ICU Nursing Report Sheet - PatientNotes.ai

VITAL SIGNS (Hourly)

TIME

0700

0800

0900

1000

1100

1200

1300

1400

HR

BP (A-line/Cuff)

MAP

CVP

SpO2

Temp

RESPIRATORY / VENTILATOR

Airway

ETT (#____) Trach (#____) NC NRB BiPAP

Mode

FiO2

PEEP

Rate (set)

Vt (set)

Vt (actual)

PS

PIP

ABG: pH___ PaCO2___ PaO2___ HCO3___ BE___

Lung Sounds:

VASOACTIVE DRIPS / INFUSIONS

Drug	Conc.	Rate	Dose	Parameters

NEUROLOGICAL

Eye (E)

/4

Verbal (V)

/5

Motor (M)

/6

GCS Total: ___/15

Left Pupil

Size: ___ mm Reactive

Right Pupil

Size: ___ mm Reactive

RASS/CAM-ICU:

Sedation:

LINES / DRAINS / DEVICES

A-line:

Central Line:

PIV:

Foley:

NGT/OGT:

Chest Tube:

Drain:

Other:

LABS

WBC

Hgb

Hct

Plt

INR

Na

K

Cl

CO2

BUN

Cr

Glu

Ca

Mg

Phos

Lactate

Trop

ProCalc

BNP

AST/ALT

INTAKE & OUTPUT (Hourly Totals)

INTAKE

Crystalloid (IVF):_______ mL

Colloid:_______ mL

Blood Products:_______ mL

PO/Tube Feed:_______ mL

IV Meds:_______ mL

TPN/Lipids:_______ mL

TOTAL INTAKE:_______ mL

OUTPUT

Urine:_______ mL

NG/OG Output:_______ mL

Chest Tube:_______ mL

Drain:_______ mL

Stool:_______ mL

Blood Loss:_______ mL

TOTAL OUTPUT:_______ mL

NET BALANCE: _______ mL

PLAN / CONSULTS / NOTES

Today's Plan / Goals:

Handoff / Safety Concerns: