Room: Patient: POD# s/p: Room: Patient: POD# s/p:

S: O/N events - S: O/N events -

CP/SOB- Pain- Flatus/Stool- Pt/Fam q’s- CP/SOB- Pain- Flatus/Stool- Pt/Fam q’s-
N/V- Ambulation- Urination- N/V- Ambulation- Urination-

O Imaging: O: Imaging:
T max
T max
T current
T current
HR A/P:
A/P: HR 1. Pain
RR
1. Pain RR
BP
BP
O2 sat 2. Drains
2. Drains O2 sat
Vent:
Vent:
Mode
Mode 3. Diet
Rate 3. Diet Rate
TV
TV 4. Ambulation
FiO2
4. Ambulation FiO2
Pressure/PEEP
Pressure/PEEP 5. Abx
pH ___ pCO2 ___
5. Abx pH ___ pCO2 ___
pO2 ___ HCO3___
ABG Sat ___ Lac ___ pO2 ___ HCO3___
ABG Sat ___ Lac ___ 6. Medical Issues
I/O _________/_______ 6. Medical Issues
I/O _________/_______
U (total) _____/_____/_____
U (total) _____/_____/_____
St (total) _____/_____/_____
St (total) _____/_____/_____
Other outs
Other outs

Ins (rate)
Ins (rate)
Labs
Labs Prophy (DVT/GI)
Chemstick ____ -- ____ Prophy (DVT/GI) DISPO
DISPO Chemstick ____ -- ____ CODE STATUS
CODE STATUS
General-
General- Card-
Card- Pulm-
Pulm- Abd-
Abd- Ext-
Ext- Wound-
Wound-
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