INTAKE AND OUTPUT MONITORING SHEET

NAME OF
PATIENT:
DATE TIME INTAKE OUTPUT
IVF IVTT PO OTHERS TOTAL URINE STOOL OTHERS TOTAL

TOTAL INTAKE TOTAL OUTPUT

NAME OF
PATIENT:
DATE TIME INTAKE OUTPUT
IVF IVTT PO OTHERS TOTAL URINE STOOL OTHERS TOTAL

TOTAL INTAKE TOTAL OUTPUT

NAME OF
PATIENT:
DATE TIME INTAKE OUTPUT
IVF IVTT PO OTHERS TOTAL URINE STOOL OTHERS TOTAL

TOTAL INTAKE TOTAL OUTPUT

NAME OF
PATIENT:
DATE TIME INTAKE OUTPUT
IVF IVTT PO OTHERS TOTAL URINE STOOL OTHERS TOTAL

TOTAL INTAKE TOTAL OUTPUT

19
 INTAKE AND OUTPUT MONITORING SHEET

NAME OF
PATIENT:
DATE TIME INTAKE OUTPUT
IVF IVTT PO OTHERS TOTAL URINE STOOL OTHERS TOTAL

TOTAL INTAKE TOTAL OUTPUT

NAME OF
PATIENT:
DATE TIME INTAKE OUTPUT
IVF IVTT PO OTHERS TOTAL URINE STOOL OTHERS TOTAL

TOTAL INTAKE TOTAL OUTPUT

NAME OF
PATIENT:
DATE TIME INTAKE OUTPUT
IVF IVTT PO OTHERS TOTAL URINE STOOL OTHERS TOTAL

TOTAL INTAKE TOTAL OUTPUT

NAME OF
PATIENT:
DATE TIME INTAKE OUTPUT
IVF IVTT PO OTHERS TOTAL URINE STOOL OTHERS TOTAL

TOTAL INTAKE TOTAL OUTPUT

20
 VITAL SIGNS MONITORING SHEET

DIRECTIONS: Summarize the vital signs of your patients on the tables below

PATIENTS NAME:
DATE & TIME T HR/PR RR BP O2 SAT

PATIENTS NAME:
DATE & TIME T HR/PR RR BP O2 SAT

PATIENTS NAME:
DATE & TIME T HR/PR RR BP O2 SAT

PATIENTS NAME:
DATE & TIME T HR/PR RR BP O2 SAT

21
 VITAL SIGNS MONITORING SHEET

DIRECTIONS: Summarize the vital signs of your patients on the tables below

PATIENTS NAME:
DATE & TIME T HR/PR RR BP O2 SAT

PATIENTS NAME:
DATE & TIME T HR/PR RR BP O2 SAT

PATIENTS NAME:
DATE & TIME T HR/PR RR BP O2 SAT

PATIENTS NAME:
DATE & TIME T HR/PR RR BP O2 SAT

22
 LABORATORY RESULTS
DIRECTIONS: Kindly copy from the patients charts all the laboratories with the results. Be sure to write
down the normal values, its interpretations and the nursing responsibilities.
LABORATORY CLIENT NORMAL INTERPRETATION NURSING RESPONSIBILITIES
RESULTS VALUES

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 RESULTS OF DIAGNOSTIC PROCEDURES
DIRECTIONS: Kindly copy from the patients charts all the diagnostic procedures (i.e. x-ray, UTZ, biopsy,
endoscopy, CT-scan, MRI, and etc.) with the results. Be sure to write down the corresponding nursing
responsibilities for each procedure
DIAGNOSTIC CLIENTS RESULTS NURSING RESPONSIBILITIES
PROCEDURES

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 ANATOMY AND PHYSIOLOGY
DIRECTIONS: Draw and label the related anatomy of the system/s affected of the client. Be sure to
discuss the physiology of the labelled functions.

Reference:

25
 PATHOPHYSIOLOGY
DIRECTIONS: Trace the pathway of the disease process down to the signs and symptoms being
presented. Please include the medical as well as nursing interventions. Please use the standard symbols
and place legends.

PATIENTS NAME:
Medical Diagnosis:

Overview of the disease condition:

MODIFIABLE FACTORS NON-MODIFIABLE FACTORS

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PATHOPHYSIOLOGY

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