Nursing 201-202 Clinical Work Sheet

Room:_______ Patient Initials:____________ DX:___________________

Age:______ Sex: M / F Diet:__________________ Activity:_________________

Time: Time: IV Running:

T: T:
P: P: Amount in bag at beginning of
R: R: clinical experience:
BP: BP:
Amount in bag at end of clinical
Pain: Pain experience:

Neuro: GI:

Resp: GU:

C/V: Skin:

Capillary Blood Glucose I&O

Time:__________ CBG:__________

Time:__________ CBG:__________

Pulse Ox

Time:________ %_________

Time:________ %_________

Time:________ %__________

Report from Primary Nurse: