BRAIN SHEET WITH SHIFT HOURS

Pt/DOB:
PMHx:

MDs:

Skin:WNL
ChestTubes:Rt/Lt/MS
Temp:
#oftubes:
Moisture:
Anterior/Posterior/Lateral
Turgor:

Color:
Crepitus:
Bruises:
ToWaterseal/Airleak
Rashes/Redness:
ToSuction:
WoundPresent?
Drainage:
Other:

Dressing:

Lastchanged?
Braden:
WoundCare(notesite,type,drains,tx,vacsettings)

Respiratory:WNL
Respirations:

BreathSounds:
LULRales
LLLRhonchi
RULCrackles
RMLDiminished
RLL
Bases
Retractions/Grunting
NasalFlaring
NPC/ProdCough?

O2______________
RTQ3/4/6/8HCPT
Safety:
Bedlow,etc
Callbellinreach
Restraints:

1:1SitterSuicide
Fallprecauitions?
Seizureprecautions?
ADLs:
Bath/Dailycare
Incontinent

Break/Lunch/Dinner
SnackFeeder

Cardiovascular:WNL
JVD:
AbnormalPulse:
Edema:pitting/non

Calftenderness:

Tele:_________________
Peripheralpulsesx2/4/6

CathLab?
Angioseal?Lt/rtgroin
Stents?
Pacemaker:A/V/AV/D
AICD

ROM:
NursingCare:

Isolation:

Activity:assist/adlib
Bedrest/brp/chair/ambulate
Turns:
D/Cplan:

MedRecdone?ChartCheck?
Woundpictures?CoreMeas?
Pneum/CHF/AMI/SCIP

ROM:WNL
Full
Weakness:
Lt/Rt

Abnormal:
Contractures
Deficits

Gastrointestinal:
WNL
Diet:

Aspirationprec.
Nausea/vomiting
Diarrhea/constip.
Abdomen:

BowelSounds:

LastBM:

Ostomy:Lt/Rt
Colo/Ileostomy
Stoma

Armbands:DNR
Falls
Allergy:___________________________
IDbands:on,Name/DOBverified?
Neuro:WNL
GU:WNL
LethargicAgitated
LastVoid:
Disorientedto:

123
I&Ocath
Nonresponsiveto:
Foley
Verbal/tactile/pain

Urine:
AbnormalSpeech:

Other:
Neurosq____

Tubes:
NGT/OGT/Dobhoff
Dateinserted:
Lt/Rtnare
Placement d
Gtube/Jtube/PEG
Clamped
ToSuction:
LIWSLCWS
Drainage:

TubeFeed:

Irrigation:

Residual:

IVAccess:
PIV/SL1
Location
Gauge
Dateinserted

IVF

PIV/SL2

Location
Gauge
DateInserted

IVF

PICC/CL/Port
SLC/DLC/TLC
Power?
Site:
Insertiondepth:
Circumference:

Dates:

Inserted
Dressingchanged
DailyReview?

IVF

Equipment:
SCDs/CPM
Bed:Atmos/Rental

Telemetry
Continuousmotion
Continuouspulseox
BSC/Cane/Walker

TodaysLabs:

TodaysTests:

FSBSAC/HSQ4H/Q6H/BID/___
TurnQ2H/FloatHeels
PT/OT/SLPEval/TX

BRAIN SHEET WITH SHIFT HOURS

Time
0700

0800

0900

1000

1100

1200

1300

1400

1500

1600

1700

1800

Med/VS/FSBS/Procedure/Turn/Off/assess