|
IV Cocktail
|
RN on Duty:
|
|
ADD ON
• • •
|
All Patient Questions Answered?
|
|
Baseline Pulse
|
Baseline BP
/
|
|
Baseline Temp
|
Baseline Respiratory Rate
|
|
Baseline O2
|
O2 Device
• • •
|
|
Using Aseptic Techniques
|
IV Access
|
|
Secured using clear occlusive dsg/tape
|
IV Access location
|
|
IV patent, flushing w/o resistance
|
|
|
Infusion initiated at (time)
|
Infusion completed at (time)
|
|
Glutathione Push
|
Glutathione push (mg)
|
|
IM Injection
|
IM Injection Site
|
|
Post Infusion Blood Pressure
/
|
Post Infusion Respiratory Rate
|
|
Post Infusion Pulse
|
Post Infusion Temp
|
|
Post Infusion O2
|
Post Infusion O2 Device
• • •
|
|
Patient Tolerated Infusion Well
|
Patient provided with after care
|
|
Vital signs stable
|
Any complications noted
|
|
Additional Notes
|
|
|
|
Nurse Signature
|
|
|
Physician Signature
|
