

O2 L

O2 Sat

Rx

VS
Infant
Temp 96-99.9F
90-170/min
HR
30-50/min
RR
85-86/37-40
BP
Labs/Diagnostics:

E. Child

M. Child

Adolescent

95.9-99F
70-150/min
20-30/min
85-93/37-52

95.9-99F
65-130/min
14-25/min
93-102/53-61

96.4-99.6F
65-110/min
12-20/min
103-118/61-67

Priority of Care:
Pathophysiology:

GU: ____________ Foley 12 Hr U/O = ____________ ml/hr

Neuro: GCS ______ Pupil R____/____ L____/____ E R B S
F
A&O x: 1 2 3 4
Mvmt: symmetrical/ non-symmetrical
Weakness: L/R U/ L/ Bilat

Medications
Time Name
07

Skin:

09

08

Dressings:
Tubes/Drains:
Activity/ Restraints/Isolation:
Activity:
Safety Precautions:
Isolation:

10
11
12
13

Amt/Rt

Route

Class/Action