This log is also available as text (107bc.txt) and as a (binary) annotation file (107bc.log).
Generated: Thursday, 23-Apr-2009 00:34:50 EDT
(All dates below are surrogates.)
id: WBC (4-11,000) t0: [03:00:00 25/02/2016] el: 0 cg: 3161 cu: CSRU v1: 7.4 n1: 7.4 rs: Final st: NotStopd id: WBC t0: [03:00:00 25/02/2016] el: 0 cg: 3161 cu: CSRU v1: 7.4 n1: 7.4 rs: Final st: NotStopd id: Hematocrit t0: [03:00:00 25/02/2016] el: 0 cg: 3161 cu: CSRU v1: 29.3 n1: 29.3 u1: % rs: Final st: NotStopd id: Hemoglobin t0: [03:00:00 25/02/2016] el: 0 cg: 3161 cu: CSRU v1: 10.1 n1: 10.1 u1: gm/dl rs: Final st: NotStopd id: Platelets t0: [03:00:00 25/02/2016] el: 0 cg: 3161 cu: CSRU v1: 196 n1: 196 rs: Final st: NotStopd id: RBC t0: [03:00:00 25/02/2016] el: 0 cg: 3161 cu: CSRU v1: 3.18 n1: 3.18 u1: /mic l rs: Final st: NotStopd id: WBC (4-11,000) t0: [03:00:00 25/02/2016] el: 0 cg: 3161 cu: CSRU v1: 7.4 n1: 7.4 rs: Final st: NotStopd
id: Less Restrict Meas. t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Medicated st: NotStopd id: Pain Present t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: No st: NotStopd id: Range of Motion t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Done st: NotStopd id: Pain Assess Method t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Grimace Scale st: NotStopd id: Service Type t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: CCU st: NotStopd id: BUN t0: [03:00:00 25/02/2016] el: 0 cg: 3161 cu: CSRU v1: 15 n1: 15 rs: Final st: NotStopd id: Circulation/SkinInt t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Circulation Adeq st: NotStopd id: Code Status t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Full Code st: NotStopd id: Riker-SAS Scale t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Sedated st: NotStopd id: Risk for Falls t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Yes st: NotStopd id: Calcium t0: [03:00:00 25/02/2016] el: 0 cg: 3161 cu: CSRU v1: 8.9 n1: 8.9 u1: mg/dl rs: Final st: NotStopd id: Chloride t0: [03:00:00 25/02/2016] el: 0 cg: 3161 cu: CSRU v1: 101 n1: 101 rs: Final st: NotStopd id: Creatinine t0: [03:00:00 25/02/2016] el: 0 cg: 3161 cu: CSRU v1: 0.4 n1: 0.4 rs: Final st: NotStopd id: Glucose t0: [03:00:00 25/02/2016] el: 0 cg: 3161 cu: CSRU v1: 92 n1: 92 rs: Final st: NotStopd id: Magnesium t0: [03:00:00 25/02/2016] el: 0 cg: 3161 cu: CSRU v1: 2.4 n1: 2.4 rs: Final st: NotStopd id: Phosphorous t0: [03:00:00 25/02/2016] el: 0 cg: 3161 cu: CSRU v1: 3.7 n1: 3.7 u1: mEq/L rs: Final st: NotStopd id: Potassium t0: [03:00:00 25/02/2016] el: 0 cg: 3161 cu: CSRU v1: 4.6 n1: 4.6 rs: Final st: NotStopd id: Sodium t0: [03:00:00 25/02/2016] el: 0 cg: 3161 cu: CSRU v1: 134 n1: 134 rs: Final st: NotStopd id: Diet Type t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: TPN st: NotStopd id: Dorsal PedPulse R/L t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Easily Palpable v2: Easily Palpable st: NotStopd id: Ectopy Frequency t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: None st: NotStopd id: Ectopy Type t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: None st: NotStopd id: GI#1 Intub Site t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Salem Sump v2: Oral st: NotStopd id: Health Care Proxy t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Yes st: NotStopd id: Education Topic #1 t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Plan of Care st: NotStopd id: Eye Opening t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 4 Spontaneously st: NotStopd id: Follows Commands t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Inconsistently st: NotStopd id: GCS Total t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 10 n1: 10 u1: points st: NotStopd id: GI Intub #1/Site t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Salem Sump v2: Oral st: NotStopd id: GI#1 Tube Stat/Drain t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Clamped st: NotStopd id: Heart Rate t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 69 n1: 69 u1: BPM st: NotStopd id: Heart Rhythm t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Normal Sinus st: NotStopd id: INV Line#2 Type/Site t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: A-Line v2: Right Radial st: NotStopd id: INV Line#2 Zero/Cal t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: No st: NotStopd id: INV Line#2InsertDate t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 2 n1: 2 v2: 11 n2: 11 st: NotStopd id: INV Line#2SiteAppear t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: WNL st: NotStopd id: INV Line#4 Type/Site t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Multi-lumen v2: Left Subclavian st: NotStopd id: INV Line#4InsertDate t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 2 n1: 2 v2: 12 n2: 12 st: NotStopd id: INV Line#4SiteAppear t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: WNL st: NotStopd id: Abdominal Assessment t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Soft st: NotStopd id: INV#2 WaveformAppear t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Sharp st: NotStopd id: IV #1 Insert Date t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 2 n1: 2 v2: 14 n2: 14 st: NotStopd id: IV #1 Site/Size t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Right Hand v2: 20 gauge st: NotStopd id: IV #4 Insert Date t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 2 n1: 2 v2: 13 n2: 13 st: NotStopd id: IV #4 Site/Size t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: LL Post Forearm v2: 20 gauge st: NotStopd id: IV Site Appear #1 t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: WNL st: NotStopd id: IV Site Appear #4 t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: WNL st: NotStopd id: Impaired Skin Site#1 t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Coccyx st: NotStopd id: Incision/Wound #1 t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Abdominal st: NotStopd id: LL Strength/Movement t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Moves on Bed st: NotStopd id: LLL Lung Sounds t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Diminished st: NotStopd id: LU Strength/Movement t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Lifts and Holds st: NotStopd id: LUL Lung Sounds t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Coarse st: NotStopd id: Level of Conscious t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Sedated st: NotStopd id: Motor Response t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 5 Localizes Pain st: NotStopd id: Oral Care t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Done st: NotStopd id: Oral Cavity t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Teeth/Tissue WNL st: NotStopd id: Orientation t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Unable to Assess st: NotStopd id: Arterial BP t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 113 n1: 113 u1: mmHg v2: 70 n2: 70 u2: mmHg st: NotStopd id: Pain Location t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Not Indicated st: NotStopd id: Pain Management t0: [04:00:00 25/02/2016] el: 1 cg: RN cu: CSRU v1: IV Gtt v2: IV Gtt st: NotStopd id: Pain Type t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: None st: NotStopd id: Arterial BP Mean t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 87 n1: 87 u1: mmHg st: NotStopd id: Position Change t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Done st: NotStopd id: PostTib. Pulses R/L t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Easily Palpable v2: Easily Palpable st: NotStopd id: Precautions t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Contact st: NotStopd id: INV#2 Dsg Change t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 2 n1: 2 v2: 15 n2: 15 st: NotStopd id: INV#4 Dsg Change t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 2 n1: 2 v2: 15 n2: 15 st: NotStopd id: ABP Alarm (Lo/Hi) t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 85 n1: 85 u1: mmHg v2: 160 n2: 160 u2: mmHg st: NotStopd id: HR Alarm (Lo/Hi) t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 50 n1: 50 u1: BPM v2: 120 n2: 120 u2: BPM st: NotStopd id: Resp Alarm (Lo/Hi) t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 8 n1: 8 u1: BPM v2: 30 n2: 30 u2: BPM st: NotStopd id: SpO2 Alarm (Lo/Hi) t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 90 n1: 90 u1: % v2: 100 n2: 100 u2: % st: NotStopd id: RL Strength/Movement t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Moves on Bed st: NotStopd id: RLL Lung Sounds t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Diminished st: NotStopd id: RU Strength/Movement t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Lifts and Holds st: NotStopd id: RUL Lung Sounds t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Coarse st: NotStopd id: Reason For Restraint t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Ext/TXInterfere st: NotStopd id: Removed x 5 Mins t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Done st: NotStopd id: Respiratory Pattern t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Regular st: NotStopd id: Respiratory Rate t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 12 n1: 12 u1: BPM st: NotStopd id: Responds to Stimuli t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Verbal v2: Localizes st: NotStopd id: Restraint Location t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Both Arms st: NotStopd id: Restraint Type t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Soft Limb st: NotStopd id: Restraints Evaluated t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: RestraintReapply st: NotStopd id: Side Rails t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: All rails up st: NotStopd id: SpO2 t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 98 n1: 98 u1: % st: NotStopd id: Spontaneous Movement t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Purposeful st: NotStopd id: Support Systems t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Relative st: NotStopd id: INV#2 Cap Change t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 2 n1: 2 v2: 15 n2: 15 st: NotStopd id: INV#2 Tubing Change t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 2 n1: 2 v2: 15 n2: 15 st: NotStopd id: INV#4 Cap Change t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 2 n1: 2 v2: 15 n2: 15 st: NotStopd id: INV#4 Tubing Change t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 2 n1: 2 v2: 15 n2: 15 st: NotStopd id: Temp. Site t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Oral st: NotStopd id: Temperature C (calc) t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 35.7778 n1: 35.7778 u1: Deg. C st: NotStopd id: Temperature F t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 96.4 n1: 96.4 u1: Deg. F st: NotStopd id: Urine Color/Appear t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Yellow v2: Clear st: NotStopd id: Urine Source t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Indwelling Cath st: NotStopd id: Verbal Response t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 1.0 ET/Trach st: NotStopd id: calprevflg t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 1 n1: 1 u1: kg st: NotStopd id: BUN (6-20) t0: [03:00:00 25/02/2016] el: 0 cg: 3161 cu: CSRU v1: 15 n1: 15 rs: Final st: NotStopd id: Calcium (8.4-10.2) t0: [03:00:00 25/02/2016] el: 0 cg: 3161 cu: CSRU v1: 8.9 n1: 8.9 u1: mg/dl rs: Final st: NotStopd id: Carbon Dioxide t0: [03:00:00 25/02/2016] el: 0 cg: 3161 cu: CSRU v1: 27 n1: 27 rs: Final st: NotStopd id: Chloride (100-112) t0: [03:00:00 25/02/2016] el: 0 cg: 3161 cu: CSRU v1: 101 n1: 101 rs: Final st: NotStopd id: Pt./Family Informed t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Yes st: NotStopd id: Creatinine (0-1.3) t0: [03:00:00 25/02/2016] el: 0 cg: 3161 cu: CSRU v1: 0.4 n1: 0.4 rs: Final st: NotStopd id: Bowel Sounds t0: [04:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Present st: NotStopd id: Glucose (70-105) t0: [03:00:00 25/02/2016] el: 0 cg: 3161 cu: CSRU v1: 92 n1: 92 rs: Final st: NotStopd id: Magnesium (1.6-2.6) t0: [03:00:00 25/02/2016] el: 0 cg: 3161 cu: CSRU v1: 2.4 n1: 2.4 rs: Final st: NotStopd id: Phosphorous(2.7-4.5) t0: [03:00:00 25/02/2016] el: 0 cg: 3161 cu: CSRU v1: 3.7 n1: 3.7 u1: mEq/L rs: Final st: NotStopd id: Potassium (3.5-5.3) t0: [03:00:00 25/02/2016] el: 0 cg: 3161 cu: CSRU v1: 4.6 n1: 4.6 rs: Final st: NotStopd id: Sodium (135-148) t0: [03:00:00 25/02/2016] el: 0 cg: 3161 cu: CSRU v1: 134 n1: 134 rs: Final st: NotStopd
id: .9% Normal Saline 1000.0ml t0: [04:00:00 25/02/2016] el: 1 ai: 107 cg: RN cu: CSRU vo: 5 vu: ml id: TPN 1000.0ml t0: [04:00:00 25/02/2016] el: 1 ai: 304 cg: RN cu: CSRU vo: 75 vu: ml id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl t0: [04:00:00 25/02/2016] el: 1 ai: 107 cg: RN cu: CSRU vo: 13 vu: ml id: Urine Out Foley t0: [04:00:00 25/02/2016] el: 1 cg: RN cu: CSRU vo: 400 vu: ml id: .9% Normal Saline 50.0ml + 50mghr Midazolam t0: [04:00:00 25/02/2016] el: 1 ai: 274 cg: RN cu: CSRU vo: 3 vu: ml
id: Midazolam t0: [04:00:00 25/02/2016] el: 1 cg: RN cu: CSRU vo: 0 do: 3 du: mghr so: .9% Normal Saline sv: 50 su: ml rt: IV Drip
id: Fentanyl t0: [04:00:00 25/02/2016] el: 1 cg: RN cu: CSRU vo: 0 do: 120 du: mcghr so: .9% Normal Saline sv: 250 su: ml rt: IV Drip
id: Service Type t0: [05:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: CCU st: NotStopd id: Code Status t0: [05:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Full Code st: NotStopd id: Risk for Falls t0: [05:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Yes st: NotStopd id: Ectopy Frequency t0: [05:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: None st: NotStopd id: Ectopy Type t0: [05:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: None st: NotStopd id: Health Care Proxy t0: [05:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Yes st: NotStopd id: Heart Rate t0: [05:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 67 n1: 67 u1: BPM st: NotStopd id: Heart Rhythm t0: [05:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Normal Sinus st: NotStopd id: Arterial BP t0: [05:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 118 n1: 118 u1: mmHg v2: 72 n2: 72 u2: mmHg st: NotStopd id: Arterial BP Mean t0: [05:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 90 n1: 90 u1: mmHg st: NotStopd id: Precautions t0: [05:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Contact st: NotStopd id: ABP Alarm (Lo/Hi) t0: [05:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 85 n1: 85 u1: mmHg v2: 160 n2: 160 u2: mmHg st: NotStopd id: HR Alarm (Lo/Hi) t0: [05:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 50 n1: 50 u1: BPM v2: 120 n2: 120 u2: BPM st: NotStopd id: Resp Alarm (Lo/Hi) t0: [05:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 8 n1: 8 u1: BPM v2: 30 n2: 30 u2: BPM st: NotStopd id: SpO2 Alarm (Lo/Hi) t0: [05:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 90 n1: 90 u1: % v2: 100 n2: 100 u2: % st: NotStopd id: Radiologic Study t0: [05:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Chest Xray st: NotStopd id: Respiratory Rate t0: [05:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 13 n1: 13 u1: BPM st: NotStopd id: SpO2 t0: [05:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 98 n1: 98 u1: % st: NotStopd id: calprevflg t0: [05:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 1 n1: 1 u1: kg st: NotStopd
id: .9% Normal Saline 1000.0ml t0: [05:00:00 25/02/2016] el: 1 ai: 107 cg: RN cu: CSRU vo: 5 vu: ml id: TPN 1000.0ml t0: [05:00:00 25/02/2016] el: 1 ai: 304 cg: RN cu: CSRU vo: 75 vu: ml id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl t0: [05:00:00 25/02/2016] el: 1 ai: 107 cg: RN cu: CSRU vo: 12 vu: ml id: Urine Out Foley t0: [05:00:00 25/02/2016] el: 1 cg: RN cu: CSRU vo: 320 vu: ml id: .9% Normal Saline 50.0ml + 50mghr Midazolam t0: [05:00:00 25/02/2016] el: 1 ai: 274 cg: RN cu: CSRU vo: 3 vu: ml
id: Midazolam t0: [05:00:00 25/02/2016] el: 1 cg: RN cu: CSRU vo: 0 do: 3 du: mghr so: .9% Normal Saline sv: 50 su: ml rt: IV Drip
pi: 4531334 hi: 27155 t0: [06:00:00 25/02/2016] tf: [05:00:00 26/02/2016] mn: Neutra-Phos pt: Unit Dose st: Expired rt: PO fr: ONCE ds: 6 dn: 1 dt: 1 di: Doses xv: 36 xu: Hours
id: Education Topic #1 t0: [05:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Plan of Care st: NotStopd id: HOB t0: [05:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 30 degrees st: NotStopd id: Activity t0: [05:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Bedrest st: NotStopd id: Activity Tolerance t0: [05:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Tolerated Well st: NotStopd id: Impaired Skin Site#1 t0: [05:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Coccyx st: NotStopd id: Inc Closure/Appear#1 t0: [05:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Suture/Staples v2: Other/Remarks st: NotStopd id: Inc Drainage/Amt #1 t0: [05:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Green v2: Moderate st: NotStopd id: Inc Dsg/Status #1 t0: [05:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Dry Sterile Dsg v2: Changed st: NotStopd id: Incision/Wound #1 t0: [05:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Abdominal st: NotStopd id: AntiEmbDevice/Status t0: [05:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Compress Sleeves v2: On st: NotStopd id: Position t0: [05:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Left Side st: NotStopd id: Assistance Device t0: [00:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 2 Person Assist st: NotStopd id: Assistance Device t0: [05:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 2 Person Assist st: NotStopd id: Side Rails t0: [05:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: All rails up st: NotStopd id: Skin Care t0: [05:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Done st: NotStopd id: Sputum Color/Consist t0: [05:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: White v2: Thick st: NotStopd id: Sputum Source/Amt t0: [05:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Suctioned v2: Moderate st: NotStopd id: Support Systems t0: [05:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Relative st: NotStopd id: Therapeutic Bed t0: [05:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: AtmosAir Mattres st: NotStopd id: Turn t0: [05:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Side to Side st: NotStopd id: Pt./Family Informed t0: [05:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Yes st: NotStopd
