• Image field 192

  • INTRAVENOUS INFUSION VISIT NOTE

  • Date
     - -
  • Date Of Birth*
     - -
  • Rows

  • Blood Pressure * / * .

  • Blood Pressure taken:
  • Blood Pressure taken:
  • Client's Allergies Reviewed*

  • Neuro

  • Neuro*

  • Pupils: Right Left .

  • Speech

  • Respiratory

  • Respiratory:*
  • Uses Oxygen?
  • Oxygen use:
  • Does Patient have a cough?
  • Is cough productive?

  • Cardiovascular

  • Cardiovascular*
  • Rows

  • Gastrointestinal

  • Gastrointestinal*
  • Appetite:
  • Intake
  • Constipation?
  • Diarrhea?

  • Skin

  • Skin*
  • Turgor
  • Wound/Decub:

  • Wound/Decub location: Size Stage      .

  • Color Amount .

  • Muscoloskeletal

  • Musculoskeletal*

  • Urinary

  • Urinary:*
  • Uses Foley Cath?
  • Foley Cath:

  • Pain

  • Pain*
  • Pain type:
  • Rows
  • Psych*

  • Intravenous Status

  • IV Access?*
  • Current IV Site:*
  • Type:*
  • Current Dressing: Dry and Intact*
  • I.V. Purpose:
  • IV Pump

  • IV pump Type: Settings:.

  • Intravenous/Nursing Intervention

  • Access Start/Re-start/Lab Access:*
  • Rows
  • I.V. Therapy or Meds Administered by:
  • Rows
  • Flushing*
  • Administered
  • Heparin
  • Changes Made this Visit
  • Lab Drawn:

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

  • IV Catheter Discontinued this visit:
  • Reason:
  • Were Pre-Meds given?*
  • Rows
  • Nursing Actions:*

  • POC Review and Care Coordination

  • POC Review*
  • Coordinated with:
  • Next visit planned?*
  • Discharge Plans: Next Visit Scheduled:*
     - -

  • Vital Sign Record

  • Expiration Date*
     - -

  • 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.

  • Rows
  • Pt tolerated w/o adverse outcome?
  • Progressing toward goals?*
  • Should be Empty: