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Nursing Observation Chart

The document is a Patient Observation Chart used in Tanzanian healthcare facilities for recording patient vital signs and other relevant information. It includes sections for patient identification, health parameters, and nursing services. The chart is designed to assist healthcare providers in monitoring patient conditions effectively.

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Alphonce Izengo
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906 views1 page

Nursing Observation Chart

The document is a Patient Observation Chart used in Tanzanian healthcare facilities for recording patient vital signs and other relevant information. It includes sections for patient identification, health parameters, and nursing services. The chart is designed to assist healthcare providers in monitoring patient conditions effectively.

Uploaded by

Alphonce Izengo
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

FORM NO.

UNITED REPUBLIC OF TANZANIA PATIENT OBSERVATION CHART


MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT,
Hospital Reg. Number……………………………….…………….…………………………………...................
GENDER, ELDERLY AND CHILDREN
Surname………………………………………………………………………….………………………….…...............
First Name.………………………………………………. Middle Name ……………………………….……..…..
Age…………………….………Sex….M / F ……………… Ward/Unit…………….………………………………
NAME OF HEALTH FACILITY

……………………………………………………………………………………….

Date
Parameters Time
Temperature OC
Pulse rate/min
Resp. rate/min
B/P (mmHg) Systolic
Diastolic
SPO2 (RA/O2) (%)
RBG (mmol/L)
Bowel open (stool, flatus) (Y/N)
Positioning (LL, RL, SUP, PRON)
Skin Status (Intact, blister, Red, Sores)
Intake Feeding NGT/ORAL/TPN
I.V Fluids (500,1000mls) (NS,RL,DNS,D5,D10,OTHERS)
Amount (Mls)
Output in mls (vomitus, drainage, urine)
Total Intake
Total output
Name of Health Care
Provider.

Date of Admission (Date…... Month….…. Year……….) Medical Diagnosis…………………………….….……………....…….… Height….….. Body Weight……….

Nursing Services Form Version 1

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