id: Fingerstick Glucose t0: [05:00:00 25/02/2016] el: 0 cg: CoWker cu: CSRU v1: 147 n1: 147 rs: Manual st: NotStopd
id: RSBI (<100) t0: [05:00:00 25/02/2016] el: 0 cg: RRT cu: CSRU v1: 35 n1: 35 u1: units st: NotStopd id: ETT Mark/Location t0: [05:00:00 25/02/2016] el: 0 cg: RRT cu: CSRU v1: 21cm v2: Lip st: NotStopd id: FiO2 Set t0: [05:00:00 25/02/2016] el: 0 cg: RRT cu: CSRU v1: 0.4 n1: 0.4 u1: torr st: NotStopd id: High Insp. Pressure t0: [05:00:00 25/02/2016] el: 0 cg: RRT cu: CSRU v1: 30 n1: 30 u1: cmH2O st: NotStopd id: High Resp. Rate t0: [05:00:00 25/02/2016] el: 0 cg: RRT cu: CSRU v1: 38 n1: 38 u1: BPM st: NotStopd id: Airway Size t0: [05:00:00 25/02/2016] el: 0 cg: RRT cu: CSRU v1: 7.5 mm st: NotStopd id: Airway Type t0: [05:00:00 25/02/2016] el: 0 cg: RRT cu: CSRU v1: Endotracheal st: NotStopd id: Inspired Gas Temp t0: [05:00:00 25/02/2016] el: 0 cg: RRT cu: CSRU u1: Deg. C st: NotStopd id: Intubation Date t0: [05:00:00 25/02/2016] el: 0 cg: RRT cu: CSRU v1: 2 n1: 2 v2: 11 n2: 11 st: NotStopd id: Low Exhaled Min Vol t0: [05:00:00 25/02/2016] el: 0 cg: RRT cu: CSRU v1: 3 n1: 3 st: NotStopd id: MDI #1 (Puff/Drug) t0: [05:00:00 25/02/2016] el: 0 cg: RRT cu: CSRU v1: 4 n1: 4 v2: Albuterol st: NotStopd id: MDI #2 (Puff/Drug) t0: [05:00:00 25/02/2016] el: 0 cg: RRT cu: CSRU v1: 4 n1: 4 v2: Atrovent st: NotStopd id: Mean Airway Pressure t0: [05:00:00 25/02/2016] el: 0 cg: RRT cu: CSRU v1: 7 n1: 7 u1: cmH2O st: NotStopd id: Minute Volume(Obser) t0: [05:00:00 25/02/2016] el: 0 cg: RRT cu: CSRU v1: 12 n1: 12 u1: L/min st: NotStopd id: PEEP Set t0: [05:00:00 25/02/2016] el: 0 cg: RRT cu: CSRU v1: 5 n1: 5 u1: cmH2O st: NotStopd id: Apnea Time Interval t0: [05:00:00 25/02/2016] el: 0 cg: RRT cu: CSRU v1: 20 n1: 20 st: NotStopd id: Peak Insp. Pressure t0: [05:00:00 25/02/2016] el: 0 cg: RRT cu: CSRU v1: 11 n1: 11 u1: cmH2O st: NotStopd id: Pressure Support t0: [05:00:00 25/02/2016] el: 0 cg: RRT cu: CSRU v1: 5 n1: 5 u1: . st: NotStopd id: RSBI (<200) t0: [05:00:00 25/02/2016] el: 0 cg: RRT cu: CSRU v1: 35 n1: 35 u1: units st: NotStopd id: Resp Rate (Total) t0: [05:00:00 25/02/2016] el: 0 cg: RRT cu: CSRU v1: 15 n1: 15 u1: BPM st: NotStopd id: Ve High t0: [05:00:00 25/02/2016] el: 0 cg: RRT cu: CSRU v1: 16 n1: 16 st: NotStopd id: Sensitivity-Vent t0: [05:00:00 25/02/2016] el: 0 cg: RRT cu: CSRU v1: 2 n1: 2 u1: cmH2O st: NotStopd id: Spon RR (Mech.) t0: [05:00:00 25/02/2016] el: 0 cg: RRT cu: CSRU v1: 21 n1: 21 u1: BPM st: NotStopd id: Spon. Vt (L) (Mech.) t0: [05:00:00 25/02/2016] el: 0 cg: RRT cu: CSRU v1: 0.6 n1: 0.6 u1: L st: NotStopd id: Tidal Volume (Spont) t0: [05:00:00 25/02/2016] el: 0 cg: RRT cu: CSRU v1: 750 n1: 750 u1: ml/B st: NotStopd id: Ventilator Mode t0: [05:00:00 25/02/2016] el: 0 cg: RRT cu: CSRU v1: CPAP+PS st: NotStopd id: Ventilator Type t0: [05:00:00 25/02/2016] el: 0 cg: RRT cu: CSRU v1: Drager st: NotStopd
id: Service Type t0: [06:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: CCU st: NotStopd id: Code Status t0: [06:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Full Code st: NotStopd id: Risk for Falls t0: [06:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Yes st: NotStopd id: Ectopy Frequency t0: [06:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: None st: NotStopd id: Ectopy Type t0: [06:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: None st: NotStopd id: Health Care Proxy t0: [06:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Yes st: NotStopd id: Heart Rate t0: [06:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 80 n1: 80 u1: BPM st: NotStopd id: Heart Rhythm t0: [06:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Normal Sinus st: NotStopd id: Arterial BP t0: [06:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 114 n1: 114 u1: mmHg v2: 67 n2: 67 u2: mmHg st: NotStopd id: Arterial BP Mean t0: [06:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 86 n1: 86 u1: mmHg st: NotStopd id: Precautions t0: [06:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Contact st: NotStopd id: ABP Alarm (Lo/Hi) t0: [06:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 85 n1: 85 u1: mmHg v2: 160 n2: 160 u2: mmHg st: NotStopd id: HR Alarm (Lo/Hi) t0: [06:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 50 n1: 50 u1: BPM v2: 120 n2: 120 u2: BPM st: NotStopd id: Resp Alarm (Lo/Hi) t0: [06:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 8 n1: 8 u1: BPM v2: 30 n2: 30 u2: BPM st: NotStopd id: SpO2 Alarm (Lo/Hi) t0: [06:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 90 n1: 90 u1: % v2: 100 n2: 100 u2: % st: NotStopd id: Respiratory Rate t0: [06:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 19 n1: 19 u1: BPM st: NotStopd id: SpO2 t0: [06:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 96 n1: 96 u1: % st: NotStopd id: Sputum Color/Consist t0: [06:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: White v2: Thick st: NotStopd id: Sputum Source/Amt t0: [06:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Suctioned v2: Copious st: NotStopd id: calprevflg t0: [06:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 1 n1: 1 u1: kg st: NotStopd
id: D5W 100.0ml t0: [06:00:00 25/02/2016] el: 2 ai: 416 cg: RN cu: CSRU vo: 100 vu: ml id: .9% Normal Saline 1000.0ml t0: [06:00:00 25/02/2016] el: 1 ai: 107 cg: RN cu: CSRU vo: 5 vu: ml id: TPN 1000.0ml t0: [06:00:00 25/02/2016] el: 1 ai: 304 cg: RN cu: CSRU vo: 75 vu: ml id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl t0: [06:00:00 25/02/2016] el: 1 ai: 107 cg: RN cu: CSRU vo: 12 vu: ml id: Urine Out Foley t0: [06:00:00 25/02/2016] el: 1 cg: RN cu: CSRU vo: 240 vu: ml id: .9% Normal Saline 50.0ml + 50mghr Midazolam t0: [06:00:00 25/02/2016] el: 1 ai: 274 cg: RN cu: CSRU vo: 3 vu: ml id: Drain Out #1 Jackson Pratt t0: [06:00:00 25/02/2016] el: 1 cg: RN cu: CSRU vo: 0 vu: ml
id: Fentanyl t0: [05:00:00 25/02/2016] el: 1 cg: RN cu: CSRU vo: 0 do: 120 du: mcghr so: .9% Normal Saline sv: 250 su: ml rt: IV Drip id: Fentanyl t0: [06:00:00 25/02/2016] el: 1 cg: RN cu: CSRU vo: 0 do: 120 du: mcghr so: .9% Normal Saline sv: 250 su: ml rt: IV Drip id: Midazolam t0: [06:00:00 25/02/2016] el: 1 cg: RN cu: CSRU vo: 0 do: 3 du: mghr so: .9% Normal Saline sv: 50 su: ml rt: IV Drip
id: Drain #1 Total Out t0: [23:00:00 25/02/2016] el: 3 cg: RN cu: CSRU cv: 15 ac: 24 ap: none re: 0
id: Service Type t0: [07:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: CCU st: NotStopd id: Code Status t0: [07:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Full Code st: NotStopd id: Risk for Falls t0: [07:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Yes st: NotStopd id: Ectopy Frequency t0: [07:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: None st: NotStopd id: Ectopy Type t0: [07:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: None st: NotStopd id: Health Care Proxy t0: [07:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Yes st: NotStopd id: Heart Rate t0: [07:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 77 n1: 77 u1: BPM st: NotStopd id: Heart Rhythm t0: [07:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Normal Sinus st: NotStopd id: Arterial BP t0: [07:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 114 n1: 114 u1: mmHg v2: 67 n2: 67 u2: mmHg st: NotStopd id: Arterial BP Mean t0: [07:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 85 n1: 85 u1: mmHg st: NotStopd id: Precautions t0: [07:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Contact st: NotStopd id: ABP Alarm (Lo/Hi) t0: [07:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 85 n1: 85 u1: mmHg v2: 160 n2: 160 u2: mmHg st: NotStopd id: HR Alarm (Lo/Hi) t0: [07:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 50 n1: 50 u1: BPM v2: 120 n2: 120 u2: BPM st: NotStopd id: Resp Alarm (Lo/Hi) t0: [07:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 8 n1: 8 u1: BPM v2: 30 n2: 30 u2: BPM st: NotStopd id: SpO2 Alarm (Lo/Hi) t0: [07:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 90 n1: 90 u1: % v2: 100 n2: 100 u2: % st: NotStopd id: Respiratory Rate t0: [07:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 17 n1: 17 u1: BPM st: NotStopd id: SpO2 t0: [07:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 95 n1: 95 u1: % st: NotStopd id: calprevflg t0: [07:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 1 n1: 1 u1: kg st: NotStopd
id: .9% Normal Saline 1000.0ml t0: [07:00:00 25/02/2016] el: 1 ai: 107 cg: RN cu: CSRU vo: 5 vu: ml id: Gastric Meds t0: [07:00:00 25/02/2016] el: 2 ai: 155 cg: RN cu: CSRU vo: 120 vu: ml id: TPN 1000.0ml t0: [07:00:00 25/02/2016] el: 1 ai: 304 cg: RN cu: CSRU vo: 75 vu: ml id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl t0: [07:00:00 25/02/2016] el: 1 ai: 107 cg: RN cu: CSRU vo: 12 vu: ml id: Urine Out Foley t0: [07:00:00 25/02/2016] el: 1 cg: RN cu: CSRU vo: 200 vu: ml id: .9% Normal Saline 50.0ml + 50mghr Midazolam t0: [07:00:00 25/02/2016] el: 1 ai: 274 cg: RN cu: CSRU vo: 3 vu: ml
id: Fentanyl t0: [07:00:00 25/02/2016] el: 1 cg: RN cu: CSRU vo: 0 do: 120 du: mcghr so: .9% Normal Saline sv: 250 su: ml rt: IV Drip id: Midazolam t0: [07:00:00 25/02/2016] el: 1 cg: RN cu: CSRU vo: 0 do: 3 du: mghr so: .9% Normal Saline sv: 50 su: ml rt: IV Drip
id: ETT Mark/Location t0: [08:00:00 25/02/2016] el: 0 cg: RT cu: CSRU v1: 21cm v2: Lip st: NotStopd id: FiO2 Set t0: [08:00:00 25/02/2016] el: 0 cg: RT cu: CSRU v1: 0.403 n1: 0.403 u1: torr st: NotStopd id: High Insp. Pressure t0: [08:00:00 25/02/2016] el: 0 cg: RT cu: CSRU v1: 30 n1: 30 u1: cmH2O st: NotStopd id: High Resp. Rate t0: [08:00:00 25/02/2016] el: 0 cg: RT cu: CSRU v1: 35 n1: 35 u1: BPM st: NotStopd id: Airway Size t0: [08:00:00 25/02/2016] el: 0 cg: RT cu: CSRU v1: 7.5 mm st: NotStopd id: Airway Type t0: [08:00:00 25/02/2016] el: 0 cg: RT cu: CSRU v1: Endotracheal st: NotStopd id: Inspired Gas Temp t0: [08:00:00 25/02/2016] el: 0 cg: RT cu: CSRU u1: Deg. C st: NotStopd id: Intubation Date t0: [08:00:00 25/02/2016] el: 0 cg: RT cu: CSRU v1: 2 n1: 2 v2: 11 n2: 11 st: NotStopd id: Low Exhaled Min Vol t0: [08:00:00 25/02/2016] el: 0 cg: RT cu: CSRU v1: 3 n1: 3 st: NotStopd id: MDI #1 (Puff/Drug) t0: [08:00:00 25/02/2016] el: 0 cg: RT cu: CSRU v1: 4 n1: 4 v2: Albuterol st: NotStopd id: MDI #2 (Puff/Drug) t0: [08:00:00 25/02/2016] el: 0 cg: RT cu: CSRU v1: 4 n1: 4 v2: Atrovent st: NotStopd id: Minute Volume(Obser) t0: [08:00:00 25/02/2016] el: 0 cg: RT cu: CSRU v1: 8.6 n1: 8.6 u1: L/min st: NotStopd id: PEEP Set t0: [08:00:00 25/02/2016] el: 0 cg: RT cu: CSRU v1: 5 n1: 5 u1: cmH2O st: NotStopd id: Apnea Time Interval t0: [08:00:00 25/02/2016] el: 0 cg: RT cu: CSRU v1: 20 n1: 20 st: NotStopd id: Pressure Support t0: [08:00:00 25/02/2016] el: 0 cg: RT cu: CSRU v1: 5 n1: 5 u1: . st: NotStopd id: Resp Rate (Total) t0: [08:00:00 25/02/2016] el: 0 cg: RT cu: CSRU v1: 13 n1: 13 u1: BPM st: NotStopd id: Tank A psi. t0: [08:00:00 25/02/2016] el: 0 cg: RT cu: CSRU v1: 2400 n1: 2400 st: NotStopd id: Tank B psi. t0: [08:00:00 25/02/2016] el: 0 cg: RT cu: CSRU v1: 1800 n1: 1800 st: NotStopd id: Ve High t0: [08:00:00 25/02/2016] el: 0 cg: RT cu: CSRU v1: 16 n1: 16 st: NotStopd id: Sensitivity-Vent t0: [08:00:00 25/02/2016] el: 0 cg: RT cu: CSRU v1: 2 n1: 2 u1: cmH2O st: NotStopd id: SpO2 t0: [08:00:00 25/02/2016] el: 0 cg: RT cu: CSRU v1: 97 n1: 97 u1: % st: NotStopd id: Tidal Volume (Spont) t0: [08:00:00 25/02/2016] el: 0 cg: RT cu: CSRU v1: 665 n1: 665 u1: ml/B st: NotStopd id: Ventilator Mode t0: [08:00:00 25/02/2016] el: 0 cg: RT cu: CSRU v1: CPAP+PS st: NotStopd id: Ventilator Type t0: [08:00:00 25/02/2016] el: 0 cg: RT cu: CSRU v1: Drager st: NotStopd
id: Service Type t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: MICU st: NotStopd id: Code Status t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Full Code st: NotStopd id: Risk for Falls t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Yes st: NotStopd id: Ectopy Frequency t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: None st: NotStopd id: Ectopy Type t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: None st: NotStopd id: Alarms t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: ON st: NotStopd id: Parameters Checked t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Yes st: NotStopd id: Health Care Proxy t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Yes st: NotStopd id: Heart Rate t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 73 n1: 73 u1: BPM st: NotStopd id: Heart Rhythm t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Normal Sinus st: NotStopd id: Arterial BP t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 99 n1: 99 u1: mmHg v2: 58 n2: 58 u2: mmHg st: NotStopd id: Arterial BP Mean t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 74 n1: 74 u1: mmHg st: NotStopd id: Precautions t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Contact st: NotStopd id: ABP Alarm (Lo/Hi) t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 85 n1: 85 u1: mmHg v2: 160 n2: 160 u2: mmHg st: NotStopd id: HR Alarm (Lo/Hi) t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 50 n1: 50 u1: BPM v2: 120 n2: 120 u2: BPM st: NotStopd id: Resp Alarm (Lo/Hi) t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 8 n1: 8 u1: BPM v2: 30 n2: 30 u2: BPM st: NotStopd id: SpO2 Alarm (Lo/Hi) t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 90 n1: 90 u1: % v2: 100 n2: 100 u2: % st: NotStopd id: Respiratory Rate t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 15 n1: 15 u1: BPM st: NotStopd id: calprevflg t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 1 n1: 1 u1: kg st: NotStopd
id: Fentanyl t0: [08:00:00 25/02/2016] el: 1 cg: RN cu: CSRU vo: 0 do: 120 du: mcghr so: .9% Normal Saline sv: 250 su: ml rt: IV Drip id: Midazolam t0: [08:00:00 25/02/2016] el: 1 cg: RN cu: CSRU vo: 0 do: 3 du: mghr so: .9% Normal Saline sv: 50 su: ml rt: IV Drip
id: D5W 100.0ml t0: [08:30:00 25/02/2016] el: 2 ai: 416 cg: RN cu: CSRU vo: 100 vu: ml
id: Urine Out Foley t0: [08:30:00 25/02/2016] el: 1 cg: RN cu: CSRU vo: 500 vu: ml
id: Less Restrict Meas. t0: [06:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Medicated st: NotStopd id: Less Restrict Meas. t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Medicated st: NotStopd id: Pain Present t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: No st: NotStopd id: Range of Motion t0: [06:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Done st: NotStopd id: Range of Motion t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Done st: NotStopd id: Pain Assess Method t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Grimace Scale st: NotStopd id: Service Type t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: MICU st: NotStopd id: Circulation/SkinInt t0: [06:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Circulation Adeq st: NotStopd id: Circulation/SkinInt t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Circulation Adeq st: NotStopd id: Code Status t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Full Code st: NotStopd id: Risk for Falls t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Yes st: NotStopd id: Diet Type t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: TPN st: NotStopd id: Dorsal PedPulse R/L t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Easily Palpable v2: Easily Palpable st: NotStopd id: Ectopy Frequency t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: None st: NotStopd id: Ectopy Type t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: None st: NotStopd id: Education Barrier t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Medicated st: NotStopd id: Education Handout t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Not Applicable st: NotStopd id: Education Learner t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Patient st: NotStopd id: Education Method t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Explanation st: NotStopd id: GI#1 Intub Site t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Salem Sump v2: Oral st: NotStopd id: Education Readiness t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: No st: NotStopd id: Health Care Proxy t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Yes st: NotStopd id: Education Response t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Reinforced st: NotStopd id: Education Topic #1 t0: [06:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Plan of Care st: NotStopd id: Education Topic #1 t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Activity st: NotStopd id: Education Topic #2 t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: ICU Environment st: NotStopd id: Eye Care t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Done st: NotStopd id: Eye Opening t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 4 Spontaneously st: NotStopd id: Follows Commands t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Inconsistently st: NotStopd id: GCS Total t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 10 n1: 10 u1: points st: NotStopd id: GI Intub #1/Site t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Salem Sump v2: Oral st: NotStopd id: GI#1 Tube Stat/Drain t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Clamped st: NotStopd id: HOB t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 30 degrees st: NotStopd id: Heart Rate t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 86 n1: 86 u1: BPM st: NotStopd id: Heart Rhythm t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Normal Sinus st: NotStopd id: INV Line#2 Type/Site t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: A-Line v2: Right Radial st: NotStopd id: INV Line#2 Zero/Cal t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Yes st: NotStopd id: INV Line#2InsertDate t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 2 n1: 2 v2: 11 n2: 11 st: NotStopd id: INV Line#2SiteAppear t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: WNL st: NotStopd id: INV Line#4 Type/Site t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Multi-lumen v2: Left Subclavian st: NotStopd id: INV Line#4InsertDate t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 2 n1: 2 v2: 12 n2: 12 st: NotStopd id: INV Line#4SiteAppear t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Redness st: NotStopd id: Abdominal Assessment t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Soft st: NotStopd id: INV#2 WaveformAppear t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Sharp st: NotStopd id: IV #1 Insert Date t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 2 n1: 2 v2: 14 n2: 14 st: NotStopd id: IV #1 Site/Size t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Right Hand v2: 20 gauge st: NotStopd id: IV #4 Insert Date t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 2 n1: 2 v2: 13 n2: 13 st: NotStopd id: IV #4 Site/Size t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: LL Post Forearm v2: 20 gauge st: NotStopd id: Activity t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Bedrest st: NotStopd id: IV Site Appear #1 t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: WNL st: NotStopd id: IV Site Appear #4 t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: WNL st: NotStopd id: Activity Tolerance t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Tolerated Well st: NotStopd id: ImpSkin Treatment #1 t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Duoderm st: NotStopd id: Impaired Skin Site#1 t0: [06:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Coccyx st: NotStopd id: Impaired Skin Site#1 t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Coccyx st: NotStopd id: Inc Closure/Appear#1 t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Suture/Staples v2: Other/Remarks st: NotStopd id: Inc Drainage/Amt #1 t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Green v2: Small st: NotStopd id: Inc Dsg/Status #1 t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Dry Sterile Dsg v2: Changed st: NotStopd id: Incision/Wound #1 t0: [06:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Abdominal st: NotStopd id: Incision/Wound #1 t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Abdominal st: NotStopd id: LL Strength/Movement t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Moves on Bed st: NotStopd id: LLL Lung Sounds t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Coarse st: NotStopd id: LU Strength/Movement t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Lifts and Holds st: NotStopd id: LUL Lung Sounds t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Coarse st: NotStopd id: Level of Conscious t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Alert st: NotStopd id: Motor Response t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 5 Localizes Pain st: NotStopd id: Oral Care t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Done st: NotStopd id: Oral Cavity t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Teeth/Tissue WNL st: NotStopd id: Orientation t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Unable to Assess st: NotStopd id: AntiEmbDevice/Status t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Compress Sleeves v2: On st: NotStopd id: Arterial BP t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 135 n1: 135 u1: mmHg v2: 82 n2: 82 u2: mmHg st: NotStopd id: Pain Location t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Not Indicated st: NotStopd id: Pain Management t0: [08:00:00 25/02/2016] el: 1 cg: RN cu: CSRU v1: IV Gtt v2: IV Gtt st: NotStopd id: Pain Type t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: None st: NotStopd id: Arterial BP Mean t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 101 n1: 101 u1: mmHg st: NotStopd id: Position t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Right Side st: NotStopd id: Position Change t0: [06:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Done st: NotStopd id: Position Change t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Done st: NotStopd id: PostTib. Pulses R/L t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Easily Palpable v2: Easily Palpable st: NotStopd id: Assistance Device t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 2 Person Assist st: NotStopd id: Precautions t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Contact st: NotStopd id: INV#2 Dsg Change t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 2 n1: 2 v2: 15 n2: 15 st: NotStopd id: INV#4 Dsg Change t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 2 n1: 2 v2: 15 n2: 15 st: NotStopd id: ABP Alarm (Lo/Hi) t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 85 n1: 85 u1: mmHg v2: 160 n2: 160 u2: mmHg st: NotStopd id: HR Alarm (Lo/Hi) t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 50 n1: 50 u1: BPM v2: 120 n2: 120 u2: BPM st: NotStopd id: Resp Alarm (Lo/Hi) t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 8 n1: 8 u1: BPM v2: 30 n2: 30 u2: BPM st: NotStopd id: SpO2 Alarm (Lo/Hi) t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 90 n1: 90 u1: % v2: 100 n2: 100 u2: % st: NotStopd id: RL Strength/Movement t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Moves on Bed st: NotStopd id: RLL Lung Sounds t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Coarse st: NotStopd id: RU Strength/Movement t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Lifts and Holds st: NotStopd id: RUL Lung Sounds t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Coarse st: NotStopd id: Reason For Restraint t0: [06:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Ext/TXInterfere st: NotStopd id: Reason For Restraint t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Ext/TXInterfere st: NotStopd id: Removed x 5 Mins t0: [06:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Done st: NotStopd id: Removed x 5 Mins t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Done st: NotStopd id: Respiratory Pattern t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Regular st: NotStopd id: Respiratory Rate t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 18 n1: 18 u1: BPM st: NotStopd id: Responds to Stimuli t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Verbal v2: Localizes st: NotStopd id: Restraint Location t0: [06:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Both Arms st: NotStopd id: Restraint Location t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Both Arms st: NotStopd id: Restraint Type t0: [06:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Soft Limb st: NotStopd id: Restraint Type t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Soft Limb st: NotStopd id: Restraints Evaluated t0: [06:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: RestraintReapply st: NotStopd id: Restraints Evaluated t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: RestraintReapply st: NotStopd id: Side Rails t0: [06:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: All rails up st: NotStopd id: Side Rails t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: All rails up st: NotStopd id: Skin Care t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Done st: NotStopd id: Skin Integrity t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Impaired st: NotStopd id: SpO2 t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 96 n1: 96 u1: % st: NotStopd id: Spontaneous Movement t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Purposeful st: NotStopd id: Sputum Color/Consist t0: [08:30:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: White v2: Frothy st: NotStopd id: Sputum Color/Consist t0: [08:40:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: White v2: Frothy st: NotStopd id: Sputum Color/Consist t0: [08:50:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: White v2: Frothy st: NotStopd id: Sputum Color/Consist t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: White v2: Frothy st: NotStopd id: Sputum Source/Amt t0: [08:30:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Suctioned v2: Small st: NotStopd id: Sputum Source/Amt t0: [08:40:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Suctioned v2: Moderate st: NotStopd id: Sputum Source/Amt t0: [08:50:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Suctioned v2: Moderate st: NotStopd id: Sputum Source/Amt t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Suctioned v2: Small st: NotStopd id: Support Systems t0: [06:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Relative st: NotStopd id: Support Systems t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Relative st: NotStopd id: INV#2 Cap Change t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 2 n1: 2 v2: 15 n2: 15 st: NotStopd id: INV#2 Tubing Change t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 2 n1: 2 v2: 15 n2: 15 st: NotStopd id: INV#4 Cap Change t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 2 n1: 2 v2: 15 n2: 15 st: NotStopd id: INV#4 Tubing Change t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 2 n1: 2 v2: 15 n2: 15 st: NotStopd id: Temp. Site t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Oral st: NotStopd id: Temperature C (calc) t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 36.3889 n1: 36.3889 u1: Deg. C st: NotStopd id: Temperature F t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 97.5 n1: 97.5 u1: Deg. F st: NotStopd id: Therapeutic Bed t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: AtmosAir Mattres st: NotStopd id: Turn t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Side to Side st: NotStopd id: Urine Color/Appear t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Yellow v2: Clear st: NotStopd id: Urine Source t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Indwelling Cath st: NotStopd id: Verbal Response t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 1.0 ET/Trach st: NotStopd id: Back Care t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Done st: NotStopd id: calprevflg t0: [09:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 1 n1: 1 u1: kg st: NotStopd id: Behavior t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Calm st: NotStopd id: Pt./Family Informed t0: [06:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Yes st: NotStopd id: Pt./Family Informed t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Yes st: NotStopd id: Bowel Sounds t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Present st: NotStopd id: Braden Activity t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Bedfast st: NotStopd id: Braden Frict/Shear t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Problem st: NotStopd id: Braden Mobility t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Very Limited st: NotStopd id: Braden Moisture t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Occ. Moist st: NotStopd id: Braden Nutrition t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Adequate st: NotStopd id: Braden Score t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 13 n1: 13 u1: number st: NotStopd id: Braden SensoryPercep t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Sl. Limited st: NotStopd
id: D5W 100.0ml t0: [09:00:00 25/02/2016] el: 2 ai: 416 cg: RN cu: CSRU vo: 250 vu: ml id: .9% Normal Saline 1000.0ml t0: [09:00:00 25/02/2016] el: 1 ai: 107 cg: RN cu: CSRU vo: 10 vu: ml id: Gastric Meds t0: [09:00:00 25/02/2016] el: 2 ai: 155 cg: RN cu: CSRU vo: 300 vu: ml id: TPN 1000.0ml t0: [09:00:00 25/02/2016] el: 1 ai: 304 cg: RN cu: CSRU vo: 150 vu: ml id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl t0: [09:00:00 25/02/2016] el: 1 ai: 107 cg: RN cu: CSRU vo: 24 vu: ml id: Urine Out Foley t0: [09:00:00 25/02/2016] el: 1 cg: RN cu: CSRU vo: 160 vu: ml id: .9% Normal Saline 50.0ml + 50mghr Midazolam t0: [09:00:00 25/02/2016] el: 1 ai: 274 cg: RN cu: CSRU vo: 6 vu: ml
id: Fentanyl t0: [09:00:00 25/02/2016] el: 1 cg: RN cu: CSRU vo: 0 do: 120 du: mcghr so: .9% Normal Saline sv: 250 su: ml rt: IV Drip id: Midazolam t0: [09:00:00 25/02/2016] el: 1 cg: RN cu: CSRU vo: 0 do: 3 du: mghr so: .9% Normal Saline sv: 50 su: ml rt: IV Drip
id: Service Type t0: [10:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: MICU st: NotStopd id: Code Status t0: [10:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Full Code st: NotStopd id: Risk for Falls t0: [10:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Yes st: NotStopd id: Ectopy Frequency t0: [10:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: None st: NotStopd id: Ectopy Type t0: [10:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: None st: NotStopd id: Health Care Proxy t0: [10:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Yes st: NotStopd id: Heart Rate t0: [10:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 93 n1: 93 u1: BPM st: NotStopd id: Heart Rhythm t0: [10:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Normal Sinus st: NotStopd id: Arterial BP t0: [10:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 122 n1: 122 u1: mmHg v2: 77 n2: 77 u2: mmHg st: NotStopd id: Arterial BP Mean t0: [10:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 94 n1: 94 u1: mmHg st: NotStopd id: Precautions t0: [10:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Contact st: NotStopd id: ABP Alarm (Lo/Hi) t0: [10:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 85 n1: 85 u1: mmHg v2: 160 n2: 160 u2: mmHg st: NotStopd id: HR Alarm (Lo/Hi) t0: [10:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 50 n1: 50 u1: BPM v2: 120 n2: 120 u2: BPM st: NotStopd id: Resp Alarm (Lo/Hi) t0: [10:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 8 n1: 8 u1: BPM v2: 30 n2: 30 u2: BPM st: NotStopd id: SpO2 Alarm (Lo/Hi) t0: [10:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 90 n1: 90 u1: % v2: 100 n2: 100 u2: % st: NotStopd id: Respiratory Rate t0: [10:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 20 n1: 20 u1: BPM st: NotStopd id: SpO2 t0: [10:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 96 n1: 96 u1: % st: NotStopd id: calprevflg t0: [10:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 1 n1: 1 u1: kg st: NotStopd
id: .9% Normal Saline 1000.0ml t0: [10:00:00 25/02/2016] el: 1 ai: 107 cg: RN cu: CSRU vo: 5 vu: ml id: Gastric Meds t0: [10:00:00 25/02/2016] el: 2 ai: 155 cg: RN cu: CSRU vo: 90 vu: ml id: TPN 1000.0ml t0: [10:00:00 25/02/2016] el: 1 ai: 304 cg: RN cu: CSRU vo: 75 vu: ml id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl t0: [10:00:00 25/02/2016] el: 1 ai: 107 cg: RN cu: CSRU vo: 12 vu: ml id: Urine Out Foley t0: [10:00:00 25/02/2016] el: 1 cg: RN cu: CSRU vo: 380 vu: ml id: .9% Normal Saline 50.0ml + 50mghr Midazolam t0: [10:00:00 25/02/2016] el: 1 ai: 274 cg: RN cu: CSRU vo: 3 vu: ml
id: Fentanyl t0: [10:00:00 25/02/2016] el: 1 cg: RN cu: CSRU vo: 0 do: 120 du: mcghr so: .9% Normal Saline sv: 250 su: ml rt: IV Drip id: Midazolam t0: [10:00:00 25/02/2016] el: 1 cg: RN cu: CSRU vo: 0 do: 3 du: mghr so: .9% Normal Saline sv: 50 su: ml rt: IV Drip
id: PO/Gastric In Total t0: [23:00:00 25/02/2016] el: 3 cg: RN cu: CSRU cv: 700 ac: 24 ap: none re: 0
id: Service Type t0: [11:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: MICU st: NotStopd id: Code Status t0: [11:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Full Code st: NotStopd id: Risk for Falls t0: [11:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Yes st: NotStopd id: Ectopy Frequency t0: [11:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: None st: NotStopd id: Ectopy Type t0: [11:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: None st: NotStopd id: Health Care Proxy t0: [11:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Yes st: NotStopd id: Heart Rate t0: [11:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 91 n1: 91 u1: BPM st: NotStopd id: Heart Rhythm t0: [11:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Normal Sinus st: NotStopd id: INV Line#2 Type/Site t0: [11:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: A-Line v2: Right Radial st: NotStopd id: INV Line#2 Zero/Cal t0: [11:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: No st: NotStopd id: INV Line#2InsertDate t0: [11:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 2 n1: 2 v2: 11 n2: 11 st: NotStopd id: INV Line#2SiteAppear t0: [11:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: WNL st: NotStopd id: INV Line#4 Type/Site t0: [11:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Multi-lumen v2: Left Subclavian st: NotStopd id: INV Line#4InsertDate t0: [11:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 2 n1: 2 v2: 12 n2: 12 st: NotStopd id: INV Line#4SiteAppear t0: [11:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Redness st: NotStopd id: INV#2 WaveformAppear t0: [11:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Sharp st: NotStopd id: IV #1 Insert Date t0: [11:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 2 n1: 2 v2: 14 n2: 14 st: NotStopd id: IV #1 Site/Size t0: [11:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Right Hand v2: 20 gauge st: NotStopd id: IV #4 Insert Date t0: [11:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 2 n1: 2 v2: 13 n2: 13 st: NotStopd id: IV #4 Site/Size t0: [11:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: LL Post Forearm v2: 20 gauge st: NotStopd id: IV Site Appear #1 t0: [11:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: WNL st: NotStopd id: IV Site Appear #4 t0: [11:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: WNL st: NotStopd id: Arterial BP t0: [11:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 114 n1: 114 u1: mmHg v2: 71 n2: 71 u2: mmHg st: NotStopd id: Arterial BP Mean t0: [11:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 87 n1: 87 u1: mmHg st: NotStopd id: Precautions t0: [11:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Contact st: NotStopd id: INV#2 Dsg Change t0: [11:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 2 n1: 2 v2: 15 n2: 15 st: NotStopd id: ABP Alarm (Lo/Hi) t0: [11:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 85 n1: 85 u1: mmHg v2: 160 n2: 160 u2: mmHg st: NotStopd id: HR Alarm (Lo/Hi) t0: [11:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 50 n1: 50 u1: BPM v2: 120 n2: 120 u2: BPM st: NotStopd id: Resp Alarm (Lo/Hi) t0: [11:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 8 n1: 8 u1: BPM v2: 30 n2: 30 u2: BPM st: NotStopd id: SpO2 Alarm (Lo/Hi) t0: [11:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 90 n1: 90 u1: % v2: 100 n2: 100 u2: % st: NotStopd id: Respiratory Rate t0: [11:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 19 n1: 19 u1: BPM st: NotStopd id: SpO2 t0: [11:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 96 n1: 96 u1: % st: NotStopd id: INV#2 Cap Change t0: [11:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 2 n1: 2 v2: 15 n2: 15 st: NotStopd id: INV#2 Tubing Change t0: [11:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 2 n1: 2 v2: 15 n2: 15 st: NotStopd id: INV#4 Cap Change t0: [11:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 2 n1: 2 v2: 15 n2: 15 st: NotStopd id: INV#4 Tubing Change t0: [11:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 2 n1: 2 v2: 15 n2: 15 st: NotStopd id: calprevflg t0: [11:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 1 n1: 1 u1: kg st: NotStopd
id: .9% Normal Saline 1000.0ml t0: [11:00:00 25/02/2016] el: 1 ai: 107 cg: RN cu: CSRU vo: 5 vu: ml id: TPN 1000.0ml t0: [11:00:00 25/02/2016] el: 1 ai: 304 cg: RN cu: CSRU vo: 75 vu: ml id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl t0: [11:00:00 25/02/2016] el: 1 ai: 107 cg: RN cu: CSRU vo: 12 vu: ml id: .9% Normal Saline 50.0ml + 50mghr Midazolam t0: [11:00:00 25/02/2016] el: 1 ai: 274 cg: RN cu: CSRU vo: 3 vu: ml
id: Fentanyl t0: [11:00:00 25/02/2016] el: 1 cg: RN cu: CSRU vo: 0 do: 120 du: mcghr so: .9% Normal Saline sv: 250 su: ml rt: IV Drip id: Midazolam t0: [11:00:00 25/02/2016] el: 1 cg: RN cu: CSRU vo: 0 do: 3 du: mghr so: .9% Normal Saline sv: 50 su: ml rt: IV Drip
id: Art.pH t0: [11:12:00 25/02/2016] el: 0 cg: 3161 cu: CSRU v1: 7.4 n1: 7.4 rs: Final st: NotStopd id: Arterial Base Excess t0: [11:12:00 25/02/2016] el: 0 cg: 3161 cu: CSRU v1: 5 n1: 5 rs: Final st: NotStopd id: Arterial CO2(Calc) t0: [11:12:00 25/02/2016] el: 0 cg: 3161 cu: CSRU v1: 32 n1: 32 rs: Final st: NotStopd id: Arterial PaCO2 t0: [11:12:00 25/02/2016] el: 0 cg: 3161 cu: CSRU v1: 50 n1: 50 u1: mmHg rs: Final st: NotStopd id: Arterial PaO2 t0: [11:12:00 25/02/2016] el: 0 cg: 3161 cu: CSRU v1: 137 n1: 137 u1: mmHg rs: Final st: NotStopd id: Arterial pH t0: [11:12:00 25/02/2016] el: 0 cg: 3161 cu: CSRU v1: 7.4 n1: 7.4 rs: Final st: NotStopd
id: ETT Mark/Location t0: [12:00:00 25/02/2016] el: 0 cg: RT cu: CSRU v1: 21cm v2: Lip st: NotStopd id: FiO2 Set t0: [12:00:00 25/02/2016] el: 0 cg: RT cu: CSRU v1: 0.4 n1: 0.4 u1: torr st: NotStopd id: High Insp. Pressure t0: [12:00:00 25/02/2016] el: 0 cg: RT cu: CSRU v1: 30 n1: 30 u1: cmH2O st: NotStopd id: High Resp. Rate t0: [12:00:00 25/02/2016] el: 0 cg: RT cu: CSRU v1: 35 n1: 35 u1: BPM st: NotStopd id: Airway Size t0: [12:00:00 25/02/2016] el: 0 cg: RT cu: CSRU v1: 7.5 mm st: NotStopd id: Airway Type t0: [12:00:00 25/02/2016] el: 0 cg: RT cu: CSRU v1: Endotracheal st: NotStopd id: Inspired Gas Temp t0: [12:00:00 25/02/2016] el: 0 cg: RT cu: CSRU u1: Deg. C st: NotStopd id: Intubation Date t0: [12:00:00 25/02/2016] el: 0 cg: RT cu: CSRU v1: 2 n1: 2 v2: 11 n2: 11 st: NotStopd id: Low Exhaled Min Vol t0: [12:00:00 25/02/2016] el: 0 cg: RT cu: CSRU v1: 3 n1: 3 st: NotStopd id: MDI #1 (Puff/Drug) t0: [12:00:00 25/02/2016] el: 0 cg: RT cu: CSRU v1: 4 n1: 4 v2: Albuterol st: NotStopd id: MDI #2 (Puff/Drug) t0: [12:00:00 25/02/2016] el: 0 cg: RT cu: CSRU v1: 4 n1: 4 v2: Atrovent st: NotStopd id: Mean Airway Pressure t0: [12:00:00 25/02/2016] el: 0 cg: RT cu: CSRU v1: 7 n1: 7 u1: cmH2O st: NotStopd id: Minute Volume(Obser) t0: [12:00:00 25/02/2016] el: 0 cg: RT cu: CSRU v1: 10.4 n1: 10.4 u1: L/min st: NotStopd id: PEEP Set t0: [12:00:00 25/02/2016] el: 0 cg: RT cu: CSRU v1: 5 n1: 5 u1: cmH2O st: NotStopd id: Apnea Time Interval t0: [12:00:00 25/02/2016] el: 0 cg: RT cu: CSRU v1: 20 n1: 20 st: NotStopd id: Pressure Support t0: [12:00:00 25/02/2016] el: 0 cg: RT cu: CSRU v1: 5 n1: 5 u1: . st: NotStopd id: Resp Rate (Total) t0: [12:00:00 25/02/2016] el: 0 cg: RT cu: CSRU v1: 16 n1: 16 u1: BPM st: NotStopd id: Ve High t0: [12:00:00 25/02/2016] el: 0 cg: RT cu: CSRU v1: 16 n1: 16 st: NotStopd id: Sensitivity-Vent t0: [12:00:00 25/02/2016] el: 0 cg: RT cu: CSRU v1: 2 n1: 2 u1: cmH2O st: NotStopd id: SpO2 t0: [12:00:00 25/02/2016] el: 0 cg: RT cu: CSRU v1: 96 n1: 96 u1: % st: NotStopd id: Tidal Volume (Spont) t0: [12:00:00 25/02/2016] el: 0 cg: RT cu: CSRU v1: 669 n1: 669 u1: ml/B st: NotStopd id: Ventilator Mode t0: [12:00:00 25/02/2016] el: 0 cg: RT cu: CSRU v1: CPAP+PS st: NotStopd id: Ventilator Type t0: [12:00:00 25/02/2016] el: 0 cg: RT cu: CSRU v1: Drager st: NotStopd
pi: 4532426 hi: 27155 t0: [13:00:00 25/02/2016] pt: TPN st: Expired
id: Fingerstick Glucose t0: [12:00:00 25/02/2016] el: 0 cg: CoWork cu: CSRU v1: 150 n1: 150 rs: Manual st: NotStopd
id: Less Restrict Meas. t0: [10:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Medicated st: NotStopd id: Less Restrict Meas. t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Medicated st: NotStopd id: Pain Present t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: No st: NotStopd id: Range of Motion t0: [10:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Done st: NotStopd id: Range of Motion t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Done st: NotStopd id: Pain Assess Method t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Grimace Scale st: NotStopd id: PainLevel Acceptable t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Yes st: NotStopd id: Service Type t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: MICU st: NotStopd id: Circulation/SkinInt t0: [10:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Circulation Adeq st: NotStopd id: Circulation/SkinInt t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Circulation Adeq st: NotStopd id: Code Status t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Full Code st: NotStopd id: Riker-SAS Scale t0: [08:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Calm/Cooperative st: NotStopd id: Riker-SAS Scale t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Sedated st: NotStopd id: Risk for Falls t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Yes st: NotStopd id: Diet Type t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: TPN st: NotStopd id: Dorsal PedPulse R/L t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Easily Palpable v2: Easily Palpable st: NotStopd id: Ectopy Frequency t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: None st: NotStopd id: Ectopy Type t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: None st: NotStopd id: Alarms t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: ON st: NotStopd id: Parameters Checked t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Yes st: NotStopd id: GI#1 Intub Site t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Salem Sump v2: Oral st: NotStopd id: Health Care Proxy t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Yes st: NotStopd id: Education Topic #1 t0: [10:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Activity st: NotStopd id: Education Topic #1 t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Activity st: NotStopd id: Eye Opening t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 3 To speech st: NotStopd id: Follows Commands t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Inconsistently st: NotStopd id: GCS Total t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 9 n1: 9 u1: points st: NotStopd id: GI Intub #1/Site t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Salem Sump v2: Oral st: NotStopd id: GI#1 Tube Stat/Drain t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Clamped st: NotStopd id: HOB t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 30 degrees st: NotStopd id: Heart Rate t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 88 n1: 88 u1: BPM st: NotStopd id: Heart Rhythm t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Normal Sinus st: NotStopd id: Abdominal Assessment t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Soft st: NotStopd id: Activity t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Bedrest st: NotStopd id: Activity Tolerance t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Tolerated Well st: NotStopd id: Impaired Skin Site#1 t0: [10:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Coccyx st: NotStopd id: Impaired Skin Site#1 t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Coccyx st: NotStopd id: Incision/Wound #1 t0: [10:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Abdominal st: NotStopd id: Incision/Wound #1 t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Abdominal st: NotStopd id: LL Strength/Movement t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Moves on Bed st: NotStopd id: LLL Lung Sounds t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Coarse st: NotStopd id: LU Strength/Movement t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Lifts and Holds st: NotStopd id: LUL Lung Sounds t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Coarse st: NotStopd id: Level of Conscious t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Arouse to Voice st: NotStopd id: Motor Response t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 5 Localizes Pain st: NotStopd id: Oral Care t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Done st: NotStopd id: Oral Cavity t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Teeth/Tissue WNL st: NotStopd id: Orientation t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Unable to Assess st: NotStopd id: AntiEmbDevice/Status t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Compress Sleeves v2: On st: NotStopd id: Arterial BP t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 107 n1: 107 u1: mmHg v2: 66 n2: 66 u2: mmHg st: NotStopd id: Pain Location t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Not Indicated st: NotStopd id: Pain Management t0: [12:00:00 25/02/2016] el: 1 cg: RN cu: CSRU v1: IV Gtt v2: IV Gtt st: NotStopd id: Arterial BP Mean t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 81 n1: 81 u1: mmHg st: NotStopd id: Position t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Supine st: NotStopd id: Position Change t0: [10:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Done st: NotStopd id: Position Change t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Done st: NotStopd id: Assistance Device t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 1 Person Assist st: NotStopd id: Precautions t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Contact st: NotStopd id: ABP Alarm (Lo/Hi) t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 85 n1: 85 u1: mmHg v2: 160 n2: 160 u2: mmHg st: NotStopd id: HR Alarm (Lo/Hi) t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 50 n1: 50 u1: BPM v2: 120 n2: 120 u2: BPM st: NotStopd id: Resp Alarm (Lo/Hi) t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 8 n1: 8 u1: BPM v2: 30 n2: 30 u2: BPM st: NotStopd id: SpO2 Alarm (Lo/Hi) t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 90 n1: 90 u1: % v2: 100 n2: 100 u2: % st: NotStopd id: RL Strength/Movement t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Moves on Bed st: NotStopd id: RLL Lung Sounds t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Coarse st: NotStopd id: RU Strength/Movement t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Lifts and Holds st: NotStopd id: RUL Lung Sounds t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Coarse st: NotStopd id: Reason For Restraint t0: [10:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Ext/TXInterfere st: NotStopd id: Reason For Restraint t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Ext/TXInterfere st: NotStopd id: Removed x 5 Mins t0: [10:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Done st: NotStopd id: Removed x 5 Mins t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Done st: NotStopd id: Respiratory Pattern t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Regular st: NotStopd id: Respiratory Rate t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 15 n1: 15 u1: BPM st: NotStopd id: Responds to Stimuli t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Verbal v2: Localizes st: NotStopd id: Restraint Location t0: [10:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Both Arms st: NotStopd id: Restraint Location t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Both Arms st: NotStopd id: Restraint Type t0: [10:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Soft Limb st: NotStopd id: Restraint Type t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Soft Limb st: NotStopd id: Restraints Evaluated t0: [10:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: RestraintReapply st: NotStopd id: Restraints Evaluated t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: RestraintReapply st: NotStopd id: Side Rails t0: [10:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: All rails up st: NotStopd id: Side Rails t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: All rails up st: NotStopd id: Skin Integrity t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Impaired st: NotStopd id: Spontaneous Movement t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Purposeful st: NotStopd id: Support Systems t0: [10:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Relative st: NotStopd id: Support Systems t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Relative st: NotStopd id: Temp. Site t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Oral st: NotStopd id: Temperature C (calc) t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 36.2222 n1: 36.2222 u1: Deg. C st: NotStopd id: Temperature F t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 97.2 n1: 97.2 u1: Deg. F st: NotStopd id: Therapeutic Bed t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: AtmosAir Mattres st: NotStopd id: Turn t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Back st: NotStopd id: Urine Color/Appear t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Yellow v2: Clear st: NotStopd id: Urine Source t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Indwelling Cath st: NotStopd id: Verbal Response t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 1.0 ET/Trach st: NotStopd id: calprevflg t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 1 n1: 1 u1: kg st: NotStopd id: Behavior t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Sedated st: NotStopd id: Pt./Family Informed t0: [10:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Yes st: NotStopd id: Pt./Family Informed t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Yes st: NotStopd id: Bowel Sounds t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Present st: NotStopd id: Braden Activity t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Bedfast st: NotStopd id: Braden Frict/Shear t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Problem st: NotStopd id: Braden Mobility t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Very Limited st: NotStopd id: Braden Moisture t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Occ. Moist st: NotStopd id: Braden Nutrition t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Adequate st: NotStopd id: Braden Score t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: 13 n1: 13 u1: number st: NotStopd id: Braden SensoryPercep t0: [12:00:00 25/02/2016] el: 0 cg: RN cu: CSRU v1: Sl. Limited st: NotStopd
id: .9% Normal Saline 1000.0ml t0: [12:00:00 25/02/2016] el: 1 ai: 107 cg: RN cu: CSRU vo: 5 vu: ml id: TPN 1000.0ml t0: [12:00:00 25/02/2016] el: 1 ai: 304 cg: RN cu: CSRU vo: 75 vu: ml id: .9% Normal Saline 250.0ml + 2500mcghr Fentanyl t0: [12:00:00 25/02/2016] el: 1 ai: 107 cg: RN cu: CSRU vo: 12 vu: ml id: Urine Out Foley t0: [12:00:00 25/02/2016] el: 1 cg: RN cu: CSRU vo: 500 vu: ml id: .9% Normal Saline 50.0ml + 50mghr Midazolam t0: [12:00:00 25/02/2016] el: 1 ai: 274 cg: RN cu: CSRU vo: 3 vu: ml
id: Fentanyl t0: [12:00:00 25/02/2016] el: 1 cg: RN cu: CSRU vo: 0 do: 120 du: mcghr so: .9% Normal Saline sv: 250 su: ml rt: IV Drip id: Midazolam t0: [12:00:00 25/02/2016] el: 1 cg: RN cu: CSRU vo: 0 do: 3 du: mghr so: .9% Normal Saline sv: 50 su: ml rt: IV Drip
id: IV Infusion In Total t0: [23:00:00 25/02/2016] el: 3 cg: RN cu: CSRU pv: 505 cv: 2858 ac: 24 ap: none re: 0 id: IV Nutrition Total t0: [23:00:00 25/02/2016] el: 3 cg: RN cu: CSRU pv: 75 cv: 1800 ac: 24 ap: none re: 0 id: 24h Total In t0: [23:00:00 25/02/2016] el: 3 cg: RN cu: CSRU pv: 580 cv: 5358 ac: 24 ap: none re: 0 id: Total Hourly Output t0: [23:00:00 25/02/2016] el: 3 cg: RN cu: CSRU pv: 480 cv: 480 ac: 1 ap: none re: 0 id: Urine Out Total t0: [23:00:00 25/02/2016] el: 3 cg: RN cu: CSRU pv: 480 cv: 6215 ac: 24 ap: none re: 0 id: 24h Net Body Balance t0: [23:00:00 25/02/2016] el: 3 cg: RN cu: CSRU pv: 100 cv: -872 ac: 24 ap: carryForward re: 0 id: LOS Net Body Balance t0: [23:00:00 25/02/2016] el: 3 cg: RN cu: CSRU pv: 100 cv: 6305.84 ac: multiple days ap: carryForward re: 0 id: Net Hourly Balance t0: [23:00:00 25/02/2016] el: 3 cg: RN cu: CSRU pv: 100 cv: 100 ac: 1 ap: none re: 0 id: 24h Total Out t0: [23:00:00 25/02/2016] el: 3 cg: RN cu: CSRU pv: 480 cv: 6230 ac: 24 ap: carryForward re: 0