3+3+2 ACCOMPLISHED REQUIREMENTS of

3-DAY BASIC INTRAVENOUS THERAPY TRAINING PROGRAM for NURSES

Name of Registered Nurse KENNEDY A. DELA CRUZ_____________ PRC Number __________________

Name of Hospital Offering IV Training CAGAYAN VALLEY MEDICAL CENTER Provider No. 060_______________
Date of IV Training Program Attended OCTOBER 5-7, 2010____________________ Venue CVMC CONFERENCE HALL

I. Initializing/ Maintaining Peripheral IV Infusions

Patien Name of Patient Age Date Time Kind of Solution Site Type of Dose Rate Signature over Printed Name of License
t No. Cannula Certified Trainer/Preceptor No.
81744 MACARIO 74 OCTOBER 11:30 PLAIN NORMAL RIGHT GAUGE 1 30
ARIMATEA YEARS 12, 2010 AM SALINE BASILIC VEIN 20 LITER gtts/min LEON C. BATUGAL, RN, MSN 01-1496
OLD SOLUTOIN
35297 MONICA DURIAN 84 OCTOBER 2:35 PM PLAIN NORMAL RIGHT GAUGE 1 20
YEARS 12, 2010 SALINE CEPHALIC 20 LITER gtts/min LEON C. BATUGAL, RN, MSN 01-1496
OLD SOLUTOIN VEIN
83176 ROGELIO 58 OCTOBER 2:00 PM PLAIN NORMAL RIGHT GAUGE 1 15
PASCUA YEARS 12, 2010 SALINE CEPHALIC 18 LITER gtts/min LEON C. BATUGAL, RN, MSN 01-1496
OLD SOLUTOIN VEIN

II. Administering Intravenous Drugs

Patient Name of Patient Age Date Time Drugs Dose Diagnosis Signature over Printed Name of License
No. Incorporated Certified Trainer/Preceptor No.
83505 CHONA 22 YEARS OCTOBER 8:00 AM FAMOTIDINE 20 mg DENGUE HEMORRHAGIC
ALLAPITAN OLD 12, 2010 FEVER STAGE 1 LEON C. BATUGAL, RN, MSN 01-1496
83176 ROGELIO PASCUA 28 YEARS OCTOBER 8:00 AM OMEPRAZOLE 40 mg UPPER GASTROINTESTINAL
OLD 12, 2010 BLEEDING, PEPTIC ULCER 01-1496
DISEASE LEON C. BATUGAL, RN, MSN
35297 MONICA DURIAN 84 YEARS OCTOBER 10:00A CEFTRIAXONE 1 gm PULMONARY NEW GROWTH
OLD 12, 2010 M 01-1496
LEON C. BATUGAL, RN, MSN
 III. Administering and Maintaining Blood Components

Patien Name of Patient Age Date Volume/Blood IV Insertion Type of Diagnosis Signature over Printed Name of License
t No. Type/Components/Rat Cannula Certified Trainer/Preceptor No.
e
83640 ARTEMIO 58 OCTOBE 240cc TYPE “O” 1 RIGHT GAUGE 18 ANEMIA
BORDEY YEARS R 12, 2010 PACKED RED BLOOD METACARPAL 01-1496
OLD CELLS at 15 gtts/min VEIN LEON C. BATUGAL, RN, MSN
39152 ROSITA ABELLA 53 OCTOBE 240cc TYPE “O” 1 LEFT GAUGE 18 ANEMIA
YEARS R 12, 2010 PACKED RED BLOOD METACARPAL SECONDARY TO
OLD CELLS at 15 gtts/min VEIN OCCULT LEON C. BATUGAL, RN, MSN 01-1496
GASTROINTESTINAL
BLEEDING

Submitted By: KENNEDY A. DELA CRUZ Date Submitted: OCTOBER 13,2010 Received By: _____________________ Approved By: OLIVIA SB. GONZALES,RN,RM,MSN,MAN
Director of Nursing Services
Signature Over Printed Name