IBE, Susanna Martha B.

2014-57561

Ward 1
TIME AND ACTIVITY PLAN

Date: Patient 1/Age: Patient 2/Age: Patient 3/Age: Patient 4/Age: Patient 5/Age: Patient 6/Age:
MAY Bed: Bed: Bed: Bed: Bed: Bed:
08, Medical Dx: Medical Dx: Medical Dx: Medical Dx: Medical Dx: Medical Dx:
2018

PIC/RIC: PIC/RIC: PIC/RIC: PIC/RIC: PIC/RIC: PIC/RIC:

________________________ _______________________ _______________________ _______________________ ________________________ ________________________

Priority
NDxs

5:15-  Arrival @ PGH, Time-In

5:55  Don apron, handwashing
 Choose patients
 Get medication cards from buddy nurse
 Secure tray/cart; Prepare initial meds
 Review charts
6:00- (L) (R) _____ (L) (R) _____ (L) (R) _____ (L) (R) _____ (L) (R) _____ (L) (R) _____
6:50 FLUID:____________________ FLUID:___________________ FLUID:___________________ FLUID:___________________ FLUID:_____________________ FLUID:___________________
ENDOR __________ ___________ ___________ ___________ _________ ___________
SEMEN
TS DIET: DIET: DIET: DIET: DIET: DIET:
(Parent _________________________ ________________________ _________________________ ________________________ __________________________ ________________________
eral ______ _______ ______ _______ _____ _______
Therap VS q VS q VS q VS q VS q VS q
y, T T T T T T
Intake, CBG CBG CBG CBG CBG CBG
Output, O2 support: O2 support: O2 support: O2 support: O2 support: O2 support:
Monito
ring,
Interve
ntions, Other NI: Other NI: Other NI: Other NI: Other NI: Other NI:
Others)

PROCEDURES PROCEDURES PROCEDURES PROCEDURES PROCEDURES PROCEDURES

 6:50- Notes (deviations from Notes (deviations from Notes (deviations from Notes (deviations from Notes (deviations from Notes (deviations from
7:10 endorsements, special endorsements, special endorsements, special endorsements, special endorsements, special endorsements, special
Initial requests) requests) requests) requests) requests) requests)
Rounds BP: T: BP: T: BP: T: BP: T: BP: T:
and HR: O2 sat: HR: O2 HR: O2 sat: HR: O2 BP: T: HR: O2 sat:
Assess RR: Pain: sat: RR: Pain: sat: HR: O2 sat: RR: Pain:
ment Contraptions (include level): RR: Pain: Contraptions (include level): RR: Pain: RR: Pain: Contraptions (include level):
Contraptions (include level): Contraptions (include level): Contraptions (include level):
Respiratory pattern: Respiratory pattern: Respiratory pattern:
Breath sounds: Respiratory pattern: Breath sounds: Respiratory pattern: Respiratory pattern: Breath sounds:
O2 support: Breath sounds: O2 support: Breath sounds: Breath sounds: O2 support:
O2 support: O2 support: O2 support:

7:10- PREPARATION OF MEDICATIONS and FEEDING

7:30
7:30- Meds: Meds: Meds: Meds: Meds: Meds:
8:00      
Admini      
ster      
medica      
tions      
Perfor      
m      
other      
interve      
ntions
     
     
Give due feeding! Give due feeding! Give due feeding! Give due feeding! Give due feeding! Give due feeding!
BP: T: BP: T: BP: T: BP: T: BP: T: BP: T:
HR: O2 sat: HR: O2 HR: O2 sat: HR: O2 HR: O2 sat: HR: O2 sat:
RR: Pain: sat: RR: Pain: sat: RR: Pain: RR: Pain:
Contraptions (include level): RR: Pain: Contraptions (include level): RR: Pain: Contraptions (include level): Contraptions (include level):
Contraptions (include level): Contraptions (include level):
Respiratory pattern: Respiratory pattern: Respiratory pattern: Respiratory pattern:
Breath sounds: Respiratory pattern: Breath sounds: Respiratory pattern: Breath sounds: Breath sounds:
O2 support: Breath sounds: O2 support: Breath sounds: O2 support: O2 support:
CBG: O2 support: CBG: O2 support: CBG: CBG:
CBG: CBG:
8:10-  Ensured patient  Ensured patient  Ensured patient  Ensured patient  Ensured patient performed  Ensured patient
9:00 performed self-care performed self-care performed self-care performed self-care self-care performed self-care
Mornin  IV/ET/trache care***  IV/ET/trache care***  IV/ET/trache care***  IV/ET/trache care***  IV/ET/trache care***  IV/ET/trache care***
g care  Wounds are dressed  Wounds are dressed  Wounds are dressed  Wounds are dressed  Wounds are dressed  Wounds are dressed
Wound  Ensured changing of  Ensured changing of  Ensured changing of  Ensured changing of  Ensured changing of linens  Ensured changing of
Care linens and drawsheets linens and drawsheets linens and drawsheets linens and drawsheets and drawsheets linens and drawsheets
 Arranged bedside  Arranged bedside  Arranged bedside  Arranged bedside  Arranged bedside (hanging  Arranged bedside
(hanging lines and (hanging lines and (hanging lines and (hanging lines and lines and monitor) (hanging lines and
monitor) monitor) monitor) monitor)  Position change monitor)
 Position change  Position change  Position change  Position change  Position change
9:00- CARRY OUT ORDERS; start open charting; check given medications
10:00 BP: T: BP: T: BP: T: BP: T: BP: T: BP: T:
Comple
te HR: O2 sat: HR: O2 HR: O2 sat: HR: O2 HR: O2 sat: HR: O2 sat:
Assess RR: Pain: sat: RR: Pain: sat: RR: Pain: RR: Pain:
ment Contraptions (include level): RR: Pain: Contraptions (include level): RR: Pain: Contraptions (include level): Contraptions (include level):
Health Contraptions (include level): Contraptions (include level):
Educati Respiratory pattern: Respiratory pattern: Respiratory pattern: Respiratory pattern:
on Breath sounds: Respiratory pattern: Breath sounds: Respiratory pattern: Breath sounds: Breath sounds:
Collabo O2 support: Breath sounds: O2 support: Breath sounds: O2 support: O2 support:
ration O2 support: O2 support:

10:00- Break; Time for the Nurse’s Self Care!

10:45
10:45- PREPARE MEDICATIONS AND FEEDING
11:30
AM
10:45- BP: T: BP: T: BP: T: BP: T: BP: T: BP: T:
12:00 HR: O2 sat: HR: O2 HR: O2 sat: HR: O2 HR: O2 sat: HR: O2 sat:
(V/S at RR: Pain: sat: RR: Pain: sat: RR: Pain: RR: Pain:
11 am) Contraptions (include level): RR: Pain: Contraptions (include level): RR: Pain: Contraptions (include level): Contraptions (include level):
Contraptions (include level): Contraptions (include level):
Respiratory pattern: Respiratory pattern: Respiratory pattern: Respiratory pattern:
Breath sounds: Respiratory pattern: Breath sounds: Respiratory pattern: Breath sounds: Breath sounds:
O2 support: Breath sounds: O2 support: Breath sounds: O2 support: O2 support:
CBG: O2 support: CBG: O2 support: CBG: CBG:
CBG: CBG:
INPUT: INPUT: INPUT: INPUT:
OUTPUT: INPUT: OUTPUT: INPUT: OUTPUT: OUTPUT:
 Urine OUTPUT:  Urine OUTPUT:  Urine  Urine
 Stool  Urine  Stool  Urine  Stool  Stool
 Stool  Stool
Change client’s position Change client’s position Change client’s position Change client’s position Change client’s position
Meds: Meds: Meds: Meds: Change client’s position Meds:
    Meds: 
      
     
Give due feeding Give due feeding Give due feeding Give due feeding  Give due feeding
Provide Rest Provide Rest Provide Rest Provide Rest Give due feeding Provide Rest
Provide Rest
Evaluation of plan of care Evaluation of plan of care Evaluation of plan of care Evaluation of plan of care Evaluation of plan of care
Evaluation of plan of care
CARRY OUT NEW ORDERS
12:00-  Endorsed the patient to  Endorsed the patient to  Endorsed the patient to  Endorsed the patient to  Endorsed the patient to  Endorsed the patient to
1:30 buddy nurse buddy nurse buddy nurse buddy nurse buddy nurse buddy nurse
 Final Rounds  Final Rounds  Final Rounds  Final Rounds  Final Rounds  Final Rounds
 Close Charting; write  Close Charting; write  Close Charting; write  Close Charting; write  Close Charting; write input  Close Charting; write
input and output and V/S input and output and input and output and V/S input and output and and output and V/S in input and output and V/S
in monitoring sheet V/S in monitoring sheet in monitoring sheet V/S in monitoring sheet monitoring sheet in monitoring sheet
1:30-  Check for other patient  Check for other patient  Check for other patient  Check for other patient  Check for other patient  Check for other patient
2:00 needs needs needs needs needs needs
 Endorse med cards to  Endorse med cards to  Endorse med cards to  Endorse med cards to  Endorse med cards to next  Endorse med cards to
next shift nurse next shift nurse next shift nurse next shift nurse shift nurse next shift nurse
2:00 ENDORSEMENT
onward
s