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Venoclysis Io Forms

The document contains venoclysis and intake/output sheets for two patients, Katherine Aquino and Lorenze Kyle Manolo. Katherine Aquino was admitted on 2/24/22 at 7:00 am for PTB. Lorenze Kyle Manolo was admitted on 2/26/22 at 6:00 am for dengue. Manolo received 750mL of D5LR intravenous solution from 8:00-8:30 am on 2/26/22. The sheets track intravenous intake and output levels over time for patient monitoring and care.

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amal abdulrahman
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529 views4 pages

Venoclysis Io Forms

The document contains venoclysis and intake/output sheets for two patients, Katherine Aquino and Lorenze Kyle Manolo. Katherine Aquino was admitted on 2/24/22 at 7:00 am for PTB. Lorenze Kyle Manolo was admitted on 2/26/22 at 6:00 am for dengue. Manolo received 750mL of D5LR intravenous solution from 8:00-8:30 am on 2/26/22. The sheets track intravenous intake and output levels over time for patient monitoring and care.

Uploaded by

amal abdulrahman
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
  • Venoclysis Sheet - Patient 1
  • Intake and Output Sheet - Patient 1
  • Venoclysis Sheet - Patient 2
  • Intake and Output Sheet - Patient 2

VENOCLYSIS SHEET

Name:Aquino,Katherine Admitting Diagnosis:(PTB) Hospital No:


Age:22y/ Sex:F Date of Attending Physician: Room/Bed
o Admission:2/24/22 Dr.William Ong No:507
7:00 am

DATE AMOUNT BOTTLE SITE ADDITIVE RATE TIME TIME REMARKS


AND TYPE NO. STARTED/ CONSUMED/
OF STARTED CONSUMED
SOLUTION BY BY
2/24/22 non
INTAKE AND OUTPUT (I&O) SHEET
Name: Admitting Diagnosis: Hospital No:

Age: Sex: Date of Admission: Attending Physician: Room/Bed No:

DATE INTAKE TOTAL OUTPUT TOTAL

IVF ORAL BLOOD OTHERS URINE STOOL VOMITUS OTHERS

6-2

2-10

10-5

TOTAL PER DAY TOTAL PER DAY

DATE INTAKE TOTAL OUTPUT TOTAL

IVF ORAL BLOOD OTHERS URINE STOOL VOMITUS OTHERS

6-2

2-10

10-5

TOTAL PER DAY TOTAL PER DAY

DATE INTAKE TOTAL OUTPUT TOTAL

IVF ORAL BLOOD OTHERS URINE STOOL VOMITUS OTHERS

6-2

2-10

10-5

TOTAL PER DAY TOTAL PER DAY

DATE INTAKE TOTAL OUTPUT TOTAL

IVF ORAL BLOOD OTHERS URINE STOOL VOMITUS OTHERS

6-2

2-10

10-5

TOTAL PER DAY TOTAL PER DAY


VENOCLYSIS SHEET

Name:Manolo,Lorenze Kyle Admitting Diagnosis:Dengue Hospital No:

Age:23y/ Sex:M Date of Attending Physician: Room/Bed No:508


o Admission:2/26/22
Dr.John Ramirez
6:00 am

DATE AMOUNT BOTTLE SITE ADDITIVE RATE TIME TIME REMARKS


AND TYPE NO. STARTED/ CONSUMED
OF STARTED /
SOLUTION BY
CONSUMED
BY

2/26/22 D5LR #1 Side 750ML 8:00am CREDIT:


drip
B.M 250 ml
left
INTAKE AND OUTPUT (I&O) SHEET
Name: Admitting Diagnosis: Hospital No:

Age: Sex: Date of Admission: Attending Physician: Room/Bed No:

DATE INTAKE TOTAL OUTPUT TOTAL

IVF ORAL BLOOD OTHERS URINE STOOL VOMITUS OTHERS

6-2

2-10

10-5

TOTAL PER DAY TOTAL PER DAY

DATE INTAKE TOTAL OUTPUT TOTAL

IVF ORAL BLOOD OTHERS URINE STOOL VOMITUS OTHERS

6-2

2-10

10-5

TOTAL PER DAY TOTAL PER DAY

DATE INTAKE TOTAL OUTPUT TOTAL

IVF ORAL BLOOD OTHERS URINE STOOL VOMITUS OTHERS

6-2

2-10

10-5

TOTAL PER DAY TOTAL PER DAY

DATE INTAKE TOTAL OUTPUT TOTAL

IVF ORAL BLOOD OTHERS URINE STOOL VOMITUS OTHERS

6-2

2-10

10-5

TOTAL PER DAY TOTAL PER DAY

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