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Patient presents for IV
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Reason for Vitamin IV Request
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General Normal
• • •
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General Abnormal
• • •
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HEENT Normal
• • •
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HEENT Abnormal
• • •
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Cardiovascular Normal
• • •
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Cardiovascular Abnormal
• • •
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Repiratory Normal
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Respiratory Abnormal
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Neurological Normal
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Neurological Abnormal
• • •
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ALLERGIES
• • •
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ALLERGIES (OTHER)
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Getting Glutathione?
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MD/NP ORDER
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IV PREPARED BY:
• • •
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FLUID BASE
• • •
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INFUSION
• • •
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IV STARTED BY:
• • •
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CATHETER SIZE
• • •
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SITE OF IV
• • •
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TIME IV STARTED
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STARTING BLOOD PRESSURE
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STARTING HEART RATE
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STARTING TEMPERATURE
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TIME IV STOPPED
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ENDING BLOOD PRESSURE
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ENDING HEART RATE
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ENDING TEMPERATURE
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INFUSION NOTE
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ADDITIONAL INFUSION COMMENTS
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IV DISCHARGE NOTE
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ADDITIONAL DISCHARGE COMMENTS
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