OTM 1.04 Nursing Brainsheet Database

NURSI
NGBRAI
NSHEETS
33Br
ains
heetDat
abas
e
Welcome to the Nursing Brainsheet Database by NRSNG.com.
I remember how hard it was in nursing school and as a new nurse to nd a brainsheet that
worked for me. They all either didnt have enough space for notes or too much or were missing
that ONE thing I needed.
Eventually, after several months on the oor in the ICU I nally found a report sheet (brainsheet)
method that worked for me.
I guess what I am trying to say is that I get it . . . there is no one size ts all brainsheet so guess
what we did . . .
We went to the source!
We asked nurses and nursing students working in the ICU, ED, MedSurg, OB, Peds . . . anywhere
to send us their brainsheet so we could create the end-all-be-all database of brainsheets.
The response was AMAZING.
We received over 100 example brainsheets.
This database includes the top 33. We will continue to grow

the database as time goes on. You can see the most up to date
version at NursingBrainSheets.com.
What is NRSNG?
Glad you asked . . . its NURSING without the vowels . . . get it?
My experience with nursing education sucked (to put it gently).
So in 2014 I set out on a mission to change the way nurses

are educated . . . and NRSNG.com was born.
We believe that through engaging students, providing

support and basically giving a damn that nursing students
can not only LEARN how to be a nurse, but enjoy it too.
The NRSNG family has now reached all 50 states and over
185 countries from Afghanistan to Zimbabwe . . . literally.
So welcome aboard . . . we are glad to have you!
Happy Nursing!
-Jon Haws RN BSN CCRN

CEO/Founder NRSNG.com
p.s. Join us on social media and say HI (FB, IG, Snapchat, Twitter,
YouTube, Pinterest . . . you get the idea).
HANDOFF AND REPORT SHEET
NAME AGE ALLERGIES CODE DX BACKGROUND PMH PSH
DOCTORS:
NEUROLOGICAL
Orientation
Pupils
Extremities
Follows Commands
Speech Clarity
Behavior
Sensation
Orientation
RESPIRATORY
O2 Delivery
Normal Stats
Lung Sounds
SKIN
Breakdown
Status of surgical sites

Dressings to change
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HANDOFF AND REPORT SHEET
CARDIAC
Rhythm, Rate, Trends

BP Trends
Medication available for control
Pulse location, strength, cap rell
Edema
SCDs, TEDS, VTE Prophylaxis
Fluids/Drips
Temps
GASTROINTESTINAL
Diet/tolerance/residuals
BM date/pattern
Nausea/Vomiting
Blood sugars/type of insulin/SCIP?
GENITOURINARY
Method
Type, amount, color
Dialysis/Schedule
PAIN
Sources of pain
Pain control/last PRN meds

Pain levels
PLAN FOR PATIENT
Discharge plans
Upcomming procedures
PRN meds
Family dynamics

ULTIMATE CLINICAL BRAIN SHEET
REASON FOR HOSPITALIZATION:
FOCUSED ASSESSMENT: ASSESSMENT NOTES:
CONSULTATION/TESTS:
PATIENT MEDICATIONS:
NAME REASON CONSIDERATIONS TIME

ULTIMATE CLINICAL BRAIN SHEET
LAB VALUES INTAKE & OUTPUT
Na 135-148 WBC 3.6-9.2 Platelet 140-400
K 3.5-5.3 RBC male 4.39-5.58 Albumin 3.5-5.0
Cl 100-112 RBC female 3.70-5.14 Ca 8.3-10.3

CO2 23-29 Hgb male 13.7-17.3 PT 10.4-12.2
BUN 5.0 - 25.0 Hgb female 12-15.5 aPTT 24-33
Creat 0.5 - 1.7 Hct male 39-49 INR 2.0-3.0

pH 7.35-7.45 Hct female 35-46 Billirubin 0.0-1.0
PATIENT VITALS:
Time Time Time

IV SITE ASSESSMENT/
Pulse Pulse Pulse FLUID/RATE
Pulse Ox Pulse Ox Pulse Ox
Respirations Respirations Respirations
BP BP BP
Temp Temp Temp
Pain Pain Pain
Time Time Time
Pulse Pulse Pulse
Pulse Ox Pulse Ox Pulse Ox CALCULATIONS

Respirations Respirations Respirations
BP BP BP
Temp Temp Temp

Pain Pain Pain
TASKS/NOTES
THINGS TO RESEARCH/
IMPROVE

PATIENTS SIMPLE BRAINSHEET
CX
Name: IV:
Tele:
Admin Fluids:
DX:
BS:
Res Res
Dr: Diet:
HX: O2: C L D W
Neuro: CP
Mobi: E
GU:
GI:
Skin: T
Pain:
T
Iso
T
CX
Name: IV:
Tele:
Admin Fluids:
DX:
BS:
Res Res
Dr: Diet:
HX: O2: C L D W
Neuro: CP
Mobi: E
GU:
GI:
Skin: T
Pain:
T
Iso
T

CX
Name: IV:
Tele:
Admin Fluids:
DX:
BS:
Res Res
Dr: Diet:
HX: O2: C L D W
Neuro: CP
Mobi: E
GU:
GI:
Skin: T
Pain:
T
Iso
T
CX
Name: IV:
Tele:
Admin Fluids:
DX:
BS:
Res Res
Dr: Diet:
HX: O2: C L D W
Neuro: CP
Mobi: E
GU:
GI:
Skin: T
Pain:
T
Iso
T

PATIENT ID LABEL PATIENT ID LABEL
Meds Meds
FS FS
IV IV
O2 O2
Tele Foley BM Pain Med Tele Foley BM Pain Med
Tests Tests
Last Pain Med Last FS Last Pain Med Last FS
Meds Meds
FS FS
IV IV
O2 O2
Tests Tests

Meds Meds
FS FS
IV IV
O2 O2
Tests Tests
Meds Meds
FS FS
IV IV
O2 O2
Tests Tests

VERTICAL PATIENTS BRAINSHEETS
Pt: Age: Rm# Pt: Age: Rm# Pt: Age: Rm#
RN: RN: RN:
Dx: Dx: Dx:
FSBS: Coverage: FSBS: Coverage: FSBS: Coverage:
T Labs: T Labs: T Labs:
K- K- K-
O2 O2 O2
Na- Na- Na-
RR RR RR
B/P B/P B/P
Pain: /10 Pain: /10 Pain: /10

/10 /10 /10
PO IV PO IV PO IV
x0700 x0700 x0700
x0800 x0800 x0800
x0900 x0900 x0900
x1000 x1000 x1000
x1100 x1100 x1100
x1200 x1200 x1200
x1300 x1300 x1300
IV IV IV
RATE RATE RATE
NOTES NOTES NOTES

VERTICAL PATIENTS BRAINSHEETS
Pt: Age: Rm# Pt: Age: Rm# Pt: Age: Rm#
RN: RN: RN:
Dx: Dx: Dx:
FSBS: Coverage: FSBS: Coverage: FSBS: Coverage:
T Labs: T Labs: T Labs:
K- K- K-
O2 O2 O2
Na- Na- Na-
RR RR RR
B/P B/P B/P
Pain: /10 Pain: /10 Pain: /10

/10 /10 /10
PO IV PO IV PO IV
x0700 x0700 x0700
x0800 x0800 x0800
x0900 x0900 x0900
x1000 x1000 x1000
x1100 x1100 x1100
x1200 x1200 x1200
x1300 x1300 x1300
IV IV IV
RATE RATE RATE
NOTES NOTES NOTES

FREEHAND BRAINSHEET
DX/Docs: DX/Docs:
Neuro: Cardio: Neuro: Cardio:
Resp: GI: Resp: GI:
GU: Skin: GU: Skin:
pH: pH:
Labs: pCO2:
Orders: Labs: pCO2:
Orders:
pO2: pO2:
HCO3: HCO3:
FiO2: FiO2:
IV/ Lines: Meds: IV/ Lines: Meds:
Allergies: Diet: Allergies: Diet:
Code Status: Precautions: Code Status: Precautions:

PMH: Activities/ Misc: PMH: Activities/ Misc:
DX/Docs: DX/Docs:
Neuro: Cardio: Neuro: Cardio:
Resp: GI: Resp: GI:
GU: Skin: GU: Skin:
pH: pH:
Labs: pCO2:
Orders: Labs: pCO2:
Orders:
pO2: pO2:
HCO3: HCO3:
FiO2: FiO2:
IV/ Lines: Meds: IV/ Lines: Meds:
Allergies: Diet: Allergies: Diet:
Code Status: Precautions: Code Status: Precautions:

PMH: Activities/ Misc: PMH: Activities/ Misc:

POSTPARTUM BRAINSHEET
Respiratory (Air):
cough dyspnea
rales wheezes
rhonchi color:
Cardiovascular (Water): lochia: /; color: ; odor: clots
breast engorgement Homan's Sign
orthostatic hypot'n disphoresis
petechiea hematomas
edema hemorrhoids
vertigo
GI (Food/Elim/Hazards): appetite/intake:
bowel sounds x n/v
abd distention constipation abd tone:
diarrhea atus
hemorrhoids
last stool
GU (Elim/Hazards): voiding pattern:

with assist? urine retention
bladder distention dysuria
oliguria
foley: Fr; @ mL
IV: @ cc/; ; ;
MS (Activity/Normalcy): fundal location: ; consistency:
uterine cramping diastasus rectus mobility:
abdominal striae perineal muscles
Integument (Hazards/Normalcy): pigmentation: (nipples, linea negra, striae, chloasma)

breasts: soft rm
nipples: dry intact
perineal: swelling bruising
laceration episiotomy
REEDA
CNS (Social Interaction/Hazards): aect:
LOC tremors
pain clonus
epidural @ DTR's
Health Deviation:
postpartum pumping
infant security teaching
Developmental / Emotional: bonding:
breastfeeding consult? need recv'd social support:
neo. care (ch. 19) inquisitive?
Sex: Apgar 1m: 5m: Blood Type: Wt. Len. Dir. Coombs:

POSTPARTUM BRAINSHEET
Student: Client Initials:

Date: Room:
Diet: Nurse:
Allergies:
Cultural Background:
Primary Language:
Date & Time of Birth:
Childbirth Prep?
Hct: Hgb: Blood Type:
T P A L Rhogam: Needed Given
Vaginal Cesarean Rubella: Imm Non-imm
Feed: Breast Bottle HBSAg: Pos Neg
Med Order Last Given
15001600: charts; assess

16001700: chart vs;
17001800:
18001900:
19002000:
20002100:
21002130: nal charting;
Input: Vitals
Temp
HR
Output: RR
Pain
BP

PATIENT MEDSURG BRAINSHEET
Date:
7 8 9 10 11 12 1 2 3 4 5 6 7
Room: Name: Age: Dx: Hx:

Assessment
O2: S/L: IV:
Tele: Diet: Amb:
P: R: B/P: O2: T:
P: R: B/P: O2: T:
P: R: B/P: O2: T:
Accu : 07 1100 1700 2100
7 8 9 10 11 12 1 2 3 4 5 6 7

Assessment
O2: S/L: IV:
Tele: Diet: Amb:
P: R: B/P: O2: T:
P: R: B/P: O2: T:
P: R: B/P: O2: T:
Accu : 07 1100 1700 2100
7 8 9 10 11 12 1 2 3 4 5 6 7

Assessment
O2: S/L: IV:
Tele: Diet: Amb:
P: R: B/P: O2: T:
P: R: B/P: O2: T:
P: R: B/P: O2: T:
Accu : 07 1100 1700 2100
Mg
Hgb Na Cl BUN
WBC Plt Glu PTT PT INR
Hct Ca PO4
K+ CO2 Cr
PATIENT MEDSURG BRAINSHEET
Date:
7 8 9 10 11 12 1 2 3 4 5 6 7

Assessment
O2: S/L: IV:
Tele: Diet: Amb:
P: R: B/P: O2: T:
P: R: B/P: O2: T:
P: R: B/P: O2: T:
Accu : 07 1100 1700 2100
7 8 9 10 11 12 1 2 3 4 5 6 7

Assessment
O2: S/L: IV:
Tele: Diet: Amb:
P: R: B/P: O2: T:
P: R: B/P: O2: T:
P: R: B/P: O2: T:
Accu : 07 1100 1700 2100
7 8 9 10 11 12 1 2 3 4 5 6 7

Assessment
O2: S/L: IV:
Tele: Diet: Amb:
P: R: B/P: O2: T:
P: R: B/P: O2: T:
P: R: B/P: O2: T:
Accu : 07 1100 1700 2100
Mg
Hgb Na Cl BUN
WBC Plt Glu PTT PT INR
Hct Ca PO4
K+ CO2 Cr

POSTPARTUM MOM-BABY BRAINSHEET
NAME BABY
TIME OF DELIVERY
PEDIATRICIAN
V C EPISIOTOMY: Y / N
COMPLICATIONS MALE FEMALE
G P WT: LBS OZ GRAMS
ALLERGIES APGARS: 1MIN 5MIN

BLOOD: A O B AB + -
GESTATION: WKS DAYS
NEED RHOGAM: Y / N
BREAST / BOTTLE / BOTH
RUBELLA: IMM / NON
FEEDING? Y / N
HEP B: POS / NEG
HIV: POS / NEG LACTATION CONSULT: Y / N
VS 0800 1200 1600 PEE: Y / N POOP: Y / N
T HEP B: Y / N
HEARING TEST: Y/ N
BP
BLOOD: A O B AB + -
RR
COOMBS: NEG / POS
O2
PAIN PKU: Y / N
B U B B L E H E VS 0800 1200 1600

0800 T
1200
RR
1600
NOTES LABS
MEDS:
MEDS
VOIDING: Y / N IN
PASSING GAS: Y / N OUT
DIET
ICU DETAILED BRAINSHEET
Rm: Name: Resp: GI: Orders: RBC:

Hgb:
Hct:
POD: Age: RR: BM:

Weight: Pulse: NG/OG/PEG: WBC:
Height: O2: TF/DIET: -
Sputum:
Plt:
HX: Admit: Cardiac: Skin/Circ: BUN:

Creat:
GFR:
BNP:
M.D's: Intervention: NA:
SCD'S: K:
TEDS: Cl:
HR: GU: CO2:
BP:
ALB:
Tele:
ALT:
DX: Neuro: AST:
BILI:
Ca:
Urine: Inc/Drsg: I. Ca:
Foley: PROT:
Temp: Voids:
Allergies: Chems q.: 7- 11- 16- Braces: TROP:
CK-MB:
Lines/gtts: Meds: Pain: Mg:
Phos:
DIG:
CT: PT:
INR:
PTT:
CVL: CXR: UA:
- COLOR:
-
CLAR:
Art Line:
GLUC:
KEY:
Ppeak: Pmean: PEEP: I:E SPGR:
BLOOD:
PH:
PROT:
FTOT: VTE: VETOT: ET SIZE: LIPID:
*
- CHOL:
LENGTH HDL:
:-
@ LIPS: LDL:
TRIG:
CHARGE NURSE BRAINSHEET
ROOM #: ROOM #: ROOM #: ROOM #:

Name:
Age
Diagnosis:
ADM Date
History
Allergy
Code FULL DNR FULL DNR FULL DNR FULL DNR
Isolation NONE NONE NONE NONE
CONTACT CONTACT CONTACT CONTACT
DROPLET DROPLET DROPLET DROPLET
AIRBORNE AIRBORNE AIRBORNE AIRBORNE
PREVENTION PREVENTION PREVENTION PREVENTION
Neuro
Cardiac/Drips
IV Access PIV X PIV X PIV X PIV X

CL CL CL CL
PICC PICC PICC PICC
HEMACATH HEMACATH HEMACATH HEMACATH
A-LINE A-LINE A-LINE A-LINE
RESP 02- RA NC FM 02- RA NC FM 02- RA NC FM 02- RA NC FM
BIPAP BIPAP BIPAP BIPAP

VENT: AC Bilevel CPAP VENT: AC Bilevel CPAP VENT: AC Bilevel CPAP VENT: AC Bilevel CPAP
Settings: Settings: Settings: Settings:
ABG: ABG: ABG: ABG:

GI OG/NG/PEG OG/NG/PEG OG/NG/PEG OG/NG/PEG
NPO NPO NPO NPO
DIET DIET DIET DIET
GU VOID ANURIC VOID ANURIC VOID ANURIC VOID ANURIC
FOLEY FOLEY FOLEY FOLEY
Labs FS q Lyte Prot FS q Lyte Prot FS q Lyte Prot FS q Lyte Prot
Skin Pressure Ulcer Pressure Ulcer Pressure Ulcer Pressure Ulcer

DVT/PUD Heparin/Arixtra/Lovenox Heparin/Arixtra/Lovenox Heparin/Arixtra/Lovenox Heparin/Arixtra/Lovenox
(circle) TEDS/SCDS TEDS/SCDS TEDS/SCDS TEDS/SCDS
Protonix/Pepcid Protonix/Pepcid Protonix/Pepcid Protonix/Pepcid
Spokesman
Name
ABX
Daily Goals 1. 1. 1. 1.
2. 2. 2. 2.
3. 3. 3. 3.
4. 4. 4. 4.

