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HEMODIALYSIS

NURSING
RECORD
PATIENT IDENTIFICATION
DATE: TIME: Pre - assessment:

Treatment Started: Treatment Completed:

Labs drawn pre-treatment:


Labs drawn post-treatment:

VITAL SIGNS: Pre-Dialysis: Post-Dialysis:


Blood Pressure:
Pulse:
Weight: KG. KG.

Total Weight Loss KG. (1 KG = 2.2 lb of fluid)

Fluids:
Normal saline solution: ml
25% Albumin: ml
Blood: ml
Other (Specify): ml
TOTAL =

Patient Education: ACCESS CARE: CATH CARE:


New Patient Handbook Graft Yes
Nutrition Fistula No
Fluid Control Catheter N/A
Others:

Medications Given:

Summary of Events:

RN SIGNATURE / TITLE:

8850119 Rev. 05/05


PART OF THE MEDICAL RECORD
Hemodialysis Nursing Record_NURSING PAGE 1 of 1

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