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ICU Nursing Checklist

This document contains a template for recording patient information and vital signs in the ICU. It includes fields for documenting the patient's name, age, gender, weight, room number, code status, diet, IV/CVL access sites, diagnoses, chief complaint, allergies, and serial vital sign measurements. Additional sections are provided for neurological, cardiac, pulmonary, abdominal, musculoskeletal, skin, and laboratory assessments. Spaces are allocated for documenting intravenous drips and medications, as well as notes from the nurse about the patient for that day.

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2K views2 pages

ICU Nursing Checklist

This document contains a template for recording patient information and vital signs in the ICU. It includes fields for documenting the patient's name, age, gender, weight, room number, code status, diet, IV/CVL access sites, diagnoses, chief complaint, allergies, and serial vital sign measurements. Additional sections are provided for neurological, cardiac, pulmonary, abdominal, musculoskeletal, skin, and laboratory assessments. Spaces are allocated for documenting intravenous drips and medications, as well as notes from the nurse about the patient for that day.

Uploaded by

api-282417591
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

ICU

NURSING BRAIN
NAME

AGE:

DOB

GENDER

WT/HT:

RM

CODE

DIET

FOLEY Y OR N

IV: R/L
CVL:

A: R/L
PA: R/L

DX
HX

CHIEF COMPLIANT
DIABETIC: Y OR N ACCU TIME: Q _____hr
ALLERGIES
VS:

BP

HR

02

RR

ABP

SVR

NIBP

ICP

CVP

MAP

CO

PAP

VS:

BP

HR

02

RR

ABP

SVR

NIBP

ICP

CVP

MAP

CO

PAP

VS:

BP

HR

02

RR

ABP

SVR

NIBP

ICP

CVP

MAP

CO

PAP

Gather supplies; check iv bags vs MAR/report; check alarm


settings; emerg. supplies (ambu, suction, O2); check vent
settings
7:00
8:00
9:00

10:00

11:00

12:00

13:00

14:00

15:00

NEURO: GCS _______


PUPIL R___/___ L___/___; PERRLA/ Sluggish/Dilated
ALERT AND ORIENTED X: 1 2 3 4
SEDATION____________ PARALYTIC____________TOF___________
HEENT:
CARDIAC: NSR, SB, ST; REG/IRR; S1,S2/ MURMUR; ADVENTIOUS
PULSES: PRESENT/ABSENT/DIMINSIHED; +/-MOTOR
CAP REFILL: > OR < 3 SEC
JVD
PULMONARY: RT tx: C / Fcrckles / Ccrackles / H / D bilat R L; SYM
SUCTION Q ______HRS; SPUTUM:
VENT: ________CM AT LIP; _________SIZE
A/C:
FiO2:
VT:
PEEP:
CHEST TUBE:
SUCTION: Y OR N PRESSURE:
AIR LEAK: Y OR N
GI:
BS: SOFT / FIRM NON DISTENDED ACTIVE / HYPO / HYPER-PASSED GAS:
LAST BM:
N/V/D
_____TUBE:
RESIDUAL
GU: PALE/CLOUDY/CLEAR YELLOW/GREEN/RED/ ORANGE
12H U/O___________cc /hr
MUSCULOSKELETAL
ROM: UPPER/LOWER
STRENGTH: EQUAL - BILAT.WEAKNESS
AMBULATE
INDEP. OR W/ ASSIST
SKIN: WARM/COLD
DRY/MOIST Good/Bad TURGOR
COLOR: NORM/CYANOTIC/FLUSHED/PALE/ MOTTLING
WOUNDS/INCISIONS:
PRESSURE ULCER
DRIPS:
Name
Rate
Amount
Titration

LABS (ABNORMAL)
ABG:

pH:

PaO2:

HCO3-:

PaCO2:

BE:

SpO2:

Hgb

16:00

WBC
HCT

17:00
Mg

Plt

Phos

N
K

CLCO2

BUN
CR

Glu

ICU NURSING BRAIN


PA Line
Time
CO
CI
PAP
ABP

Additional Info:

IV DRIPS: Medication; initial start rate; titrate rate/time; Goal; Max


MEDICATION
INITIAL START RT.
TIT. RATE/TIME

Notes from the day:

GOAL

MAX

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