5 PATIENT VERTICAL BRAINSHEET
Room Isolation Room Isolation Room Isolation Room Isolation Room Isolation
Patient Patient Patient Patient Patient
Diagnosis Diagnosis Diagnosis Diagnosis Diagnosis
Allergies Allergies Allergies Allergies Allergies
Code / Box / Rhythm Code / Box / Rhythm Code / Box / Rhythm Code / Box / Rhythm Code / Box / Rhythm
LOC / Activity / Fall Level LOC / Activity / Fall Level LOC / Activity / Fall Level LOC / Activity / Fall Level LOC / Activity / Fall Level
O2 / Breath Sounds O2 / Breath Sounds O2 / Breath Sounds O2 / Breath Sounds O2 / Breath Sounds
IV Site / Fluid / Rate IV Site / Fluid / Rate IV Site / Fluid / Rate IV Site / Fluid / Rate IV Site / Fluid / Rate
Diet / Accuchek Diet / Accuchek Diet / Accuchek Diet / Accuchek Diet / Accuchek
GI / GU GI / GU GI / GU GI / GU GI / GU
Skin / Pressure Ulcer Risk Skin / Pressure Ulcer Risk Skin / Pressure Ulcer Risk Skin / Pressure Ulcer Risk Skin / Pressure Ulcer Risk
Abnormal Labs Abnormal Labs Abnormal Labs Abnormal Labs Abnormal Labs
Med-Pass Med-Pass Med-Pass Med-Pass Med-Pass
PRN Meds PRN Meds PRN Meds PRN Meds PRN Meds
Consults / Tests / Surgery Consults / Tests / Surgery Consults / Tests / Surgery Consults / Tests / Surgery Consults / Tests / Surgery
To Do / Collect To Do / Collect To Do / Collect To Do / Collect To Do / Collect
Notes Notes Notes Notes Notes
MD MD MD MD MD
ICU BODY SYSTEM REPORT BRAINSHEET
CODE STATUS ISOLATION ALLERGIES
PRECAUTIONS MD
DX NEURO WNL LABS heparin drip 3% nacl drip
sedated paralyzed icp drains NIHSS
CARDIO WNL CULTURES
pacer / aicd ivc stents prn > SERIAL LABS

PULMO WNL
VENT
ELECTROLYTE PROTOCOL
ett trach weaning chest tubes K Mg Ca Phos
GI WNL IMAGING
NPO
TF
BS: LBM: TFR:

ng og peg colostomy drains SLP
ENDO WNL IV ACCESS PIV PICC CVC HD
Accuchek Q DRIPS:
insulin drip glucommander lantus / 70/30
PAST MEDICAL HISTORY RENAL WNL
DIALYSIS d/c foley dsg change: tpa limb alert

FAMILY / POA / ADVANCE DIRECTIVES YES ORTHO / MOBILITY WNL PROPHYLAXIS
pepcid protonix
Device: PT/OT lovenox heparin scds other:

NOTES SKIN / LDAs PRN MEDS
TEMP: TEMP: TEMP:
UO: UO: UO: UO: UO: UO:
PATIENT VERTICAL BRAINSHEET
Rm: Code: Age: Rm: Code: Age: Rm: Code: Age:
Name: Name: Name:
Dr: Dr: Dr:
Dx: Dx: Dx:
Hx: Hx: Hx:
VS: Wt: ______ BS: VS: Wt: ______ BS: VS: Wt: ______ BS:
20 ________________ 21 ______ 20 ________________ 21 ______ 20 ________________ 21 ______
24 ________________ 06 ______ 24 ________________ 06 ______ 24 ________________ 06 ______
04 ________________ 04 ________________ 04 ________________
I ________ I ________ I ________ I ________ I ________ I ________
O ________ O ________ O ________ O ________ O ________ O ________
IV ________ IV ________ IV ________ IV ________ IV ________ IV ________
Lungs: 02: Lungs: 02: Lungs: 02:
Heart: R: Heart: R: Heart: R:
Edema: Edema: Edema:
GI: LBM: GI: LBM: GI: LBM:
GU: GU: GU:
Skin: Skin: Skin:
Pain: Pain: Pain:
IV: IV: IV:
Diet: Diet: Diet:
Act: Act: Act:
Labs: Labs: Labs:

Name: Name: Name:
Dr: Dr: Dr:
Dx: Dx: Dx:
Hx: Hx: Hx:
20 ________________ 21 ______ 20 ________________ 21 ______ 20 ________________ 21 ______
24 ________________ 06 ______ 24 ________________ 06 ______ 24 ________________ 06 ______
04 ________________ 04 ________________ 04 ________________
I ________ I ________ I ________ I ________ I ________ I ________
O ________ O ________ O ________ O ________ O ________ O ________
IV ________ IV ________ IV ________ IV ________ IV ________ IV ________
GU: GU: GU:
Skin: Skin: Skin:
Pain: Pain: Pain:
IV: IV: IV:
Diet: Diet: Diet:
Act: Act: Act:
Labs: Labs: Labs:
PATIENT VERTICAL BRAINSHEET
Name: Name: Name:
Dr: Dr: Dr:
Dx: Dx: Dx:
Hx: Hx: Hx:
20 ________________ 21 ______ 20 ________________ 21 ______ 20 ________________ 21 ______
24 ________________ 06 ______ 24 ________________ 06 ______ 24 ________________ 06 ______
04 ________________ 04 ________________ 04 ________________
I ________ I ________ I ________ I ________ I ________ I ________
O ________ O ________ O ________ O ________ O ________ O ________
IV ________ IV ________ IV ________ IV ________ IV ________ IV ________
GU: GU: GU:
Skin: Skin: Skin:
Pain: Pain: Pain:
IV: IV: IV:
Diet: Diet: Diet:
Act: Act: Act:
Labs: Labs: Labs:

Name: Name: Name:
Dr: Dr: Dr:
Dx: Dx: Dx:
Hx: Hx: Hx:
20 ________________ 21 ______ 20 ________________ 21 ______ 20 ________________ 21 ______
24 ________________ 06 ______ 24 ________________ 06 ______ 24 ________________ 06 ______
04 ________________ 04 ________________ 04 ________________
I ________ I ________ I ________ I ________ I ________ I ________
O ________ O ________ O ________ O ________ O ________ O ________
IV ________ IV ________ IV ________ IV ________ IV ________ IV ________
GU: GU: GU:
Skin: Skin: Skin:
Pain: Pain: Pain:
IV: IV: IV:
Diet: Diet: Diet:
Act: Act: Act:
Labs: Labs: Labs:
PATIENT DETAILED BRAINSHEET
Dx PMH
Neuro AOX 3 2 1 Confused Forgetful Cards SR ST SB AF FL EF Venodynes
Resp LPM NC RA GI Incont Guiaic
GU Foley Voiding Incont Skin/Wound
Routine VS q4 Daily Wgt Strict I/O Labs Ca BNP
T BP
Mag CK
HR O2
R LS PT/INR PTT
Pho Trop
Meds Cath/EP Lab IV SL gtts
8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 FS Fent
Versed
Cont
8 12 17 18 22
IVF
Plans Call MD
HR < >
SBP< >
DBP> T>
RR < >
O2 < PTT >
R Fall
Activity Precaution Diet

ad lib BR x BRP Fall Bleed ASP
AMB OOB to Chair c Assist x Cont Air Drop NPO HH 2gNA ADA Renal Regular
Name & Age Code Allergy NKDA MD N

R1 CC
Full DNR/I
I/O
LC# DX Rm
ICU REPORT BRAINSHEET
CODE STATUS ISOLATION ALLERGIES
PRECAUTIONS MD
DX NEURO WNL LABS heparin drip 3% nacl drip
sedated paralyzed icp drains NIHSS

CARDIO WNL CULTURES
pacer / aicd ivc stents prn > SERIAL LABS

PULMO WNL
VENT
ELECTROLYTE PROTOCOL
ett trach weaning chest tubes K Mg Ca Phos
GI WNL IMAGING
NPO
TF
BS: LBM: TFR:

ng og peg colostomy drains SLP
ENDO WNL IV ACCESS PIV PICC CVC HD
Accuchek Q DRIPS:
insulin drip glucommander lantus / 70/30
PAST MEDICAL HISTORY RENAL WNL
DIALYSIS d/c foley dsg change: tpa limb alert

FAMILY / POA / ADVANCE DIRECTIVES YES ORTHO / MOBILITY WNL PROPHYLAXIS
pepcid protonix
Device: PT/ OT lovenox heparin scds other:

NOTES SKIN / LDAs PRN MEDS
TEMP: TEMP: TEMP:
UO: UO: UO: UO: UO: UO:

BOX BRAINSHEET
Room # Pt. Name: Age: EMV:
Sex:
Service: Admit Date & Diagnosis: PMH:
Attending:
Allergies:
Procedures:
ISO: Password:
Diet: Output: Activity: O2: VS: FS:
12
Telemetry:
IV: Fluids/Drips: 17
21
Meds:
Skin: To Do:
Pump/ Drain Totals:

HOURLY BRAINSHEET
wt: vs: iso:
allergies: admit:
History
Neuro : Resp :
- activity BS: WOB: aeration:
- pupils
- pain rate: sats: O2:
tx:
CV : access:
- temp
GI/GU :
- HR - feeding tube
- BP - abdomen
- p/p - urine
- stool
Skin : Social & Teaching :
08/20 09/21 10/22 11/23 12/00 13/01
14/02 15/03 16/04 17/05 18/06 19/07
quad conex allergies IPOC ER equipment monitors ID Kardex board tubing uids bath linens

CARDIAC BRAINSHEET
Room: Age: D.C: Allergies: PATIENT ID LABEL
Tx: Dx:
PMHx:
Diet: Post-Op day: Pre/Post W:
ADT: MM/DD/YYYY GU: Mobility: ISO:
SED0H:
Meds (check the box) Meds

0700 | 15/3 1100 | 19/7
0800 | 16/4 1200 | 20/8
0900 | 17/5 13/1 | 21/9
1000 | 18/6 14/2 | 22/10
PNR Meds: BCL AM

Mg Ca TP
Hgb Na Cl BUN 12
WBC Plt Glu
Hct Ca PO4 PO4 7
K+ CO2 Cr
PM
Assess: IV Edema
L
1. Safety 2. LOC 3. Check Re-site
Bed low O/Ax3 Chest Pain Cough Tubing R
Bed rail GCS Dizziness SOB Bag
Call bell PEERLA Turgor Radial Pulse
Allergy/ID L Skin Color/ T 0
Suction/ O2 R Pedal Pulse
4. Auscultation Notes:
APE to Mam. Apical HR
Lungs
BS x 4
BM (last)
Flatus
Incision
Dressing :
Site
Tele/Rhythm

CARDIAC BRAINSHEET
Time
BP
HR
SpO2
Temp
RR
Pain
I/O %Eaten: Fluid Restriction: (ml)
D: U/BM/Y/BL Time (ml) Color/Odor/Type I: (What) Time (ml)
SBAR Report Orders:

1. All meals sign o
2. Three owsheets done
Report:

ED BRAINSHEETS
Room#/ Chief Complaint Lab work Imaging Medications Abnormal

Name Results
Done Needs XR- Given:
Redraws: CT- Needs:

US-
CT-
Redraws: Needs:
US-
CT-
Redraws: Needs:
US-
CT-
Redraws: Needs:
US-
CT-
Redraws: Needs:
US-

ROUNDS BRAINSHEET
Room: Date: PATIENT ID LABEL
Chief Complaint:
Diagnosis: MD:
Code Status: Level of Care:
PMH: Allergies:
Precautions:
VS: MJ: Required For Daily Health Care Team Rounds

Case management reports, Dx, OBS, GMLOS, RightCare
Neuro:
From: Home/SNF
Cardiac:
Telemetry: Y/N Rhythm: Respiratory:
O2 Needs: Chronic: Y/N

Resp: IV/access: IV meds:
Restraints: Y/N
GI: Diet: Tolerating: Y/N
GU: Activity: PT Eval: Y/N
Skin: VTE proph: Mech/Chem/Amb 3x per day
Last BM: Foley: Y/N

Safety/Mobility:
Chronic: Y/N
Pain: Barriers to Transitioning to Next Level of Care? Anticipated
Transition Date?
Lab Results:
Test Results:

DETAILED BODY SYSTEM BRAINSHEET
Room #: Level of Care: PCU/5B/ICU
24 Hour Events Doctors/Consults
PATIENT ID LABEL
RT#
Code: Allergy:
Dx/Scenario:
ISOL:
PMHx:
Social/Family: Last updated:
POA:
NEURO: Fall Risk: CAM-ICU: MAAS: Rounds Sequence

Y/N +/-
A/OX:
SAT 1. Description of Patient
Pain:
Y/N 2. Sig. Events of last 24 hrs.
CARDIAC: Gtts:
PIV CL PICC 3. Vital Signs/
Rhythm/HR:
BP: 4. DVT Prophylaxis
Qtc: 5. Oxygen Status
ART
T max: EF:
6. Lines
PULM: ABG SBT Ventilator Bipap
pH Y/N MODE: MODE: 7. Mas/Sed gtts/CAM-ICU
PCO2 Pass/Fail VT: FiO2:
8. Skin/Surgical Wounds
FiO2: PS:
PO2
PEEP: 9. Mobility Status
HCO3
PS:
10. Nutrition
GI: POC: BS: 11. Concerns/Request
Diet/TF: Last BM: 07*19 12. Safety Risk(s)
High risk med/safety
08*20
GU: I/O: ID Band Check
09*21 Alarm Limit Checks
24 hr UO: Bedside Assessment
10*22
Needed?
11*23
Any Questions?
SKIN:
12*00
Wounds:
13*01
14*02
Wound Consult: Y/N
15*03
ABS/TESTS: PT
16*04
PTT Hg
Hct
17*05
INR
WBC Plt
18*06
19*07
Na Cl Ica Phos
K CO2 Mg BUN/Cr
glucose
Repeat Labs:
4 PATIENT OB BRAINSHEETS
Mom Education Care Plan Baby Education Care Plan
Room Name Day Boy Girl Name Breast Bottle
Dr. G P Age Dr. GA Weight
Date & Time of Delivery F/C DTV AGA SGA LGA BGMs until NICU
Blood type 24 Hr VS/CCHD/PKU due @
Ante Vag CS PPS Epis/Lac Anesthesia
Bath Given Circumcision TCI @ hrs.
Blood type Rubella GBS HepB HIV
Vitals
Flu Tdap Married FOB 1900 2300 0300
Time Temp HR RR
Allergies:
Time Temp HR RR
Hx: Additional Info:
Time Feed Void Stool
Pain Meds: Anaprox Motrin @

Percocet @
Scheduled Meds:

Vitals
Time Temp HR RR
Allergies:
Time Temp HR RR

Percocet @
Scheduled Meds:

4 PATIENT OB BRAINSHEETS
Vitals
Time Temp HR RR
Allergies:
Time Temp HR RR

Percocet @
Scheduled Meds:

Vitals
Time Temp HR RR
Allergies:
Time Temp HR RR

Percocet @
Scheduled Meds:

NEURO ICU BRAINSHEET
PACU:
Intake 19:
PATIENT ID LABEL Output
EBL
Drains Output 20:
NEURO DEFICITS
21:
22:
DRAINS
Type: 24 hr Output: CSF Studies:
23:
Level: Drainage:
CV PULMONARY
Rhythm: IVF/Drips 24:
Breath Sounds: RR:
BP Limits: O2 Therapy: O2 Stats:
CPV Limits:
Central Line: Y/N Tracheostomy: Y/N size: 01:
Location:
Change date: Ventilator: Y/N
Peripheral IV: Y/N Settings:
Site/Gauge/Date Inserted: Secretions: 02:
GI Diet: GU
Swallow Eval?
Tube Feeds: Y/N Voids: Y/N Last BM:
03:
Type/Rate:
Dobho or PEG Catheter Type:

Leg Strap on: Y/N
Location: 04:
Size and Markings:
SKIN/ACTIVITY/RESTRICTIONS PRN MEDS LABS

PT/OT/Speech/MSW 05:
Restraint Type: 06:

Due:
07:
Accuchecks: AC/HS Q6H gtt TO DO ASK MD
-Max: TED/SCDs

ICU BRAINSHEET
Room: DATE:
Patient Age Sex Admitted: HD: LOS:
Diagnosis: Procedure
Comorbid Conditions\Hx: Code Status: Allergies
SIGNIFICAT HOSPITAL HISTORY BODY SYSTEMS
Neuro: Neuro: PLAN: VARIANCE

Orientation:
Psych/Soc Pupils:
Extremity Strength Temp:
Activity Weight:
Fall Precaution: Restraints
CV: Cardiovascular: PLAN: VARIANCE

Rhythm: HR:
BP:
A Line
Swan Ganz: PA PAWP
CVP: CO
Pacer Wires:
K+: CPK: CBC: Hct: PT
Mg+: MBs: Trop: HGB PTT
Ca:
Edema (small= +1 moderate=+2 Pitting= +3)
Pulses (R) (L) (absent=0 weak=1 strong=2)
PICC/Central line/ IJ:
Hep Lock:
DRIPS: cc/hr
PUL: Extub: RR: O2 Respiratory PLAN: VARIANCE

BS: Mask:
Coughing Sputum Tri ow
Chest Tubes: Bipap:
ABG: Mode: Cu
Pressure
FiO2
TV rate
GI Abd Contour GI: PLAN: VARIANCE

BS Flatus:
NG pH:
Diet: BM
Feeding Appetite:
Chemstrip:
GU Foley: Cath Care: SG GU: PLAN: VARIANCE

PD I&Os
Urine Output: Hemo
Skin/dressing/incisions: Specimens:
Test, Labs
Braden Scale: Procedures, hx, preps
Other: Other:
Discharge Plan: Teaching/learning:
Consults:
Variance to Discharge Plan: Barrier
Resolution: Special Needs:
Consults:
Ca PTT CPK CKMB%

Mg PT CKMB TROP

BOXES BRAINSHEET
Name: MD: Age: Room:

Code Status:
Diagnostic Symptoms Personal Family Activity Vent
Neuro Cardio Resp History
Skin Urinary GI
Nutrition Labs IV Education

Na CL BUN
K CO2 CR
Wbc hgb plts

Hct

BOXES BRAINSHEET
Tests POC Meds Core

Measures/VTE
1800 2200 0200
1900 2300 0300
V/S: V/S: V/S:
2000 0000 0400
2100 0100 0500 In Out

SIMPLIFIED BRAINSHEET
To Do:
N:
CV:
R:
GI:
GU: Labs needed:
Sk:
IV:
Dx:
Pain:
Cons:
VS:
Plan:
Accu:
Report:
Dem:
All:
I: O: Adm, c/c:
PMHx:
Labs: Plan:
Systems:
IV:
Rx:
Labs:
Pending:
Issues:

WHITESPACE BRAINSHEET
Rm: Name: CODE: DONE:

In Out VS
Med
Mar
IV
Post
Pt.
Strip
Labs Tape
IV Fluids Re-check
NaCl
Hep
NTG
Protocols Time Value Replace Re-check MAR Times Glucs
K+ 0700
Mg 1200
Heparin 1700
NOC

MEDSURG BRAINSHEET
RM# PT: age: M / F Code:

DX: Diet:
HX
Allergies:
Neuro AOX 1 2 3 Confused Forgetful Skin/Wound
GI Incont UG Foley Voiding Incont
I/O Activity
VS Resp
T BP
HR O2
R
Meds Labs
Precautions: contact / fall / seizure / IV/Lines
aspiration (HOB ) / neuro
Diabetic Mgmt Consult/Appts

Insulin
accu
SS

PATIENT CIRCLE BRAINSHEET
RM# PT: age: M / F Dr.

DX: diet: d/weight
Allergies:
O2 : nebs activity: ad lib / bed rest / in chair / PT / walker / assist x
IV uids: access: PCA (dem / morph)
DNR pain meds (last dose?):

voids: BRP / foley / BSC / urinal / diaper SNF / rehab consult (need /done)
UA / C&S (need / done) stool x for guiac / c-di / WBC

precautions: contact / fall / seizure / aspiration (HOB ) / neuro
FSBS: ac&hs / q hrs / SS: regular insulin / Novolog
2100: 0730: 1130: 1630:
labs: CBC / MP / CE / BNP / Mag / Phos / K / Lytes / H&H / PT/INR / PTT /
CXR / EKG / Echo / MRI / US / CT permit? Y / N list? Y / N

VS 0600 T P R BP O2
T P R BP O2
Notes:
Hx :
Labs:
Na:
K:
BUN:
Creat:
WBC:
H/H:
Plat:

SBAR BRAINSHEET
Patient name Age allergies Physician
S Room number Admit date Attending
Code status
1 Dx 2 Dx Consultants
Advanced directive on
C/O chart? Pgr/#
History Isolation Core Measures

B Surgery: Surgeon Restraints CHF MI PNA
Anesthesia Anesthesiologist EBL Fall risk Vaccine- PNA Flu
Cardiac: BP/HR/Peripheral pulses/Edema/Heart sounds Pain/sedation

A Current rhythm Pain scale
Daily wt? Location
Meds type and last dose

DVT prophylaxis
Pulmonary: Breath sounds/Secretions/ SpO2/UPAs/PIP/ Vent/bipap etc Accu checks A1C

Spontaneous VT & VE
settings Frequency
Last Results
GI NG/OGT Skin
Diet GI Wounds/Drainage
BS Last BM Prophylaxis
Staples
Drains
GU Foley/void
Location
Output
Ducub photo on admission
IV Date inserted Psych Social
Fluids Gtts
Meds Pending orders
Na Cl Bun gluc mg BNP Coags Hct UA CT
INR W CXR
K Co Cr Ca Phos DDimer Pl Cultures
PTT MRI
Cardiac enz 1 2 3 Next lab Echo

Hgb
DC Plan. Is pt informed of plan 24 hour orders reviewed Shift goals

R

MEDS-LABS-VITALS BRAINSHEET
Date: Phone# Charted ? Voice Care?
Room # Name: Age: Code Status:
DR: DX: Allergies:
Diet: Activity: 02: HT/WT: IV:
MEDS: 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 00 01 02 03 04 05 06
TIME: TIME: TIME: Glucometer: IN: OUT: Monitor Reports:
T T T Break: 7-3
P P P Lunch:
R R R Dinner: 3-11
BP BP BP H.S.:
POX POX POX 11-7
HX REPORT Plans for the
A&O____ Confused Shift:
AP Reg Irreg
Lungs: clear decreased rhonchi
insp exspir wheezes
abd soft nontender distended
BSX4 hyper hypo
+PP edema - 0 1 2 3 4 LE UE
Pain Foley
ASSESS Yesterday Today

A&O Confused RBC (4.2-5.4)
WBC (4.8-10.8)
AP Reg Irreg HGB (M14-18)(F12-16)
Lungs: clear decreased rhonchi HCT (M42-52)(F37-47)
insp exspir wheezes PLTS (150-400)
abd soft nontender distended PT (9.3-11.8)
INR (0.0-3.5)
BSX4 hyper hypo PTT (23-33.4)
+PP edema - 0 1 2 3 4 LE UE BUN (M9-21)(F7-18)
Pain Foley CREAT (M0.8-1.2)(F.7-1.2)
Na+ (135-145)
TESTS/RESULTS K+ (3.5-5.5)
Mag+ (1.8-2.4)
Ca++ (8.5-10.5)
DIG (0.9-2.0)
BNP (0-100)
NEW ORDERS
Troponin
Enzymes: + - 1 2 3

ICU BOX BRAINSHEET
NAME Wt: CODE: PMD: 1900
DOB ISO: Consults: _____________________

Rm# 2000
Admit Date ALLERGIES
_____________________
2100
Diagnosis Medical Hx Procedure/Surgery
_____________________
2200
POD#
_____________________
Diet BP LABS 2300
P _____________________
IV RR 0000
T _____________________
0100
SpO
2 _____________________
NEURO RESP O2: Tx: CARDIAC Tele/Rhythm 0200
Vent Settings: Pacemaker
_____________________
0300
_____________________
0400
_____________________
SKIN GI/GU MUSC Activity 0500
_____________________
0600
_____________________
0700
Orders/Plan:


OTM 1.04 Nursing Brainsheet Database

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OTM 1.04 Nursing Brainsheet Database

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NURSI

We went to the source!

The response was AMAZING.

We received over 100 example brainsheets.

This database includes the top 33. We will continue to grow

My experience with nursing education sucked (to put it gently).

So in 2014 I set out on a mission to change the way nurses

We believe that through engaging students, providing

So welcome aboard . . . we are glad to have you!

-Jon Haws RN BSN CCRN

NAME AGE ALLERGIES CODE DX BACKGROUND PMH PSH

Status of surgical sites

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Rhythm, Rate, Trends

Pain control/last PRN meds

PLAN FOR PATIENT

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REASON FOR HOSPITALIZATION:

FOCUSED ASSESSMENT: ASSESSMENT NOTES:

NAME REASON CONSIDERATIONS TIME

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LAB VALUES INTAKE & OUTPUT

Na 135-148 WBC 3.6-9.2 Platelet 140-400

K 3.5-5.3 RBC male 4.39-5.58 Albumin 3.5-5.0

Cl 100-112 RBC female 3.70-5.14 Ca 8.3-10.3

BUN 5.0 - 25.0 Hgb female 12-15.5 aPTT 24-33

Creat 0.5 - 1.7 Hct male 39-49 INR 2.0-3.0

Time Time Time

Temp Temp Temp

Pain Pain Pain

Time Time Time

Pulse Pulse Pulse

Pulse Ox Pulse Ox Pulse Ox CALCULATIONS

Temp Temp Temp

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PATIENT ID LABEL PATIENT ID LABEL

Last Pain Med Last FS Last Pain Med Last FS

PATIENT ID LABEL PATIENT ID LABEL

Last Pain Med Last FS Last Pain Med Last FS

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PATIENT ID LABEL PATIENT ID LABEL

Last Pain Med Last FS Last Pain Med Last FS

PATIENT ID LABEL PATIENT ID LABEL

Last Pain Med Last FS Last Pain Med Last FS

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Pt: Age: Rm# Pt: Age: Rm# Pt: Age: Rm#

RN: RN: RN:

Dx: Dx: Dx:

FSBS: Coverage: FSBS: Coverage: FSBS: Coverage:

T Labs: T Labs: T Labs:

B/P B/P B/P

Pain: /10 Pain: /10 Pain: /10

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Pt: Age: Rm# Pt: Age: Rm# Pt: Age: Rm#

RN: RN: RN:

Dx: Dx: Dx:

FSBS: Coverage: FSBS: Coverage: FSBS: Coverage:

T Labs: T Labs: T Labs:

B/P B/P B/P

Pain: /10 Pain: /10 Pain: /10

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