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ADDRESSED BY
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Vitals completed
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Hygeine
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Mood
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Dx understanding
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Nurse discussed and reviewed the following
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Nursing Interventions
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ALL Intervention (select)
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Intervention HTN
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Intervention HEALTHY WEIGHT
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Intervention BMI
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Intervention HEALTHY EATING
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Intervention OBESITY
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Intervention FLUID & RESTRICTION
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Intervention CONSTIPATION
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SLEEP HABITS response
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Intervention COPING
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BM response
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Injections
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TORADOL
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Dosage (mg)
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Location
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Did the patient have a reaction to this medication?
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Reaction (if applicable)
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TESTOSTERONE
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Dosage (mL)
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Location
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Did the patient have a reaction to this medication?
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Reaction (if applicable)
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B12
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Dosage (mL)
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Location
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Did the patient have a reaction to this medication?
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Reaction (if applicable)
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MIC/B12
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Dosage
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Location
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Did the patient have a reaction to this medication?
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Reaction (if applicable)
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MIC
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Dosage
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Location
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Did the patient have a reaction to this medication?
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Reaction (if applicable)
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MESOTHERAPY
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Medication Used
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Site #1
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Dosage
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Site #2
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Dosage
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Site #3
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Dosage
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Site #4
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Dosage
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Site #5
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Dosage
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Site #6
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Dosage
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Did the patient have a reaction to this medication?
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Reaction (If applicable)
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Injection(s) given by:
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IV Push
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IV Infusion
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IV Push (Initial)
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IV Infusion (Initial)
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IV Push (Subsequent)
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IV Infusion (Subsequent)
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Glutathione Dosage
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Glutathione Dosage
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Vitamin C 500 mg/mL Dosage
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Vitamin C 500 mg/mL Dosage
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Myers Cocktail IV Push
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Myers Cocktail
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Needle Gauge
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Needle Gauge
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Site
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Site
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Number of Attempts
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Number of Attempts
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Did the patient have a reaction to this treatment?
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Reaction (if applicable)
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IV performed by:
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Post Procedure Status
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Labs
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Initial Labs
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Repeat Labs
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Site
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Number of Attempts
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Needle Gauge
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Patient tolerated procedure well
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Labs drawn by:
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PLAN
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Comments:
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