• Image-192

  • INTRAVENOUS INFUSION VISIT NOTE

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  •  - -
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  • Blood Pressure * / * .

  • Neuro

  • Pupils: Right Left .

  • Respiratory

  • Cardiovascular

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  • Gastrointestinal

  • Skin

  • Wound/Decub location: Size Stage      .

  • Color Amount .

  • Muscoloskeletal

  • Urinary

  • Pain

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  • Intravenous Status

  • IV pump Type: Settings:.

  • Intravenous/Nursing Intervention

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  •  

  • Lab drawn from (specify access) Specimen taken to: .

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  • POC Review and Care Coordination

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  • Clear
  • Clear

  • Vital Sign Record

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  • Vital Signs should be taken every 15 minutes for the 1st hour; every 30 minutes for the next hour and then hourly until the end of infusion. For
    change in patient status and/ or rate change vital signs should be restarted at 15 minutes intervals and documented on a supplemental record.

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  • Clear
  • Clear
  • Should be Empty: