3Day BASIC INTRAVENOUS THERAPY TRAINING PROGRAM FOR NURSES Name of Registered Nurse: RAMBOYONG, DIANA JANE D.

2012 Name of Hospital Offering IV Training: PINES CITY DOCTORS HOSPITAL Date of IV training Attended: April 15, 16 and 17, 2011 CONFERENCE ROOM

PRC Number/Expiry Date: 0575031/ 09-04Provider No. 235 Venue: PINES CITY DOCTORS HOSPITAL

I.
Patient Number

Initiating/ Maintaining Peripheral IV Infusions Name of Patient Ag Date Time e

Kind of Infusion

Site

Type of Cannul a Bioflon G-20

Dose

Rate

Signature over printed name of certified Trainer/Preceptor

IV License Number 0202489

77-84-20

Aspiras, Mirasol

16

April 22, 2011

3:05 pm

5% Dextrose in Lactated Ringers Solution 5% Dextrose in Lactated Ringers Solution Plain Normal Saline Solution

Right Cephalic vein

1liter

31 drops/ minute Myrna Boado

94-84-20

Dacanay, Marieta

43

April 28, 2011

8:00 am

Left metacarpal Vein

Bioflon G-20

1liter

31 drops/ minute Myrna Boado

0202489

28-73-20

Sambolledo, Ricardo

55

April 30, 2011

12:45 pm

Left Metacarpal Vein

Bioflon G-18

1liter

20 drops/ minute Myrna Boado

0202489

I. Patient Number 77-84-20

Administering Intravenous Drugs Name of Patient Ag Date e Aspiras, Mirasol 16 April 28, 2011 April 28, 2011 April 28, 2011

Time

Drugs Incorporated

Dose

Diagnosis

Signature over printed name of certified Trainer/Preceptor

IV License Number 0202489

4:00 pm

Paracetamol (D5LRS iL)

300mg

Dengue Fever Stage I Myrna Boado

80-84-20

Asprec, Amparo

60

8:00 pm

Citicholine (PNSS iL)

1g

Hypertension Myrna Boado

0202489

07-83-20

Ballesteros, Federico

74

8:00 pm

Cefuroxime (PNSS iL)

750mg

Anemia Myrna Boado

0202489

II.

Administering and Maintaining Blood and Blood Components

Patient Number

Name of Patient

Ag e

Date

Time

Volume/Blood Type Component/Rate/S erial number

Site

Type of Cannul a

Diagnosis

Signature over Printed Name of Certified Trainer/ Preceptor

IV License Number

22-70-13

Laroco, Gloria

54

May 1, 2011

2:30 pm

250cc/ AB+/PRBC 2021drops/minute/ Serial no. 60-90-69

Right Metacarpal vein

Bioflon G-18

Aplastic Anemia Myrna Boado

0202489

28-73-20

Sambolledo, Ricardo

55

May 1, 2011

6pm

250cc/ AB+/PRBC 2021drops/minute/ Serial no. 90-88-57

Left Metacarpal vein

Bioflon G-18

Anemia secondary to Renal Cancer Stage II

0202489 Myrna Boado

Submitted by:. RAMBOYONG, DIANA JANE D. Date: May 03, 2011 B. PADALLA, RN, MAN Signature over Printed Name Director, Nursing services

Received By:________________________

Approved by: Mrs. ELIZABETH