Nursing Brain Sheet (1 Patient)

VITAL SIGNS

0800

1200

1600

2000

0000

BP

HR

RR

Temp

SpO2

Pain

O2 Delivery

Blood Sugar

SCHEDULED MEDICATIONS

Medication	Dose	Route	Time	Given

INTAKE & OUTPUT

INTAKE

PO:_______

IV:_______

Blood:_______

TPN:_______

Tube Feed:_______

TOTAL IN:_______

OUTPUT

Urine:_______

Stool:_______

Emesis:_______

NG:_______

Drain:_______

TOTAL OUT:_______

IV Site / Type

IV Fluids / Rate

SYSTEMS ASSESSMENT

Neuro

Alert Oriented x4 Confused Sedated

GCS / RASS

Cardiovascular

Regular Irregular Edema

Rhythm / Pulses

Respiratory

Clear Diminished Crackles Wheezes

O2 / Vent Settings

GI/GU

Soft Distended BS+ Foley

Diet / Last BM

Skin/Wounds

Intact Incision Wound Pressure Injury

Braden Score

Activity/Safety

Bedrest OOB Fall Risk Restraints

Morse Score

LABS / DIAGNOSTICS

WBC

Hgb

Hct

Plt

Na

K

Cl

CO2

BUN

Cr

Glu

Ca

Mg

Phos

INR

Trop

Pending Labs / Tests

TO-DO LIST & NOTES

TASKS

____________________ ____________________ ____________________ ____________________ ____________________

FOLLOW UP

HANDOFF NOTES

NURSING BRAIN SHEET