MED-SURG NURSING GRID

Shift:
Date:
RN:
PATIENT 1 Room: _____
VITALS
BP
HR
RR
Temp
SpO2
Pain
MEDICATIONS
_______________
_______________
_______________
_______________
I&O
IN
PO:____
IV:____
OUT
Urine:____
Other:____
ASSESSMENT
Neuro:
Cardiac:
Resp:
GI/GU:
TO-DO / NOTES
_______________
_______________
PATIENT 2 Room: _____
VITALS
BP
HR
RR
Temp
SpO2
Pain
MEDICATIONS
_______________
_______________
_______________
_______________
I&O
IN
PO:____
IV:____
OUT
Urine:____
Other:____
ASSESSMENT
Neuro:
Cardiac:
Resp:
GI/GU:
TO-DO / NOTES
_______________
_______________
PATIENT 3 Room: _____
VITALS
BP
HR
RR
Temp
SpO2
Pain
MEDICATIONS
_______________
_______________
_______________
_______________
I&O
IN
PO:____
IV:____
OUT
Urine:____
Other:____
ASSESSMENT
Neuro:
Cardiac:
Resp:
GI/GU:
TO-DO / NOTES
_______________
_______________
PATIENT 4 Room: _____
VITALS
BP
HR
RR
Temp
SpO2
Pain
MEDICATIONS
_______________
_______________
_______________
_______________
I&O
IN
PO:____
IV:____
OUT
Urine:____
Other:____
ASSESSMENT
Neuro:
Cardiac:
Resp:
GI/GU:
TO-DO / NOTES
_______________
_______________

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